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2012 Series -  January 24, 2012 Lecture 49 of 52  NEXT»

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This three-year-old boy presented with a history of his eyes being straight at times, turning in at times, and turning out at other times. He had surgery for what was described as congenital esotropia at age one year. No medical records were available, but the appearance of his conjunctiva indicated that he probably had undergone bimedial rectus recession. The child was never prescribed glasses. Cover testing revealed just what the mother reported; after alternate cover testing approximately 40 prism diopters of exotropia was seen. After cover testing was stopped, the boy rapidly became esotropic with a deviation that was estimated to be 35 prism diopters. At other times, the eyes appeared straight for brief intervals. Visual acuity was 20/30 in each eye uncorrected. Ductions were normal in each eye and the physical examination of the eyes proved to be normal. Cycloplegic refraction was + 6.00 in each eye.

1. The following could be said about the initial surgical procedure:

a. The boy probably would have been better off with a recession of one medial rectus and a resection of the lateral rectus.
b. Surgery was ill advised and should not have been done.
c. The surgery was probably correct, but a certain percentage of patients with congenital esotropia become exotropic even with the proper surgery.
d. This is a typical response when a child with Duane syndrome is operated early.
e. No definitive statement can be made about the prior surgery.

2. What should be done with this patient now?

a. alternate patching for at least three months, then re-measure
b. begin fusion training
c. prescribe full plus glasses or as much plus as the patient will tolerate
d. determine the angle of deviation after wearing the glasses
e. (c) and (d)

3. What can you tell the family at this first visit?
a. additional surgery will be needed
b. it is likely that the boy will wear glasses or some optical correction full time and probably for the rest of his life
c. the initial surgery was probably not indicated
d. there is a good possibility that with additional surgery the child will obtain straight eyes and be able to use them together with good alignment
e. all of the above

For answers to the above, click here on or after January 31, 2012.



Lecture 49 of 52 «Previous Lecture   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52    Next»