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Answers: 2007 series -  February 13, 2007 Lecture 46 of 52  NEXT»

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This 4-year-old girl had a cyst removed from her brain at age 2 years.  It was benign and she has done very well since then except for the esotropia.  Immediately after her surgery the right eye was noted to turn in.  The parents have observed this but are seeking medical care from an ophthalmologist now for the first time.   The girl’s vision is OD 20/80 and OS 20/20.  She denies diplopia.  Her refraction after cycloplegia is OD +1.25 +0.25 X 90 and OS  +1.50.  Her media are clear and the fundus is normal in each eye.

1.  The first thing to do for this child is:   

e -- none of the above

None of the above!  This girl simply needs to have a patch on the left eye and monitoring of the vision for recovery from the amblyopia.  Recent studies by the U.S. Pediatric Eye Disease Investigator Group (PEDIG) has shown the value of part-time occlusion with good compliance, claiming that the results are as good as prescribed full-time occlusion.  One conclusion from this is that children are very unlikely to comply with full-time occlusion and may wear the patch more if told to only wear it part-time, something much easier to accomplish.  Not all strabismologists suscribe to this program of part-time patching.


2.  When amblyopia therapy is completed consider:  

c -- surgery

This child will be best served by surgery.


3.  This child would benefit most from:

a -- a recession of the right medial rectus and resection of the left lateral rectus an appropriate amount

Since she can abduct the right eye well past the midline, the apparent VI nerve palsy in that eye is mild.  This means that a muscle transfer is not needed.  A recess/resect procedure will be all that is needed to align the eyes.

Lecture 46 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»