The Value of Strabismus Surgery


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Volume 1 - The Value of Strabismus Surgery

Lecture 17 of 24 NEXT»

Strabismus = misaligned eyes

It has been said: "Every human has the right to look like a human." Since the human normally has eyes which are aligned with parallel visual axes it would follow that every human has the right to have "straight" or aligned eyes. This should be true even if the eye to be aligned is a "blind" eye.

In addition to enabling a person to look like a human, "straight" (aligned) eyes can enable the following:

Fusion This is the union of the two objects (one seen by each eye) into a single object. This is motor fusion - the antidiplopia mechanism. When this is achieved objects may also be seen in depth. This occurs by blending of the slightly dissimilar view from each eye resulting in sensory fusion or stereopsis.

Diplopia Avoidance A visual adult (over approximately 7 years old) or even a much younger child with misaligned eyes will see the same object in two places, one clear and one less clear. This is diplopia or double vision. Alignment of the eyes can eliminate diplopia.

Improved Head Posture When the visual axes are misaligned (strabismus) an abnormal head posture may be assumed to achieve single binocular vision - avoid diplopia, or in rare cases to make the images farther apart to make it easier to ignore diplopia.

the system

treatment

For Example: In the case of a patient who has never established normal motor fusion

Congenital ET

Bimedial Rectus Recession

Aligned Eyes

Surgery on the eye muscles to align the eyes early (+ 1 year) results in better alignment and in some cases better binocular function in patients with congenital esotropia. In a way this is driving the system "backward" in the hope that better alignment will induce better motor fusion and even allow expression of sensory fusion. These patients, usually infants, must be followed closely, usually requiring additional surgery by the teen years.

Patients, who are born with normal motor fusion potential*, have established motor fusion, and who later develop strabismus, can have immediate and gratifying results from realignment of the eye with glasses, prism, amblyopia treatment, or strabismus surgery.

* Intermittent Exotropia

* IV Nerve (Superior Oblique) Palsy

* Partially Refractive Esotropia

* Diplopia after Cataract

* Duane Syndrome

* Brown Syndrome

* Thyroid Myopathy

* Blow Out Fracture

* Diplopia after R.D. Repair

* Myasthenia

* VI N (Abducens) Palsy

* III N (Trigeminal) Palsy (Limited Single Vision)

* Torticollis with Aligned Eyes

* Nystagmus with Decreased Visual Acuity

Realigning the eyes by means of strabismus surgery is functional. Although the individual also looks better after the eyes are aligned, strabismus surgery is not cosmetic. Changing hair color or changing the contour of an otherwise functional nose is cosmetic!

In a clinical research project, job applications with identical resumes were submitted. The application with a photograph of the applicant with aligned eyes was graded significantly higher than the same application with the photograph digitally altered to produce strabismus.

Fixing a compound fracture makes a leg look better; but it is not cosmetic, it is functional.

* Throughout these pages you will find the comment: "There are only two kinds of strabismus - congenital esotropia and all the rest."

Editor-in-Chief: Eugene M. Helveston, M.D.

Associate Editor: Faruk H. Orge, M.D.

Editorial Board: Bradley C. Black, M.D.

   Edward R. O'Malley, M.D.

   David A. Plager, M.D.

   Derek T. Sprunger, M.D.

   Daniel E. Neely, M.D.

   Naval Sondhi, M.D.

Senior Editorial Consultant: Gunter K. von Noorden, M.D.

Graphics: Michelle L. Harmon

Technical Support: George J. Sheplock, M.D.

Lecture 17 of 24

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