Eugene R. Folk

Consecutive exotropia following surgery.

We studied 250 patients with consecutive exotropia. The interval between the surgical procedure and the onset of the consecutive exotropia may take many years. Consecutive exotropia occurred with all types of corrective esotropia surgery that we studied. Amblyopia and medial rectus limitation postoperatively seemed to be common factors associated with consecutive exotropia.

Absence of the superior rectus muscle in Apert's syndrome.

A patient with classical Aperts syndrome is discussed along with the finding of absent superior rectus muscle. This anomaly may be more common than thought, especially in relation to craniofacial anomalies. A review of Aperts syndrome and superior rectus agenesis is presented.

The surgical treatment of overcorrected esotropia.

The medical records of 33 consecutive patients who developed secondary exotropia following surgery for esotropia were reviewed. Only six patients (18%) had normal medial rectus function. Lateral rectus recession proved to be an excellent procudure for correcting the deviation in these patients, provided the surgery was limited to the eye with the narrower palpebral fissure. Twenty-seven patients (82%) exhibited limitation of adduction secondary to medial rectus underaction. Of these patients, 75% were successfully corrected following a 12 mm advancement and resection of the underacting medial rectus muscle. The details of the surgical technique performed are discussed.

Previous strabismus surgery and eye position under anesthesia.

We studied eye position under general anesthesia in 51 patients with concomitant esotropia or exotropia, divided into two groups. One group consisted of strabismus patients who had had no previous surgery. The second group consisted of strabismus patients who had undergone previous surgery on one (asymmetric) or both (symmetric) eyes. We found that both groups showed either no change or more divergence under general anesthesia in comparison to their preoperative state. Those patients who had had no previous surgery revealed an equal divergence in both eyes. This relationship also held true for those patients who had undergone symmetrical surgery in both eyes. However, those patients who had had surgery in one eye only showed more divergence in the operated eye than in the unoperated one. These findings reflect the mechanical--anatomical factors created by the surgery itself.

Invasive Sinonasal Polyps Causing Ophthalmoplegia, Exophthalmos, and Visual Field Loss

In a 20-year-old man with a history of sinonasal polyps, bilateral ophthalmoplegia, exophthalmos, and optic nerve dysfunction developed. Radiologic imaging showed a polypoid mass filling the nose and sinuses, eroding into the pituitary fossa, basal cisterns, and orbits, and compressing the cavernous sinuses. Six months after bilateral maxillary, ethmoid, and sphenoid exploration, ocular motility returned to normal, but there remained mild generalized visual field loss in the right eye. The pathologic specimen showed polypoid respiratory mucosa with acute and chronic inflammation as well as eosinophiles.

Simulated superior oblique tendon sheath syndrome

Three patients with simulated Browns superior oblique tendon sheath syndrome are presented. With the use of computed tomographic (CT) findings, the site of the pathology could be demonstrated. In all three patients, there were definite abnormal findings in the anterior sheath of the reflected tendon of the superior oblique. The abnormal findings in one case were confirmed at the time of surgery. Therapy in two of the cases was determined by the abnormal findings on the CT scan.

Transection of the Inferior Rectus Muscle

Four cases of isolated inferior rectus transection secondary to trauma are presented. The clinical and CT scan findings are illustrated. The CT scan findings are very useful in the surgical management and prognosis of these cases.

What should the GP tell the mother of a cross-eyed child?

The general practitioner must be aware of the fears of the mother of a cross-eyed child. He should emphasize that cross-eyed children develop, learn and perform normally. When a deviation is present, early referral is important. The mother should be assured that in most cases cross-eye is correctable.