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Chapter-46 Dissociated Deviations

BOOK TITLE: Surgical Techniques in Ophthalmology (Pediatric Ophthalmic Surgery)

Author
1. Wilson M Edward
2. Burger Berdine M
ISBN
9789350251485
DOI
10.5005/jp/books/11282_46
Edition
1/e
Publishing Year
2011
Pages
3
Author Affiliations
1. Albert Florens Storm Eye Institute, Miles Center for Pediatric Ophthalmology, Medical University of South Carolina, Charleston, USA, N Edgar Miles Center; Storm Eye Institute Medical University of South Carolina Charleston, South Carolina, USA, Miles Center for Pediatric, Ophthalmology, Charleston, USA, N Edgar Miles Center for Pediatric Ophthalmology, Strom Eye Institute, Medical University of South Carolina, Charleston, SC, USA, Storm Eye Institute, Charleston SC, USA, Miles Center for Pediatric Ophthalmology, Charleston, USA, Storm Eye Institute, Medical University of South Carolina Charleston, USA, Storm Eye Institute, Miles Center for Pediatric Ophthalmology, Medical University of South Carolina, Charleston, SC 29425, USA, Director Albert Florens Storm Eye Institute Medical University of South Carolina Charleston, SC, USA, Albert Florens Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA 29425, Medical University of South Carolina, Charleston, SC, USA, Albert Florens Storm Eye
2. Storm Eye Institute, Medical University of South Carolina, 167, Ashley Avenue, Charleston SC, USA, Storm Eye Institute, Medical University of South Carolina, USA, Storm Eye Institute Medical University of South Carolina 167, Ashley Avenue Charleston, USA
Chapter keywords

Abstract

Dissociated movements and misalignments of the eyes are grouped into what is known as the dissociated strabismus complex (DSC). Dissociated ocular deviations can be vertical (DVD), horizontal (DHD), or torsional (DTD). The DSC is commonly associated with congenital esotropia, but it may also be seen in association with other forms of strabismus. The classic DSC pattern is of a non fixating eye slowly elevating, extorting, and abducting upon the spontaneous loss of binocular function or with cover testing. A reversal of these movements is seen with recovery and refixation. The DSC is nearly always bilateral but asymmetric. DVD remains the predominant manifestation in most cases of DSC. Placing base-down prisms before the higher eye or base-up prisms before the lower eye until all refixation movements are neutralized can quantitate a true hypertropia. When one is attempting to quantify DVD or DHD, each eye must be measured separately.DHD is distinguished from intermittent exotropia by the slow speed of the abducting movement, the association of DTD, and the absence of true neutralization with prisms.Despite its ability to be disfiguring, most patients with DSC do not need treatment.Available treatments are imperfect and none of them can eliminate DSC totally.Nonsurgical treatment options to reduce the frequency of manifest DSC have met with limited success.

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