ANOMALOUS HEAD POSTURES IN STRABISMUS AND NYSTAGMUS DIAGNOSIS AND MANAGEMENT.

UNLABELLED: Abnormal head positions are adopted in order to improve visual acuity, to avoid diplopia or to obtain a more comfortable binocular vision. The head can be turned or tilted toward right or left, with the chin rotated up or downwards or combination of these positions. The ophthalmologic examination including the assessment of versions leads to the diagnosis. When versions are free, the cause may be congenital nystagmus or strabismus with large angle. When versions are limited we suspect paralytic or restrictive strabismus. The head tilted to one shoulder suggests cyclotropia (IV Nerve Palsy) or congenital nystagmus. We present few of the above cases. An adequate surgical treatment can improve or correct the ocular deviation, diplopia and the abnormal head posture. CONCLUSIONS: The abnormal head posture must be assessed and treated early in order to correct the ocular position and head posture. All patient presenting abnormal head position HAD TO BE investigated by an ophthalmologist.

[Dynamic nuclear magnetic resonance in strabismus]. / Rezonanta magnetica nucleara dinamic în evaluarea pacientului cu strabism.

PURPOSE: To demonstrate that dynamic MRI is a useful tool in complex strabismus patients. SUBJECTS AND METHODS: 16 patients were referred to us with suspicion of slipped or '"lost" medial rectus (MR), 15 after strabismus surgery. 1 case with lost MR after trauma. One patient had "A" pattern exotropia with over depression in adduction. 8 underwent dynamic MRI examination. RESULTS: The dynamic MRI showed the precise muscle location and the contractility of the muscle. All patients underwent surgery, according to deviation and ocular motility changes. All slipped muscles were found and re-attached to the globe. In the "A" pattern exotropia MRI showed superior displacement of the LR pulleys. The inferior rectus did not demonstrate contractility and a transfer procedure was made. CONCLUSIONS: MRI is an index of functional muscle contractility and precise muscle location. It should be considered in complex cases of strabismus as an important argument in choosing the surgical technique.

[Postoperative results in VI nerve palsy]. / Rezultate postoperatorii în paralizia de nerv VI.

This study analyze the surgical results obtained in a lot of patients with sixth nerve paralysis operated with different techniques. The results were evaluated using the following parameters: deviation in primary position, abduction deficit, existence of induced vertical deviation and presence of anterior segment ischemia. Ortotropia was achieved in higher percentage in full tendon transposition technique, closely followed by recession-resection technique; the weakest results were recorded in partial tendon transposition technique. Similar results were obtained in abduction improvement. The induced vertical deviation was present in higher percentage in partial transposition technique. The anterior segment ischemia wasn't recorded in any case regardless of the selected surgical technique. Careful analysis of the ocular motility deficit (paresis or palsy) is crucial in selecting the appropriate surgical procedure.

[Therapeutic options in III. nerve paralysis]. / Optiuni terapeutice în paralizia de nerv III.

The treatment of ocular motility disorders, which occur in paralytic strabismus, presents a therapeutic challenge. The goal of treatment is to create an area of single binocular vision that is centered around the primary-gaze position. Careful analysis of the ocular motility deficit is crucial in selecting the appropriate surgical procedure. Paralytic strabismus is difficult to treat because of the incomitance of the deviation depending on the direction of gaze, respectively an increase of the deviation in the gaze with limited motility. Moreover, the possibility that horizontal and vertical components may be present, like in third nerve palsies, is another obstacle. Finally, in patients with long-stand paralysis, the ocular motility defect may have a restrictive component due to contracture of the antagonist muscle. Recognition of this phenomenon is important because any planned surgical procedure must deal with the induced restriction.