Hypertropia
This article includes a improve this article by introducing more precise citations. (February 2014) ) |
Hypertropia | |
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Misaligned eyes Amarna Miller, an actress with hypertropia. | |
Specialty | Ophthalmology |
Hypertropia is a condition of misalignment of the
Presentation
Associated defects
Refractive errors such as
- Strabismic amblyopia, (due to deprivation / suppression of the deviating eye)
- cosmetic defect (most noticed by parents of a young child and in photographs)
- Face turn, depending on presence of binocular vision in a particular gaze
- diplopia or double vision - more seen in adults (maturity / plasticity of neural pathways) and suppression mechanisms of the brain in sorting out the images from the two eyes.
- cyclotropia, a cyclotorsional deviation of the eyes (rotation around the visual axis), particularly when the root cause is an oblique muscle paresis causing the hypertropia.
Causes
Hypertropia may be either congenital or acquired, and misalignment is due to imbalance in
- Superior oblique Palsy / Congenital fourth nerve palsy
- Inferior oblique overaction
- Brown's syndrome
- Duane's retraction syndrome
- Double elevator palsy
- Fibrosis of rectus muscle in Graves Disease(most commonly inferior rectus is involved)
- Surgical trauma to the vertical muscles (e.g. during scleral buckling surgery or cataract surgery causing iatrogenic trauma to the vertical muscles).
Sudden onset hypertropia in a middle aged or elderly adult may be due to compression of the
Treatment
In general, strabismus can be approached and treated with a variety of procedures. Depending on the individual case, treatment options include:
- Correction of refractive errors by glasses
- Prism therapy (if tolerated, to manage diplopia)
- Vision Therapy
- Patching (mainly to manage amblyopiain children and diplopia in adults)
- Botulinum toxin injection
- Surgical correction
Surgical correction of the hypertropia is desired to achieve binocularity, manage diplopia and/or correct the cosmetic defect. Steps to achieve the same depend on mechanism of the hypertropia and identification of the offending muscles causing the misalignment. Various surgical procedures have been described and should be offered after careful examination of eyes, including a detailed orthoptic examination focussing on the disturbances in ocular motility and visual status. Specialty fellowship trained pediatric ophthalmologists and strabismus surgeons are best equipped to deal with these complex procedures.
See also
References
- Wright, Kenneth Weston; Spiegel, Peter H. (January 2003). Pediatric Ophthalmology and Strabismus. Springer. p. 17. ISBN 978-0-387-95478-3.
- AAPOS website on Strabismus, also containing FAQ's on the subject of Strabismus