Managing a patient with vertical misalignment of the eyes can be challenging. Small deviations that are less than 8 to 10 prism diopters can often be managed with prism eyeglasses. However, many patients require surgical management to treat intractable diplopia. For all patients, realistic expectations must be established—most cases are not fully "curable" because many cases of vertical eye misalignment are associated with some degree of incomitance.
Evaluation of a patient with vertical strabismus requires an excellent history. Thereafter, specific examination techniques can allow the ophthalmologist to determine if the cause of the vertical eye misalignment is restrictive, paralytic, or dissociative. Finally, imaging studies are often employed to aid in diagnosis and management. The goal of therapy is to produce a large field of central, binocular vision to allow the patient the greatest visual function for daily tasks.
Upon completion of this Focal Points
issue, you should be able to:
- Perform a motility exam on a patient with vertical strabismus.
- Classify the likely etiology of the strabismus.
- Initiate the appropriate medical and/or surgical management to restore alignment and reduce patient symptoms.
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