Ten Pearls in the Management of Paralytic Strabismus
Paralytic strabismus is an incomitant strabismus resulting from complete (paralysis) or partial (paresis) motor deficiency of one or a group of extraocular muscles, which are supplied by the third, fourth or sixth cranial nerve. 1 History and basic examination Paralytic strabismus may be congenital or acquired. Careful history-taking will rule out an antecedent fever, trauma, neurological symptoms, or systemic illness in acquired cases. Patients complain of ocular deviation, limitation of ocular movements or abnormal head posture. Diplopia is usually a feature of recent-onset strabismus but congenital cases with spontaneous decompensation may also present with diplopia. Facial asymmetry can be noted in some congenital superior oblique palsy(SOP) with a head tilt. Visual acuity is usually preserved in isolated acquired paralytic strabismus. Amblyopia develops only in patients in whom paralysis occurs early and when the patient is unable to maintain binocular single vision in any gaze. F
Dr. Karthika Bhaskaran · Dr. Pradeep Sharma