Etiologies and treatment of manifest vertical deviations: series of 95 patients

Abstract

AbstractPurposeManifest vertical deviations (MVD) are permanent vertical misalignment of one or both eyes. A hypertropia is a form of vertical strabismus where one eye is deviated upwards in comparison to the fellow eye, as opposed to hypotropia, where one eye is deviated downwards. The aim of this study is to analyze the different etiologies associated with MVD and their management.MethodsA retrospective analysis of patients referred to our center with MVD between September 2013 and February 2016 was done. A total of 95 patients were included. Each patient received an orthoptic and complete ophthalmological assessment. The outcomes studied were the age, sex of the patient, etiologies associated with MVD, angle of deviation in primary position at near and distance fixation as well as the proposed treatment.ResultsFifty men (53%) and 45 women (47%) were included with a mean age of 33 years (range 2‐86 years), without statistically significant difference of affected eye or to gender. The mean deviation angle, at far and near distances, was 10 diopters. The majority of MVD were acquired (46%), congenital (35%), residual (13%) and consecutive (6%). The most common etiology was cranial nerves IV paralysis (29% n = 26). The other etiologies were cranial nerves III paralysis (20% n = 19), residual MVD (12% n = 10), strabismus (6% n = 5), consecutive MVD (5% n = 4),cranial nerves VI paralysis (3% n = 3), Graves’ disease (3% n = 3), orbital floor fracture (1% n = 1), other etiologies (21% n = 24). Treatment was surgical for 52% of patients, prism correction (25%), eye occlusion (4%), optical correction alone (5%). Eleven per cent are regressed spontaneously and treatment was not specified for the remaining 3%.ConclusionsMVD are the most common finding in acquired oculomotor palsy. The variability of the clinical forms and etiologies makes their proper diagnosis and testing challenging. Indications of the treatment are guided by functional repercussion.