1 Q l AV Strabismus An A or

1 Q l A/V Strabismus An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze

2 A/V Strabismus A-pattern exotropia

3 A/V Strabismus V-pattern exotropia

4 A l A/V Strabismus An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze

5 Q l A/V Strabismus An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l % Occurs in about 20% of strabismus cases

6 A l A/V Strabismus An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l Occurs in about 20% of strabismus cases

7 Q l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: EOM 1) Oblique dysfunction problem a different problem 2) Horizontal or. EOM vertical rectus dysfunction serious congenital problem 3) Craniosynostosis w/ secondary EOM effects

8 A l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

9 Q l A/V Strabismus An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze Which pattern (A vs V) is associated with which oblique overaction? overaction pattern (A’s are ‘superior’) l--SO Occurs in causes…A about 20% of strabismus cases --IO overaction causes…V pattern strabismus l Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

10 A l A/V Strabismus An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze Which pattern (A vs V) is associated with which oblique overaction? overaction pattern (A’s are ‘superior’) l--SO Occurs in causes…A about 20% of strabismus cases --IO overaction causes…V pattern strabismus l Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

11 Q l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs about of strabismus To in what does the 20% term craniosynostosis refer? cases To the premature closing of cranial suture(s) Can be secondary to: What results from premature suture closing? Premature closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific and well-recognized patterns of craniofacial malformation may result. 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

12 A l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs about of strabismus To in what does the 20% term craniosynostosis refer? cases To the premature closing of cranial suture(s) Can be secondary to: What results from premature suture closing? Premature closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific and well-recognized patterns of craniofacial malformation may result. 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

13 Q l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs about of strabismus To in what does the 20% term craniosynostosis refer? cases To the premature closing of cranial suture(s) Can be secondary to: What results from premature suture closing? Premature closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific and well-recognized patterns of craniofacial malformation may result. 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

14 A l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs about of strabismus To in what does the 20% term craniosynostosis refer? cases To the premature closing of cranial suture(s) Can be secondary to: What results from premature suture closing? Premature closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific and well-recognized patterns of craniofacial malformation may result. 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

15 Q l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs about of strabismus To in what does the 20% term craniosynostosis refer? cases To the premature closing of cranial suture(s) Can be secondary to: What results from premature suture closing? Premature closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific and well-recognized patterns of craniofacial malformation may result. 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction Two categories of 3) Craniosynostosis craniofacial syndrome Craniosynostoses ? What is the other broad category of craniofacial syndrome?

16 A l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs about of strabismus To in what does the 20% term craniosynostosis refer? cases To the premature closing of cranial suture(s) Can be secondary to: What results from premature suture closing? Premature closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific and well-recognized patterns of craniofacial malformation may result. 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction Two categories of 3) Craniosynostosis craniofacial syndrome Craniosynostoses Not craniosynostoses What is the other broad category of craniofacial syndrome?

17 Q l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs about of strabismus To in what does the 20% term craniosynostosis refer? cases To the premature closing of cranial suture(s) Can be secondary to: What results from premature suture closing? Premature closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific and well-recognized patterns of craniofacial malformation may result. 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction Two categories of 3) Craniosynostosis craniofacial syndrome Craniosynostoses Not craniosynostoses --? Which not-craniosynostosis craniofacial --? malformations are addressed in the Peds book? --?

18 A l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs about of strabismus To in what does the 20% term craniosynostosis refer? cases To the premature closing of cranial suture(s) Can be secondary to: What results from premature suture closing? Premature closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific and well-recognized patterns of craniofacial malformation may result. 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction Two categories of 3) Craniosynostosis craniofacial syndrome Craniosynostoses Not craniosynostoses --Goldenhar Which not-craniosynostosis craniofacial --Treacher Collins malformations are addressed in the Peds book? --Pierre Robin sequence --Fetal alcohol

19 Q l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs about of strabismus To in what does the 20% term craniosynostosis refer? cases To the premature closing of cranial suture(s) Can be secondary to: What results from premature suture closing? Premature closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific and well-recognized patterns of craniofacial malformation may result. 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction Two categories of 3) Craniosynostosis craniofacial syndrome Craniosynostoses Which craniosynostosis syndromes are addressed in the Peds book? --? --? Not craniosynostoses --Goldenhar --Treacher Collins --Pierre Robin sequence --Fetal alcohol

20 A l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs about of strabismus To in what does the 20% term craniosynostosis refer? cases To the premature closing of cranial suture(s) Can be secondary to: What results from premature suture closing? Premature closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific and well-recognized patterns of craniofacial malformation may result. 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction Two categories of 3) Craniosynostosis craniofacial syndrome Craniosynostoses Which craniosynostosis syndromes are addressed in the Peds book? --Crouzon --Apert --Pfeiffer --Saethre-Chotzen Not craniosynostoses --Goldenhar --Treacher Collins --Pierre Robin sequence --Fetal alcohol

21 Q l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

22 A l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

23 Q l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

24 A l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

25 Q l All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

26 A l All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies only Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

27 Crouzon syndrome: Characteristic facies

28 Q l All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies only Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

29 A l All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies only Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

30 Apert syndrome: Characteristic facies and marked syndactyly

31 A l All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies only Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Mnemonics: ‘Patients with Apert syndrome can’t get their fingers and toes apert’ (apart) Can be secondary to: ‘Michelle Pfeiffer has huge thumbs and toes’ 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

32 Q l All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies only Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Mnemonics: ‘Patients with Apert syndrome can’t get their fingers and toes apert’ (apart) Can be secondary to: ‘Michelle Pfeiffer has huge thumbs and toes’ 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

33 A l All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies only Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Mnemonics: ‘Patients with Apert syndrome can’t get their fingers and toes apert’ (apart) Can be secondary to: ‘Michelle Pfeiffer has huge thumbs and toes’ 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

34 Pfeiffer syndrome: Characteristic facies, broad thumbs/great toes

35 A l All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies only Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Mnemonics: ‘Patients with Apert syndrome can’t get their fingers and toes apert’ (apart) Can be secondary to: ‘Michelle Pfeiffer has huge thumbs and toes’ (not really) 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

36 Q l A/V Strabismus All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze to V-pattern XT, what otherof ocular abnormalities l. In addition Occurs in about 20% strabismus l cases are often present in pts with craniosynostosis? Mnemonics: -‘Patients with Apert syndrome can’t get their fingers and toes apert’ (apart) --‘Michelle Pfeiffer has huge thumbs and toes’ --- Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

37 A l A/V Strabismus All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze to V-pattern XT, what otherof ocular abnormalities l. In addition Occurs in about 20% strabismus l cases are often present in pts with craniosynostosis? Mnemonics: --hypertelorism ‘Patients with Apert syndrome can’t get their fingers and toes apert’ (apart) --telecanthus --shallow orbits ‘Michelle Pfeiffer has huge thumbs and toes’ --extorsion of the orbits --papilledema Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

38 Q l A/V Strabismus All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze to V-pattern XT, iswhat ocular abnormalities l. In addition Occurs in about 20% of strabismus cases What the other difference between hypertelorism and telecanthus? l are often present in pts with craniosynostosis? Hypertelorism refers to an abnormally increased distance Mnemonics: --hypertelorism thesyndrome medial orbital telecanthus an (apart) ‘Patientsbetween with Apert can’t walls; get their fingers andrefers toes to apert’ --telecanthus abnormally increased distance between the medial canthi. --shallow orbits ‘Michelle Pfeiffer has huge thumbs and toes’ --extorsion of the orbits Which manifests as an increased interpupillary distance? --papilledema Hypertelorism Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

39 A l A/V Strabismus All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze to V-pattern XT, iswhat ocular abnormalities l. In addition Occurs in about 20% of strabismus cases What the other difference between hypertelorism and telecanthus? l are often present in pts with craniosynostosis? Hypertelorism refers to an abnormally increased distance Mnemonics: --hypertelorism thesyndrome medial orbital telecanthus an (apart) ‘Patientsbetween with Apert can’t walls; get their fingers andrefers toes to apert’ --telecanthus abnormally increased distance between the medial canthi. --shallow orbits ‘Michelle Pfeiffer has huge thumbs and toes’ --extorsion of the orbits Which manifests as an increased interpupillary distance? --papilledema Hypertelorism Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

40 Q l A/V Strabismus All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze to V-pattern XT, iswhat ocular abnormalities l. In addition Occurs in about 20% of strabismus cases What the other difference between hypertelorism and telecanthus? l are often present in pts with craniosynostosis? Hypertelorism refers to an abnormally increased distance Mnemonics: --hypertelorism thesyndrome medial orbital telecanthus an (apart) ‘Patientsbetween with Apert can’t walls; get their fingers andrefers toes to apert’ --telecanthus abnormally increased distance between the medial canthi. --shallow orbits ‘Michelle Pfeiffer has huge thumbs and toes’ --extorsion of the orbits Which manifests as an increased interpupillary distance? --papilledema Hypertelorism Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

41 A l A/V Strabismus All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze to V-pattern XT, iswhat ocular abnormalities l. In addition Occurs in about 20% of strabismus cases What the other difference between hypertelorism and telecanthus? l are often present in pts with craniosynostosis? Hypertelorism refers to an abnormally increased distance Mnemonics: --hypertelorism thesyndrome medial orbital telecanthus an (apart) ‘Patientsbetween with Apert can’t walls; get their fingers andrefers toes to apert’ --telecanthus abnormally increased distance between the medial canthi. --shallow orbits ‘Michelle Pfeiffer has huge thumbs and toes’ --extorsion of the orbits Which manifests as an increased interpupillary distance? --papilledema Hypertelorism Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

42 Q l A/V Strabismus All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze to V-pattern XT, what otherof ocular abnormalities l. In addition Occurs in about 20% strabismus l cases are often present in pts with craniosynostosis? Mnemonics: --hypertelorism ‘Patients with Apert syndrome can’t get their fingers and toes apert’ (apart) --telecanthus What serious sequelae can result from shallow orbits? --shallow orbits Shallowhas orbits produce proptosis, ‘Michelle Pfeiffer huge thumbs and toes’which may lead to --extorsion of the orbitsexposure keratopathy --papilledema Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

43 A l A/V Strabismus All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze to V-pattern XT, what otherof ocular abnormalities l. In addition Occurs in about 20% strabismus l cases are often present in pts with craniosynostosis? Mnemonics: --hypertelorism ‘Patients with Apert syndrome can’t get their fingers and toes apert’ (apart) --telecanthus What serious sequelae can result from shallow orbits? --shallow orbits Shallowhas orbits produce proptosis, ‘Michelle Pfeiffer huge thumbs and toes’which may lead to --extorsion of the orbitsexposure keratopathy --papilledema Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

44 Q l A/V Strabismus All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze to V-pattern XT, what otherof ocular abnormalities l. In addition Occurs in about 20% strabismus l cases are often present in pts with craniosynostosis? Mnemonics: --hypertelorism ‘Patients with Apert syndrome can’t get their fingers and toes apert’ (apart) --telecanthus What are the sequelae of orbital extorsion? --shallow orbits of the rectus muscles are extorted as well. For ‘Michelle Pfeiffer. The haslocation huge thumbs and toes’ --extorsion of the orbits example, the medial recti are located in the superonasal orbit. --papilledema Thus, when the eyes adduct they also elevate, giving the impression of IO overaction (called pseudo-IO overaction). Orbital extorsion contributes to the overall V-pattern XT. Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

45 A l A/V Strabismus All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze to V-pattern XT, what otherof ocular abnormalities l. In addition Occurs in about 20% strabismus l cases are often present in pts with craniosynostosis? Mnemonics: --hypertelorism ‘Patients with Apert syndrome can’t get their fingers and toes apert’ (apart) --telecanthus What are the sequelae of orbital extorsion? --shallow orbits of the rectus muscles are extorted as well. For ‘Michelle Pfeiffer. The haslocation huge thumbs and toes’ --extorsion of the orbits example, the medial recti are located in the superonasal orbit. --papilledema Thus, when the eyes adduct they also elevate, giving the impression of IO overaction (called pseudo-IO overaction). Orbital extorsion contributes to the overall V-pattern XT. Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

46 Q l A/V Strabismus All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze to V-pattern XT, what otherof ocular abnormalities l. In addition Occurs in about 20% strabismus l cases are often present in pts with craniosynostosis? Mnemonics: --hypertelorism ‘Patients with Apert syndrome can’t get their fingers and toes apert’ (apart) --telecanthus --shallow orbits ‘Michelle Pfeiffer has huge thumbs and toes’ --extorsion of the orbits Why do craniosynostosis patients get papilledema? --papilledema Premature suture closure leads to elevated ICP, thereby producing papilledema Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

47 A l A/V Strabismus All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze to V-pattern XT, what otherof ocular abnormalities l. In addition Occurs in about 20% strabismus l cases are often present in pts with craniosynostosis? Mnemonics: --hypertelorism ‘Patients with Apert syndrome can’t get their fingers and toes apert’ (apart) --telecanthus --shallow orbits ‘Michelle Pfeiffer has huge thumbs and toes’ --extorsion of the orbits Why do craniosynostosis patients get papilledema? --papilledema Premature suture closure leads to elevated ICP, thereby producing papilledema Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

48 Q l A/V Strabismus All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze to V-pattern XT, what otherof ocular abnormalities l. In addition Occurs in about 20% strabismus l cases are often present in pts with craniosynostosis? Mnemonics: --hypertelorism ‘Patients with Apert syndromewith can’t get their fingers and toes apert’ (apart) A-pattern strabismus is associated another congenital condition --telecanthus involving abnormal closure of the skeleton housing the CNS—what is --shallow ‘Michelle Pfeiffer has huge thumbs and toes’ thatorbits condition? --extorsion of bifida the orbits Why do craniosynostosis patients get papilledema? Spina --papilledema Premature suture closure leads to elevated ICP, thereby producing papilledema Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

49 A l A/V Strabismus All three craniosynostoses have similar facies. How can they be differentiated? Crouzon syndrome: Characteristic facies Apert syndrome: Facies + syndactyly of hands and feet Pfeiffer syndrome: Facies + broad thumbs and broad big toes An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze to V-pattern XT, what otherof ocular abnormalities l. In addition Occurs in about 20% strabismus l cases are often present in pts with craniosynostosis? Mnemonics: --hypertelorism ‘Patients with Apert syndromewith can’t get their fingers and toes apert’ (apart) A-pattern strabismus is associated another congenital condition --telecanthus involving abnormal closure of the skeleton housing the CNS—what is --shallow ‘Michelle Pfeiffer has huge thumbs and toes’ thatorbits condition? --extorsion of bifida the orbits Why do craniosynostosis patients get papilledema? Spina --papilledema Premature suture closure leads to elevated ICP, thereby producing papilledema Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis What strabismus pattern are craniosynostoses usually associated with? V-pattern XT What are three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome

50 Q l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: Management of A/V pattern strabismus 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis EOM --Correct oblique overaction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus on primary and reading positions --If no oblique overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently

51 A l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: Management of A/V pattern strabismus 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis --Correct oblique overaction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus on primary and reading positions --If no oblique overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently

52 Q l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: Management of A/V pattern strabismus 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis --Correct oblique overaction if present same --Rule of thumb: Large A/V deviations usually involve oblique overaction EOM --Focus on primary and reading positions --If no oblique overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently

53 A l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: Management of A/V pattern strabismus 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis --Correct oblique overaction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus on primary and reading positions --If no oblique overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently

54 Q l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: Management of A/V pattern strabismus 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis --Correct oblique overaction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus on primary and reading positions --If no oblique overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently

55 A l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: Management of A/V pattern strabismus 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis --Correct oblique overaction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus on primary and reading positions --If no oblique overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently

56 Q l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: Management of A/V pattern strabismus 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis --Correct oblique overaction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus on primary and reading positions two EOMs --If no oblique overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently

57 A l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: Management of A/V pattern strabismus 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis --Correct oblique overaction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus on primary and reading positions --If no oblique overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently

58 Q l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: Management of A/V pattern strabismus 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis --Correct oblique overaction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus on primary and reading positions --If no oblique overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently A pattern ? ? V pattern

59 A l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: Management of A/V pattern strabismus 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis --Correct oblique overaction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus on primary and reading positions --If no oblique overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the Medial recti toward the Apex, and the Lateral recti toward the Empty space --Plan and correct the horizontal deviation independently A pattern LR MR MR LR V pattern

60 A l An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze l l A/V Strabismus Occurs in about 20% of strabismus cases Can be secondary to: Management of A/V pattern strabismus 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis --Correct oblique overaction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus on primary and reading positions --If no oblique overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the Medial recti toward the Apex, and the Lateral recti toward the Empty space --Plan and correct the horizontal deviation independently A pattern LR MR MR LR V pattern