This chapter includes an eclectic collection of redacted versions of e-mail consultations I have received about complex strabismus cases. I consider this entire chapter advanced information, so I will not be repeatedly using that icon. For the most part I have avoided giving “outcomes” for these case presentations, and I am anticipating many readers will be troubled by this and may consider it an unfortunate omission. Over the years, I have received many e-mail consultations that are strikingly similar to one another. For presentation here, I often combined the salient points from multiple patients to end up with one conflated (perhaps hypothetical) patient presentation. In that case an “outcome” would also be fictitious. In addition, it is unfortunately the rule, rather than the exception, that I do not get follow-up from the ophthalmologist requesting advice. I am often unsure if they even followed my advice. In addition, my recommendations only represent one of many possible acceptable approaches—there are many roads to orthophoria. I have often felt that my making a recommendation, and then writing that it worked well, conveys the inappropriate idea that my approach was the one right one, and all others are incorrect. My intention in presenting these cases is to outline a thought process of how one may approach complex strabismus. For each one I will list one or more take-home “pearls” that the case was chosen to highlight.
KeywordsAmniotic membrane Angle kappa Anti-elevation syndrome (AES) Brown syndrome Diplopia Dissociated vertical divergence (DVD) Divergence insufficiency Esotropia (ET) Excyclotropia Exotropia (XT) Flap tear Fourth cranial nerve palsy Harada-Ito procedure Heavy eye syndrome Hypertropia (HT) Hypotropia (HYPO) Incyclotropia Inferior oblique anterior transposition (IO AT) Masked bilateral superior oblique palsy Mitomycin C Nystagmus Orbital floor fracture Pulleys Pullover sutures Rotary forced ductions Scleral buckling surgery Superior oblique (SO) incarceration syndrome Superior oblique palsy (SOP) SO posterior tenectomy SO tuck Third nerve palsy Thyroid eye disease (TED) Torsion
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