obsolete monocular esotropia with V pattern

Obsolete Monocular Esotropia with V Pattern: A Review

Monocular esotropia with a V pattern is a type of strabismus characterized by the inward misalignment of one eye, with a distinctive "V" shape in its deviation. This condition was previously classified as a separate entity from other forms of esotropia.

Definition and Prevalence

According to medical literature [3], monocular esotropia is defined as the convergent (inward) misalignment of one eye, with a divergent (outward) misalignment, exotropia; an upward misalignment, hypertropia; and a downward misalignment, hypotropia being its counterparts. Monocular esotropia with a V pattern is considered to be significant if the difference in horizontal deviation between the 2 gazes is ≥ 15 prism diopters [10].

Etiology

Several conditions or etiologies are associated with pattern strabismus, including oblique muscle dysfunction. Specifically, inferior oblique muscle overaction can lead to a V pattern, while superior oblique muscle overaction results in an A pattern [11]. These patterns are found in approximately 15-25% of all horizontal strabismus cases, with the V pattern being the most common overall [11].

Treatment and Management

The treatment for monocular esotropia with a V pattern typically involves surgical procedures to correct the deviation. A comparative study on medial rectus slanting recession versus recession with downward transposition for correction of V-pattern esotropia has been conducted, highlighting the effectiveness of these methods [14]. Additionally, botulinum treatment and other forms of strabismus surgery may be considered in certain cases.

Conclusion

Monocular esotropia with a V pattern is an obsolete classification that was previously used to describe a specific type of strabismus. While it is no longer considered a distinct entity, its characteristics and treatment options remain relevant for ophthalmologists and optometrists working with patients presenting this condition.

References:

[3] Medical literature reference: Monocular esotropia definition [10] Medical literature reference: V pattern significance [11] Medical literature reference: Etiology of pattern strabismus [14] Medical literature reference: Comparative study on medial rectus slanting recession

Signs and Symptoms of Monocular Esotropia with V Pattern

Monocular esotropia with a V pattern is a type of eye misalignment where one eye turns inward, resulting in a characteristic "V" shape. The signs and symptoms of this condition can be quite specific.

• Stable deviation: One eye remains consistently turned inward, even when the other eye is aligned properly [3].
• No improvement with refractive correction: Glasses or contact lenses cannot correct the misalignment [3].
• Comitance in horizontal gazes: When looking straight ahead, both eyes may turn inward together, but this can vary depending on the individual case [3].
• Similar angles of deviation at near and far distances: The degree of eye misalignment remains relatively consistent whether the person is reading or looking into the distance [3].

In addition to these specific signs, individuals with monocular esotropia with a V pattern may also experience more general symptoms such as:

• Intermittent diplopia: Double vision can occur when the eyes are not aligned properly.
• Headaches and eyestrain: Prolonged periods of reading or other activities that require sustained focus can lead to discomfort and fatigue in the eyes.

It's essential to note that these symptoms can vary in severity and may not be present all the time. A proper diagnosis by an eye care professional is necessary for accurate identification and treatment of this condition [9].

References: [3] - Context result 3 [9] - Context result 9

Based on the provided context, it appears that diagnostic tests for monocular esotropia with a V pattern are crucial in evaluating the degree of alignment of the eye.

• Visual Acuity Testing: This test is essential in assessing the visual acuity of the affected eye without correction (HOTV) [1]. It helps to determine if there's any significant difference in visual acuity between the two eyes.
• Pupils Examination: A thorough examination of the pupils can help identify any abnormalities, such as anisocoria or irregular pupil shape, which may be associated with monocular esotropia with a V pattern [2].
• Intraocular Pressure (iCare Tonometry): Measuring intraocular pressure is essential in ruling out any underlying conditions that may be contributing to the esotropia, such as glaucoma [3].
• Stereo Vision Testing: This test can help determine if there's any stereo vision deficit, which may be associated with monocular esotropia with a V pattern [4].
• Motility and Cover Test: The cover test is used to measure the amount of deviation between the two eyes in different gaze positions. It helps to identify if there's any significant difference in motility between the two eyes [5].

These diagnostic tests can help determine the presence and severity of monocular esotropia with a V pattern, which is essential for developing an effective treatment plan.

References: [1] Context 2 [2] Context 2 [3] Context 2 [4] Context 2 [5] Context 13

Based on the provided context, it appears that there are limited treatment options for monocular esotropia with a V-pattern, and surgery is often considered the most effective approach.

However, according to search result [10], in some cases, nonsurgical treatment options may be indicated. In the case of monocular esotropia with a V-pattern, one such option mentioned is the use of lenses or prisms to correct the deviation (search result [2]).

Regarding drug treatment specifically for obsolete monocular esotropia with a V pattern, there seems to be limited information available in the provided context. However, search result [9] mentions that administering a 1% atropine drop in both eyes daily for a few weeks can be effective in encouraging the child to use the bifocal glasses correctly.

It's essential to note that these treatment options may not be universally applicable and should be considered on a case-by-case basis. Consultation with an eye care professional is recommended to determine the best course of treatment for individual patients.

• Nonsurgical treatment options, such as lenses or prisms, may be indicated in some cases (search result [2]).
• Atropine drops may be used to encourage correct use of bifocal glasses (search result [9]).
• Surgery is often considered the most effective approach for monocular esotropia with a V-pattern (implied by search results [10] and [11]).

The differential diagnosis for obsolete monocular esotropia with a V-pattern involves considering various conditions that can cause similar symptoms. Here are some possible causes:

• Inferior Oblique Overaction (IOOA): This is a common cause of V-pattern strabismus, where the inferior oblique muscle is overactive, leading to an inward deviation of the eye [8].
• Craniofacial syndromes: Certain craniofacial syndromes can be associated with apparent IOOA and V-pattern strabismus [9].
• X-pattern strabismus: This is a type of strabismus where there is a crossing pattern, which can be similar to a V-pattern.
• Intracranial tumors or Chiari I malformation: These conditions can cause esotropia with a V-pattern due to the compression of the brain and nerves [2].
• Cranial nerve palsy (CN VI palsy): This is a condition where there is weakness or paralysis of the abducens nerve, leading to an inward deviation of the eye.
• Idiopathic intracranial hypertension: This is a condition where there is increased pressure in the brain without any known cause.

It's essential to note that these conditions can have overlapping symptoms and require a comprehensive evaluation by an ophthalmologist or neurologist to determine the underlying cause.