obsolete monocular exotropia with V pattern

Monocular Exotropia with V Pattern: An Obsolete Condition

Monocular exotropia with V pattern, also known as monocular exotropia with a V-pattern strabismus, is an outdated medical condition that was previously recognized in the field of ophthalmology. This condition refers to a type of strabismus where there is a divergent (outward) misalignment of one eye, resulting in a V-shaped pattern when looking at objects.

Characteristics

• The convergent (inward) misalignment of one eye is defined as esotropia; a divergent (outward) misalignment, exotropia; an upward misalignment, hypertropia; and a downward misalignment, hypotropia [5].
• In monocular exotropia with V pattern, the deviation is more pronounced in downgaze than in upgaze, resulting in a characteristic V-shaped pattern [10].

Causes and Associations

• This condition was previously associated with craniosynostosis, a congenital disorder where one or more of the bones in the skull fuse together prematurely [7].
• It was also linked to other craniofacial syndromes that may present with apparent inferior oblique overaction [8].

Treatment and Management

• Unfortunately, there is limited information available on the treatment and management of monocular exotropia with V pattern.
• However, it's worth noting that various surgical procedures have been developed to address other forms of exodeviation, including exotropia with convergence insufficiency [9].

Conclusion

Monocular exotropia with V pattern is an outdated medical condition that was previously recognized in the field of ophthalmology. While there is limited information available on this specific condition, it's essential to understand its characteristics and associations to provide accurate diagnoses and treatment plans for patients presenting with similar symptoms.

References:

[5] Definition of esotropia, exotropia, hypertropia, and hypotropia. [7] Association between monocular exotropia with V pattern and craniosynostosis. [8] Link between monocular exotropia with V pattern and other craniofacial syndromes. [9] Surgical procedures for exotropia with convergence insufficiency. [10] Characteristics of monocular exotropia with V pattern.

Common Signs and Symptoms of Monocular Exotropia with V Pattern

Monocular exotropia with V pattern is a type of strabismus where one eye turns outward, away from the nose, and the deviation is more pronounced in upgaze than in downgaze. The exact cause of this condition is not fully understood, but it is thought to be related to a weakness or imbalance in the muscles that control eye movement.

Common Signs and Symptoms:

• Eyes That Turn Outward: One or both eyes deviating towards the ear, which may occur all the time or intermittently, especially when the person is tired, ill, or focusing on distant objects. [10][14]
• V Pattern Deviation: The deviation of one eye from the other is more pronounced in upgaze than in downgaze, creating a V shape. [11][12]
• Intermittent Exotropia: The condition may not be present all the time and can come and go, especially when the person is tired or under stress. [10]
• Globe Retraction: In some cases, the eye may retract into the orbit, which can lead to a decrease in vision. [13]

Other Possible Signs and Symptoms:

• Ptosis: Intermittent ptosis (drooping eyelid) may occur due to weakness or imbalance in the muscles that control eye movement.
• Diplopia: Double vision may be experienced, especially when looking at distant objects.

It's essential to note that these symptoms can vary depending on the individual and the severity of the condition. If you suspect that you or your child has monocular exotropia with V pattern, it's crucial to consult an eye care professional for a proper diagnosis and treatment plan.

Based on the provided context, it appears that there are several diagnostic tests and procedures associated with monocular exotropia with a V-pattern.

• Patch test: This test is used to control tonic fusional convergence and differentiate pseudo-divergence excess from true divergence excess (Search Result 5). It may also be used to measure near deviation and avoid misdiagnosing a high AC/A ratio (Search Result 1).
• Monocular occlusion: This procedure should be used before measuring near deviation with +3.00 D lenses, especially in cases where there is a risk of misdiagnosing a high AC/A ratio (Search Result 1).
• Vertical transposition of horizontal recti: This surgical procedure is preferred for A-V patterns and may also be considered for V-pattern exotropia (Search Result 6).
• Lateral deviation analysis (LDA): While LDA should be used with caution in patients with esophoria or previously operated for intermittent exotropia, it may still be a useful diagnostic tool in certain cases (Search Result 7).

It's worth noting that the diagnosis of monocular exotropia with a V-pattern is often supported by the observation of over-elevation in adduction, which is commonly demonstrated in this condition (Search Result 11). However, the efficacy of vision therapy for treating V-pattern exotropia has not been entirely confirmed by existing literature.

References:

• Search Result 1: Monocular occlusion should be used before +3.00 D lenses to measure near deviation, to avoid misdiagnosing a high AC/A ratio.
• Search Result 5: The patch test is used to control the tonic fusional convergence & to differentiate pseudo-divergence excess from true divergence excess & also ...
• Search Result 6: Vertical transposition of horizontal recti is the preferred procedure for A-V patterns (and may be considered for V-pattern exotropia).
• Search Result 7: LDA should be used with caution in patients with esophoria or previously operated for intermittent exotropia.
• Search Result 11: The diagnosis is supported by the observation of over-elevation in adduction, which is commonly demonstrated in V-pattern exotropia.

Treatment Options for Monocular Exotropia with V Pattern

Monocular exotropia with a V pattern refers to a type of strabismus where one eye turns outward, and the deviation is more pronounced in upgaze than in downgaze. While surgical treatment options are available, drug treatment can also be considered in some cases.

• Atropine Therapy: Part-time monocular atropine therapy has been explored as a treatment option for intermittent exotropia control in young children [5]. However, its effectiveness and safety for monocular exotropia with V pattern are not well established.
• Botulinum Toxin Injection: Botulinum toxin injection is generally not indicated for patients with monocular exotropia, including those with a V pattern [12]. This is because botulinum toxin can weaken the extraocular muscles, which may exacerbate the deviation in some cases.

Current Recommendations

Based on the available information, it appears that surgical treatment options are more commonly recommended for monocular exotropia with V pattern. However, further research and clinical studies are needed to determine the most effective and safe treatment approaches for this condition.

References:

[5] Part-time monocular 1% atropine therapy for intermittent exotropia control in young children Vision Dev & Rehab 2024; 10(3):145-54. [12] Monocular exotropia with V pattern: SNOMED CT: Monocular exotropia with V pattern (111529008); Monocular exotropia with V-pattern strabismus (111529008)

Based on the provided context, it appears that differential diagnosis for obsolete monocular exotropia with a V-pattern involves considering various conditions and etiologies.

• Oblique muscle dysfunction: This is one of the conditions associated with pattern strabismus, specifically inferior oblique muscle overaction leading to a V-pattern (12).
• Congenital monocularity media opacity: Sensory exotropia can be seen in cases of congenital monocular media opacity and other causes of congenital monocular vision loss (8).
• Duane Syndrome: This is another condition that may present with esotropia or exotropia, including a V-pattern, particularly in patients with unilateral type II Duane Syndrome (14).

It's also worth noting that the diagnosis and management of strabismus, including differential diagnoses for various types of strabismus, are discussed in guidelines such as the American Academy of Ophthalmology's Preferred Practice Pattern Guidelines (6).

When considering a differential diagnosis for obsolete monocular exotropia with a V-pattern, it's essential to take into account the patient's medical history, ocular alignment, and other relevant factors.

References: * [12] Oblique muscle dysfunction is associated with pattern strabismus, including inferior oblique muscle overaction leading to a V-pattern. * [8] Congenital monocularity media opacity can cause sensory exotropia with a V-pattern. * [14] Duane Syndrome may present with esotropia or exotropia, including a V-pattern in patients with unilateral type II Duane Syndrome. * [6] The American Academy of Ophthalmology's Preferred Practice Pattern Guidelines discuss the diagnosis and management of strabismus.