Techniques 1
Where type of incision is used for most strabismus surgeries?
Fornix incision
This is a temporary suture that is attached to the sclera at the limbus or under a rectus muscle insertion, brought out through the eyelids, and secured to periocular skin over a bolster to fix the eye in a selected position during postoperative healing
Stay suture
Describe the oculocardiac reflex and tell how it is treated
Stretch receptors in the EOM fire afferent signals through CN5 (trigeminal) and an efferent reflex through CN7 (vagus) to the myocardium and SA node, leading to bradycardia.
Let go of the muscle! If no improvement, administer IV anticholinergic (e.g. atropine or glycopyrrolate
An elderly patient with HTN and DM undergoing a recess/resect is at risk for what complication?
anterior segment ischemia
Approximately ___ of correction in primary position can be expected for every millimeter of vertical rectus muscle recession
3Δ
This procedure involves suturing a recuts muscle to the sclera far posterior to its insertion
Posterior fixation
Which muscle is most problematic when it is ‘lost’ during surgery and why?
medial rectus – it has no other attachments
With what type of incision are dellen more likely to be seen and how are they treated?
limbal – lubrication
These can be used to avoid an immediately obvious poor result or to increase the likelihood of success (type of suture)
Adjustable sutures
What procedure is used to treat Brown syndrome?
Superior Oblique tenotomy
What is PITS syndrome and name 2 risk factors.
advanced age, myopathies, previous surgery, trauma or infiltrative disease
What are the signs of ASI and how is it treated?
cells and flare – then k edema; treat with steroids
Weakening: myotomy, myectomy, tenotomy, tenectomy, recession, denervation and extirpation, recession and anteriorization, posterior fixation suture
Strengthening: resection, plication, tuck, advancement
What procedure is used for 6th nerve palsy with no abduction past midline?
transposition of vertical rectus muscles
How can you avoid change in eyelid position with vertical rectus surgery?
ensure that all fascial attachments are severed 12-15 mm posterior to insertion
Name 3 ways to manage diplopia after strabismus surgery?
prisms, additional surgery or occlusion
What procedure is effective for treatment of dissociated vertical deviation (DVD) and is especially useful when DVD and inferior oblique overaction coexist.
inferior oblique anterior transposition, inferior oblique anteriorization- Moving the insertion of the inferior oblique muscle anteriorly to a point adjacent to the lateral border of the inferior rectus muscle
In this special procedure, the anterior half of the superior oblique tendon alone may be advanced temporally and somewhat anteriorly
Fells modification of the Harada- Ito procedure
What is the earliest sign of malignant hyperthermia?
unexplained elevation of end-tidal carbon dioxide concentration – surgery is then terminated
What are three complications of botox treatment?
Ptosis, lagophthalmos, dry eye, induced vertical strabismus after injection of horizontal muscles, scleral perf, retrobulbar hemorrhage,