Management of paralytic strabismus

Abstract

Patients with ocular palsies need full investigation to try and establish the cause. Whilst waiting for spontaneous improvement, the affiected eye may be occluded if adequate binocular single vision cannot be attained by adopting a compensatory head posture. When the patient is in familiar surroundings, the good eye should be occluded as this may reduce the development of contractures. Prisms have a very limited role, if any. After 6 months, if the Hess charts show a static situation, appropriate corrective surgery may be performed. The problems of contracture and of reduced speed of movement of the affiected eye, even after good static alignment, should make us all cautious in our prognoses. A cine film demonstrated the simplicity of the operation of advancement of the anterior half of the superior oblique, particularly when the speculum is replaced by lid clips to the upper lid only to give the maximum exposure. It is never necessary temporarily to disinsert the superior rectus for full access to the superior oblique insertion. A second film illustrated the reduced speed of abduction in an adult who had had full abduction restored by horizontal recession/resection for a left partial VIth nerve palsy. As this patient followed an object moving across his field of vision from right to left the eyes alone pursued the target until only a few degrees to the left of the mid-position and the following was then continued by face turning which still allowed binocular fixation. This was his compensation for slow left abduction.