Journey from Esotropia Resulting from Bilateral 6th Nerve Palsy in Infancy to Orthotropia
A detailed case study presented at the 9th Annual State Ophthalmological Conference showcases the successful management of esotropia resulting from bilateral 6th nerve palsy. The journey of a 30-year-old male patient from childhood inward eye deviation to achieving orthotropia post-surgical intervention is documented. The patient regained full range of eye movement and excellent vision outcome. Effective management of fibrosis due to 6th nerve palsy led to a successful surgical outcome, emphasizing the importance of proper diagnosis and intervention in such cases.
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Manoj Mathur E-Poster [Title of the E-Poster] [Presenting Author s Name] 9thAnnual State Ophthalmological Conference TOSCON 2024 12thto 14thJuly, 2024 at Katriya Hotel & Towers, Hyderabad JOURNEY FROM ESOTROPIA RESULTING FROM BILATERAL 6th NERVE PALSY IN INFANCY TO ORTHOTROPIA TO DATE Dr Imran Saberi
INTRODUCTION In the 6th nerve palsy the greatest esotropia occurs on attempts to abduct the paretic eye . Patients usually have compensatory face turn in the direction of paralyzed muscle. Unopposed action of the antagonistic medial rectus results in esotropia . In bilateral paralysis ,both eyes maybe in a position of abduction.
METHODS CASE HISTORY : A 30 year old male patient presented to the department of Squint and Orthoptics with a chief complaint of inward deviation of both eyes since childhood.The patients birth history was uneventful. The patient had no known significant past history. There were no similar complaints in the family. OCULAR EXAMINATION Vision RE: 6/18 LE ? PL Anterior segment : NAD BE Fundus: Within normal limits BE CHP : Head tilt to right, Face turn to left HCRT : RE central, LE > 45 degrees esotropia ON COVER, UNCOVER, ACT, BE are showing redressal movements and fixing. PBCT: > 90 PD STEREOPSIS: Poor WFDT: LE suppression for both near and distance Childhood photograph of the patient Patient at the time of presentation
Surgical Intervention Step 1 - Both eye Bimedial large recession of MR of 8mm on 6-12-18 Step 2 - Second surgery of RE LR resection of 7mm on 13-12-18
DISCUSSION 6th nerve palsy is known to have the greatest esotropia , so here we bring to you an example of a 30 year old male patient with chief complaint of bilateral invert deviation with no significant past history. After successful diagnosis and surgical intervention the patient regained orthotropia and good vision of 6/6 in both the eyes . This shows that effective management of fibrosis resulting from bilateral 6th nerve palsy resulted in an excellent outcome
CONCLUSION Effective management of fibrosis resulting from BL 6th nerve palsy has resulted in excellent surgical outcome and orthotropia. The patient has regained orthotropia and full range of abduction in both the eyes after the two step surgery. The patient also regained a good vision of 6/6 in both the eyes as reported by himself
