WordNet

be cross-eyed; have a squint or strabismus
cross ones eyes as if in strabismus; "The children squinted so as to scare each other" (同)squinch
partly close ones eyes, as when hit by direct blinding light; "The driver squinted as the sun hit his windshield"
the act of squinting; looking with the eyes partly closed

PrepTutorEJDIC

斜視,やぶにらみ / 《英話》一べつ,一目 / 斜視である(進行形にできない) / (…を,を通して)横目で見る;(まぶしいとき,狙いをつけるときなどに)細目で見る《+『at』(『through』)+『名』》 / 〈目〉‘を'細める

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2019/04/11 05:10:30」(JST)

wiki en

Hypertropia is a condition of misalignment of the eyes (strabismus), whereby the visual axis of one eye is higher than the fellow fixating eye. Hypotropia is the similar condition, focus being on the eye with the visual axis lower than the fellow fixating eye. Dissociated Vertical Deviation is a special type of hypertropia leading to slow upward drift of one or rarely both eyes, usually when the patient is inattentive.

Presentation

Associated defects

Refractive errors such as hyperopia and Anisometropia may be associated abnormalities found in patients with vertical strabismus. The vertical miscoordination between the two eyes may lead to

Strabismic amblyopia, (due to deprivation / suppression of the deviating eye)
cosmetic defect (most noticed by parents of a young child and in photographs)
Face turn, depending on presence of binocular vision in a particular gaze
diplopia or double vision - more seen in adults (maturity / plasticity of neural pathways) and suppression mechanisms of the brain in sorting out the images from the two eyes.
cyclotropia, a cyclotorsional deviation of the eyes (rotation around the visual axis), particularly when the root cause is an oblique muscle paresis causing the hypertropia.

Causes

Amarna Miller, an actress with hypertropia.

Hypertropia may be either congenital or acquired, and misalignment is due to imbalance in extraocular muscle function. The superior rectus, inferior rectus, superior oblique, and inferior oblique muscles affect the vertical movement of the eyes. These muscles may be either paretic, restrictive (fibrosis) or overactive effect of the muscles. Congenital cases may have developmental abnormality due to abnormal muscle structure, usually muscle atrophy / hypertrophy or rarely, absence of the muscle and incorrect placement. Specific & common causes include:

Superior oblique Palsy / Congenital fourth nerve palsy
Inferior oblique overaction
Brown's syndrome
Duane's retraction syndrome
Double elevator palsy
Fibrosis of rectus muscle in Graves Disease (most commonly inferior rectus is involved)
Surgical trauma to the vertical muscles (e.g. during scleral buckling surgery or cataract surgery causing iatrogenic trauma to the vertical muscles).

Sudden onset hypertropia in a middle aged or elderly adult may be due to compression of the trochlear nerve and mass effect from a tumor, requiring urgent brain imaging using MRI to localise any space occupying lesion. It could also be due to infarction of blood vessels supplying the nerve, due to diabetes and atherosclerosis. In other instances it may be due to an abnormality of neuromuscular transmission, i.e., Myasthenia Gravis.

Treatment

In general, strabismus can be approached and treated with a variety of procedures. Depending on the individual case, treatment options include:

Correction of refractive errors by glasses
Prism therapy (if tolerated, to manage diplopia)
Patching (mainly to manage amblyopia in children and diplopia in adults)
Botulinum toxin injection
Surgical correction

Surgical correction of the hypertropia is desired to achieve binocularity, manage diplopia and/or correct the cosmetic defect. Steps to achieve the same depend on mechanism of the hypertropia and identification of the offending muscles causing the misalignment. Various surgical procedures have been described and should be offered after careful examination of eyes, including a detailed orthoptic examination focussing on the disturbances in ocular motility and visual status. Specialty fellowship trained pediatric ophthalmologists and strabismus surgeons are best equipped to deal with these complex procedures.

References

Wright, Kenneth Weston; Spiegel, Peter H. (January 2003). Pediatric Ophthalmology and Strabismus. Springer. p. 17. ISBN 978-0-387-95478-3.
AAPOS website on Strabismus, also containing FAQ's on the subject of Strabismus

External links

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 小児における垂直斜視の原因 causes of vertical strabismus in children
2. 小児における第4脳神経（滑車神経）麻痺 fourth cranial nerve trochlear nerve palsy in children
3. 複視の概要 overview of diplopia
4. 視覚変化が認められた小児患者に対するアプローチ approach to the pediatric patient with vision change
5. 成人における第三脳神経（動眼神経）麻痺 third cranial nerve oculomotor nerve palsy in adults

English Journal

Comparison of dexamethasone or intravenous fluids or combination of both on postoperative nausea, vomiting and pain in pediatric strabismus surgery.

Sayed JA1, F Riad MA2, M Ali MO3.
Journal of clinical anesthesia.J Clin Anesth.2016 Nov;34:136-42. doi: 10.1016/j.jclinane.2016.03.049. Epub 2016 May 3.
BACKGROUND: Strabismus surgery is perhaps a pediatric surgical procedure that has the strongest evidence of postoperative nausea and vomiting (PONV) risk. This randomized controlled blind study was designed to evaluate the efficacy of combined therapy of dexamethasone and intraoperative superhydrati
PMID 27687360

Accommodative changes after SMILE for moderate to high myopia correction.

Zheng K1, Han T1, Zhou X2.
BMC ophthalmology.BMC Ophthalmol.2016 Oct 4;16(1):173.
BACKGROUND: To investigate accommodative response and accommodative lag changes after femtosecond laser small incision lenticule extraction (SMILE) for moderate to high myopia correction.METHODS: A total of 32 eyes of 32 patients with no strabismus who underwent SMILE were enrolled in this prospecti
PMID 27716112

Massive iatrogenic orbital cysts following glaucoma drainage implant and strabismus surgery.

Demirkilinc Biler E1, Yagci A1, Uretmen O1, Palamar M1.
BMJ case reports.BMJ Case Rep.2016 Oct 4;2016. pii: bcr2016216486. doi: 10.1136/bcr-2016-216486.
We describe 2 paediatric patients who developed large orbital conjunctival epithelium-lined inclusion cysts postsurgery. Case 1 underwent Ahmed glaucoma valve implant surgery 8 months ago and case 2 underwent strabismus surgery 7 years ago. Both cases had either symptomatic strabismus or a mass
PMID 27702931

Japanese Journal

臨床研究 50歳以上の高齢者にみられた加齢による斜視の長期観察

日本眼科学会雑誌 119(9), 619-624, 2015-09
NAID 40020591381

Ocular Tilt Reaction due to a Cerebellar Hemorrhage

Internal Medicine 53(19), 2251-2254, 2014
NAID 130004694532

Related Pictures

Amblyopia and Strabismus Atlas of Ophthalmology: Orbital lymphangioma by Professor Chua Chung Nen Hypertropia is characterized by the misalignment of the eyes, in which the visual axis Google Images Strabismus (eyes turning) - Wright Center hirschbergtest - cameronswaby Hypertropia - Wikipedia ATTITUDE THERAPY: Masalah Berkaitan Mata