1 A/V Strabismus Q

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze 2 A/V Strabismus

A-pattern exotropia 3 A/V Strabismus

V-pattern exotropia 4 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze 5 A/V Strabismus Q

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze

 Occurs in about 20%% of strabismus cases 6 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases 7 A/V Strabismus Q

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to:

EOM 1) Obliqueproblem dysfunction

2) Horizontala different or EOM vertical problem rectus dysfunction

serious congenital problem 3) Craniosynostosisw/ secondary EOM effects 8 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis 9 A/V Strabismus Q

 An A or V pattern strabismus is simply one

thatWhich changes pattern (A vs V magnitude) is associated with in which up- oblique and overaction? downgaze --SOOccurs overaction in causes…about A20%pattern of strabismusstrabismus(A’s arecases ‘superior’) --IO overaction causes…V pattern strabismus  Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis 10 A/V Strabismus A

 An A or V pattern strabismus is simply one

thatWhich changes pattern (A vs V magnitude) is associated with in which up- oblique and overaction? downgaze --SOOccurs overaction in causes…about A20%pattern of strabismusstrabismus(A’s arecases ‘superior’) --IO overaction causes…V pattern strabismus  Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis 11 A/V Strabismus Q

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze

 OccursTo inwhat about does the 20% term craniosynostosis of strabismus refer? cases To the premature closing of cranial suture(s)  Can be secondary to: What results from premature suture closing? 1) ObliquePremature dysfunction closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific 2) Horizontaland well-recognized or vertical patterns rectus of craniofacial dysfunction malformation may result. 3) Craniosynostosis 12 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze

 OccursTo inwhat about does the 20% term craniosynostosis of strabismus refer? cases To the premature closing of cranial suture(s)  Can be secondary to: What results from premature suture closing? 1) ObliquePremature dysfunction closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific 2) Horizontaland well-recognized or vertical patterns rectus of craniofacial dysfunction malformation may result. 3) Craniosynostosis 13 A/V Strabismus Q

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze

 OccursTo inwhat about does the 20% term craniosynostosis of strabismus refer? cases To the premature closing of cranial suture(s)  Can be secondary to: What results from premature suture closing? 1) ObliquePremature dysfunction closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific 2) Horizontaland well-recognized or vertical patterns rectus of craniofacial dysfunction malformation may result. 3) Craniosynostosis 14 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze

 OccursTo inwhat about does the 20% term craniosynostosis of strabismus refer? cases To the premature closing of cranial suture(s)  Can be secondary to: What results from premature suture closing? 1) ObliquePremature dysfunction closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific 2) Horizontaland well-recognized or vertical patterns rectus of craniofacial dysfunction malformation may result. 3) Craniosynostosis 15 A/V Strabismus Q

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze

 OccursTo inwhat about does the 20% term craniosynostosis of strabismus refer? cases To the premature closing of cranial suture(s)  Can be secondary to: What results from premature suture closing? 1) ObliquePremature dysfunction closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific 2) Horizontaland well-recognized or vertical patterns rectus of craniofacial dysfunction malformation may result. Two 3) Craniosynostosis categories of craniofacial syndrome Craniosynostoses ?

What is the other broad category of craniofacial syndrome? 16 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze

 OccursTo inwhat about does the 20% term craniosynostosis of strabismus refer? cases To the premature closing of cranial suture(s)  Can be secondary to: What results from premature suture closing? 1) ObliquePremature dysfunction closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific 2) Horizontaland well-recognized or vertical patterns rectus of craniofacial dysfunction malformation may result. Two 3) Craniosynostosis categories of craniofacial syndrome Craniosynostoses Not craniosynostoses

What is the other broad category of craniofacial syndrome? 17 A/V Strabismus Q

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze

 OccursTo inwhat about does the 20% term craniosynostosis of strabismus refer? cases To the premature closing of cranial suture(s)  Can be secondary to: What results from premature suture closing? 1) ObliquePremature dysfunction closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific 2) Horizontaland well-recognized or vertical patterns rectus of craniofacial dysfunction malformation may result. Two 3) Craniosynostosis categories of craniofacial syndrome Craniosynostoses Not craniosynostoses --? Which not-craniosynostosis craniofacial --? malformations are addressed in the Peds book? --? --? 18 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze

 OccursTo inwhat about does the 20% term craniosynostosis of strabismus refer? cases To the premature closing of cranial suture(s)  Can be secondary to: What results from premature suture closing? 1) ObliquePremature dysfunction closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific 2) Horizontaland well-recognized or vertical patterns rectus of craniofacial dysfunction malformation may result. Two 3) Craniosynostosis categories of craniofacial syndrome Craniosynostoses Not craniosynostoses --Goldenhar Which not-craniosynostosis craniofacial --Treacher Collins malformations are addressed in the Peds book? --Pierre Robin sequence --Fetal alcohol 19 A/V Strabismus Q

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze

 OccursTo inwhat about does the 20% term craniosynostosis of strabismus refer? cases To the premature closing of cranial suture(s)  Can be secondary to: What results from premature suture closing? 1) ObliquePremature dysfunction closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific 2) Horizontaland well-recognized or vertical patterns rectus of craniofacial dysfunction malformation may result. Two 3) Craniosynostosis categories of craniofacial syndrome Craniosynostoses Not craniosynostoses --? --Goldenhar Which craniosynostosis syndromes --? --Treacher Collins are addressed in the Peds book? --? --Pierre Robin sequence --? --Fetal alcohol 20 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze

 OccursTo inwhat about does the 20% term craniosynostosis of strabismus refer? cases To the premature closing of cranial suture(s)  Can be secondary to: What results from premature suture closing? 1) ObliquePremature dysfunction closure produces abnormal growth patterns of the skull and face. Depending upon which suture(s) closes prematurely, specific 2) Horizontaland well-recognized or vertical patterns rectus of craniofacial dysfunction malformation may result. Two 3) Craniosynostosis categories of craniofacial syndrome Craniosynostoses Not craniosynostoses --Crouzon --Goldenhar Which craniosynostosis syndromes --Apert --Treacher Collins are addressed in the Peds book? --Pfeiffer --Pierre Robin sequence --Saethre-Chotzen --Fetal alcohol 21 A/V Strabismus Q

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 22 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 23 A/V Strabismus Q

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 24 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 25 A/V Strabismus Q All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome: Characteristicstrabismus facies is simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes  Occurs in about 20% of strabismus cases  Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 26 A/V Strabismus A All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is only simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes  Occurs in about 20% of strabismus cases  Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 27

Crouzon syndrome: Characteristic facies 28 A/V Strabismus Q All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is only simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes  Occurs in about 20% of strabismus cases  Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 29 A/V Strabismus A All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is only simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes  Occurs in about 20% of strabismus cases  Can be secondary to: 1) Oblique dysfunction 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 30

Apert syndrome: Characteristic facies and marked syndactyly 31 A/V Strabismus A All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is only simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes  Occurs in about 20% of strabismus cases Mnemonics:  Can be ‘Patientssecondary with Apert syndrome to: can’t get their fingers and toes apert’ (apart) 1) Oblique‘Michelle dysfunction Pfeiffer has huge thumbs and toes’ 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 32 A/V Strabismus Q All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is only simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome magnitude: Facies + broad in thumbsup- andand broad downgaze big toes  Occurs in about 20% of strabismus cases Mnemonics:  Can be ‘Patientssecondary with Apert syndrome to: can’t get their fingers and toes apert’ (apart) 1) Oblique‘Michelle dysfunction Pfeiffer has huge thumbs and toes’ 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 33 A/V Strabismus A All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is only simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome magnitude: Facies + broad in thumbsup- andand broad downgaze big toes  Occurs in about 20% of strabismus cases Mnemonics:  Can be ‘Patientssecondary with Apert syndrome to: can’t get their fingers and toes apert’ (apart) 1) Oblique‘Michelle dysfunction Pfeiffer has huge thumbs and toes’ 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 34

Pfeiffer syndrome: Characteristic facies, broad thumbs/great toes 35 A/V Strabismus A All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is only simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome magnitude: Facies + broad in thumbsup- andand broad downgaze big toes  Occurs in about 20% of strabismus cases Mnemonics:  Can be ‘Patientssecondary with Apert syndrome to: can’t get their fingers and toes apert’ (apart) 1) Oblique‘Michelle dysfunction Pfeiffer has huge thumbs and toes’ (not really) 2) Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 36 A/V Strabismus Q All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes In additionOccurs to V-pattern in about XT, what 20% other of ocular strabismus abnormalities cases are often presentMnemonics in pts with: craniosynostosis?  Can-- be ‘Patientssecondary with Apert syndrome to: can’t get their fingers and toes apert’ (apart) -- 1)-- Oblique‘Michelle dysfunction Pfeiffer has huge thumbs and toes’ -- 2)-- Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 37 A/V Strabismus A All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes In additionOccurs to V-pattern in about XT, what 20% other of ocular strabismus abnormalities cases are often presentMnemonics in pts with: craniosynostosis?  Can--hypertelorism be ‘Patientssecondary with Apert syndrome to: can’t get their fingers and toes apert’ (apart) --telecanthus 1)--shallow Oblique orbits‘Michelle dysfunction Pfeiffer has huge thumbs and toes’ --extorsion of the orbits 2)--papilledema Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 38 A/V Strabismus Q All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes

In additionOccurs to V-pattern in aboutWhat XT, iswhat the20% otherdifference of ocular strabismus between abnormalities hypertelorism cases and telecanthus? are often presentMnemonics in ptsHypertelorism with: craniosynostosis?refers to an abnormally increased distance  Can--hypertelorism be ‘Patientssecondarybetween with Apert the syndrome medialto: orbital can’t walls;get their telecanthus fingers andrefers toes apertto an ’ (apart) --telecanthus abnormally increased distance between the medial canthi. 1)--shallow Oblique orbits‘Michelle dysfunction Pfeiffer has huge thumbs and toes’ --extorsion of the orbitsWhich manifests as an increased interpupillary distance? 2)--papilledema Horizontal orHypertelorism vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 39 A/V Strabismus A All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes

In additionOccurs to V-pattern in aboutWhat XT, iswhat the20% otherdifference of ocular strabismus between abnormalities hypertelorism cases and telecanthus? are often presentMnemonics in ptsHypertelorism with: craniosynostosis?refers to an abnormally increased distance  Can--hypertelorism be ‘Patientssecondarybetween with Apert the syndrome medialto: orbital can’t walls;get their telecanthus fingers andrefers toes apertto an ’ (apart) --telecanthus abnormally increased distance between the medial canthi. 1)--shallow Oblique orbits‘Michelle dysfunction Pfeiffer has huge thumbs and toes’ --extorsion of the orbitsWhich manifests as an increased interpupillary distance? 2)--papilledema Horizontal orHypertelorism vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 40 A/V Strabismus Q All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes

In additionOccurs to V-pattern in aboutWhat XT, iswhat the20% otherdifference of ocular strabismus between abnormalities hypertelorism cases and telecanthus? are often presentMnemonics in ptsHypertelorism with: craniosynostosis?refers to an abnormally increased distance  Can--hypertelorism be ‘Patientssecondarybetween with Apert the syndrome medialto: orbital can’t walls;get their telecanthus fingers andrefers toes apertto an ’ (apart) --telecanthus abnormally increased distance between the medial canthi. 1)--shallow Oblique orbits‘Michelle dysfunction Pfeiffer has huge thumbs and toes’ --extorsion of the orbitsWhich manifests as an increased interpupillary distance? 2)--papilledema Horizontal orHypertelorism vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 41 A/V Strabismus A All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes

In additionOccurs to V-pattern in aboutWhat XT, iswhat the20% otherdifference of ocular strabismus between abnormalities hypertelorism cases and telecanthus? are often presentMnemonics in ptsHypertelorism with: craniosynostosis?refers to an abnormally increased distance  Can--hypertelorism be ‘Patientssecondarybetween with Apert the syndrome medialto: orbital can’t walls;get their telecanthus fingers andrefers toes apertto an ’ (apart) --telecanthus abnormally increased distance between the medial canthi. 1)--shallow Oblique orbits‘Michelle dysfunction Pfeiffer has huge thumbs and toes’ --extorsion of the orbitsWhich manifests as an increased interpupillary distance? 2)--papilledema Horizontal orHypertelorism vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 42 A/V Strabismus Q All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes In additionOccurs to V-pattern in about XT, what 20% other of ocular strabismus abnormalities cases are often presentMnemonics in pts with: craniosynostosis?  Can--hypertelorism be ‘Patientssecondary with Apert syndrome to: can’t get their fingers and toes apert’ (apart) --telecanthus What serious sequelae can result from shallow orbits? 1)--shallow Oblique orbits‘Michelle dysfunction PfeifferShallowhas orbits huge produce thumbs pr optosis,and toes’ which may lead to --extorsion of the orbitsexposure keratopathy 2)--papilledema Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 43 A/V Strabismus A All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes In additionOccurs to V-pattern in about XT, what 20% other of ocular strabismus abnormalities cases are often presentMnemonics in pts with: craniosynostosis?  Can--hypertelorism be ‘Patientssecondary with Apert syndrome to: can’t get their fingers and toes apert’ (apart) --telecanthus What serious sequelae can result from shallow orbits? 1)--shallow Oblique orbits‘Michelle dysfunction PfeifferShallowhas orbits huge produce thumbs pr optosis,and toes’ which may lead to --extorsion of the orbitsexposure keratopathy 2)--papilledema Horizontal or vertical rectus dysfunction 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 44 A/V Strabismus Q All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes In additionOccurs to V-pattern in about XT, what 20% other of ocular strabismus abnormalities cases are often presentMnemonics in pts with: craniosynostosis?  Can--hypertelorism be ‘Patientssecondary with Apert syndrome to: can’t get their fingers and toes apert’ (apart) --telecanthus What are the sequelae of orbital extorsion? 1)--shallow Oblique orbits‘Michelle dysfunction PfeifferThehas location huge thumbs of the rectusand toes’ muscles are extorted as well. For --extorsion of the orbits example, the medial recti are located in the superonasal orbit. 2)--papilledema Horizontal or verticalThus, when rectus the eyes dysfunction adduct they also elevate, giving the impression of IO overaction (called pseudo-IO overaction). 3) CraniosynostosisOrbital extorsion contributes to the overall V-pattern XT.

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 45 A/V Strabismus A All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes In additionOccurs to V-pattern in about XT, what 20% other of ocular strabismus abnormalities cases are often presentMnemonics in pts with: craniosynostosis?  Can--hypertelorism be ‘Patientssecondary with Apert syndrome to: can’t get their fingers and toes apert’ (apart) --telecanthus What are the sequelae of orbital extorsion? 1)--shallow Oblique orbits‘Michelle dysfunction PfeifferThehas location huge thumbs of the rectusand toes’ muscles are extorted as well. For --extorsion of the orbits example, the medial recti are located in the superonasal orbit. 2)--papilledema Horizontal or verticalThus, when rectus the eyes dysfunction adduct they also elevate, giving the impression of IO overaction (called pseudo-IO overaction). 3) CraniosynostosisOrbital extorsion contributes to the overall V-pattern XT.

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 46 A/V Strabismus Q All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes In additionOccurs to V-pattern in about XT, what 20% other of ocular strabismus abnormalities cases are often presentMnemonics in pts with: craniosynostosis?  Can--hypertelorism be ‘Patientssecondary with Apert syndrome to: can’t get their fingers and toes apert’ (apart) --telecanthus 1)--shallow Oblique orbits‘Michelle dysfunction Pfeiffer has huge thumbs and toes’ --extorsion of the orbitsWhy do craniosynostosis patients get papilledema? 2)--papilledema Horizontal orPremature vertical suture rectus closure leads dysfunction to elevated ICP, thereby producing papilledema 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 47 A/V Strabismus A All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes In additionOccurs to V-pattern in about XT, what 20% other of ocular strabismus abnormalities cases are often presentMnemonics in pts with: craniosynostosis?  Can--hypertelorism be ‘Patientssecondary with Apert syndrome to: can’t get their fingers and toes apert’ (apart) --telecanthus 1)--shallow Oblique orbits‘Michelle dysfunction Pfeiffer has huge thumbs and toes’ --extorsion of the orbitsWhy do craniosynostosis patients get papilledema? 2)--papilledema Horizontal orPremature vertical suture rectus closure leads dysfunction to elevated ICP, thereby producing papilledema 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 48 A/V Strabismus Q All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes In additionOccurs to V-pattern in about XT, what 20% other of ocular strabismus abnormalities cases are often presentMnemonics in pts with: craniosynostosis?  Can--hypertelorism Abe-pattern ‘Patientssecondary strabismus with Apert is associated syndrome to: with can’t another get their congenital fingers and condition toes apert ’ (apart) --telecanthusinvolving abnormal closure of the skeleton housing the CNS—what is 1)--shallow Obliquethat orbits condition?‘Michelle dysfunction Pfeiffer has huge thumbs and toes’ --extorsionSpina of bifidathe orbitsWhy do craniosynostosis patients get papilledema? 2)--papilledema Horizontal orPremature vertical suture rectus closure leads dysfunction to elevated ICP, thereby producing papilledema 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 49 A/V Strabismus A All three craniosynostoses have similar facies. How can they be differentiated?  An A orCrouzonV pattern syndrome strabismus: Characteristic facies is simply one Apert syndrome: Facies + syndactyly of hands and feet that changesPfeiffer syndrome: magnitude Facies + broad in thumbs up- and and broad downgaze big toes In additionOccurs to V-pattern in about XT, what 20% other of ocular strabismus abnormalities cases are often presentMnemonics in pts with: craniosynostosis?  Can--hypertelorism Abe-pattern ‘Patientssecondary strabismus with Apert is associated syndrome to: with can’t another get their congenital fingers and condition toes apert ’ (apart) --telecanthusinvolving abnormal closure of the skeleton housing the CNS—what is 1)--shallow Obliquethat orbits condition?‘Michelle dysfunction Pfeiffer has huge thumbs and toes’ --extorsionSpina of bifidathe orbitsWhy do craniosynostosis patients get papilledema? 2)--papilledema Horizontal orPremature vertical suture rectus closure leads dysfunction to elevated ICP, thereby producing papilledema 3) Craniosynostosis

What strabismus pattern are craniosynostoses usually associated with? V-pattern XT

What are the three most common craniosynostoses associated with V-pattern XT? --Crouzon syndrome --Apert syndrome --Pfeiffer syndrome 50 A/V Strabismus Q

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: Management1) Oblique of A/V dysfunction pattern strabismus --Correct obliqueEOM overaction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus2) on Horizontal primary and reading or vertical positions rectus dysfunction --If no3) oblique Craniosynostosis overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently 51 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: Management of A/V pattern strabismus --Correct1) Obliqueoblique overaction dysfunction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus2) on Horizontal primary and reading or vertical positions rectus dysfunction --If no3) oblique Craniosynostosis overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently 52 A/V Strabismus Q

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: Management of A/V pattern strabismus --Correct1) Obliqueoblique overaction dysfunction if present same --Rule of thumb: Large A/V deviations usually involve obliqueEOM overaction --Focus2) on Horizontal primary and reading or vertical positions rectus dysfunction --If no3) oblique Craniosynostosis overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently 53 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: Management of A/V pattern strabismus --Correct1) Obliqueoblique overaction dysfunction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus2) on Horizontal primary and reading or vertical positions rectus dysfunction --If no3) oblique Craniosynostosis overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently 54 A/V Strabismus Q

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: Management of A/V pattern strabismus --Correct1) Obliqueoblique overaction dysfunction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus2) on Horizontal primary and reading or verticalpositions rectus dysfunction --If no3) oblique Craniosynostosis overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently 55 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: Management of A/V pattern strabismus --Correct1) Obliqueoblique overaction dysfunction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus2) on Horizontal primary and reading or verticalpositions rectus dysfunction --If no3) oblique Craniosynostosis overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently 56 A/V Strabismus Q

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: Management of A/V pattern strabismus --Correct1) Obliqueoblique overaction dysfunction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus2) on Horizontal primary and reading or verticalpositions rectus dysfunction --If no3) oblique Craniosynostosis overaction, correct by displacing the medial andtwo EOMslateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently 57 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: Management of A/V pattern strabismus --Correct1) Obliqueoblique overaction dysfunction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus2) on Horizontal primary and reading or verticalpositions rectus dysfunction --If no3) oblique Craniosynostosis overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the L ateral recti toward the E mpty space --Plan and correct the horizontal deviation independently 58 A/V Strabismus Q

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: A pattern Management of A/V pattern strabismus --Correct1) Obliqueoblique overaction dysfunction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction ? ? --Focus2) on Horizontal primary and reading or verticalpositions rectus dysfunction ? ? --If no3) oblique Craniosynostosis overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the M edial recti toward the A pex, and the

L ateral recti toward the ? ? ? ? E mpty space --Plan and correct the horizontal deviation independently V pattern 59 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: A pattern Management of A/V pattern strabismus --Correct1) Obliqueoblique overaction dysfunction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus2) on Horizontal primary and reading or verticalpositions rectus dysfunction LR MR MR LR --If no3) oblique Craniosynostosis overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the Medial recti toward the Apex, and the Lateral recti toward the LR MR MR LR Empty space --Plan and correct the horizontal deviation independently V pattern 60 A/V Strabismus A

 An A or V pattern strabismus is simply one that changes magnitude in up- and downgaze  Occurs in about 20% of strabismus cases  Can be secondary to: A pattern Management of A/V pattern strabismus --Correct1) Obliqueoblique overaction dysfunction if present --Rule of thumb: Large A/V deviations usually involve oblique overaction --Focus2) on Horizontal primary and reading or verticalpositions rectus dysfunction LR MR MR LR --If no3) oblique Craniosynostosis overaction, correct by displacing the medial and lateral recti according to the mnemonic MALE: Transpose the Medial recti toward the Apex, and the Lateral recti toward the LR MR MR LR Empty space --Plan and correct the horizontal deviation independently V pattern