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2010 Series : August 10, 2010

December 28, 2010  |  December 21, 2010  |  December 14, 2010  |  December 7, 2010  |  November 30, 2010  |  November 23, 2010  |  November 16, 2010  |  November 9, 2010  |  November 2, 2010  |  October 26, 2010  |  October 19, 2010  |  October 12, 2010  |  October 5, 2010  |  September 28, 2010  |  September 21, 2010  |  September 14, 2010  |  September 7, 2010  |  August 31, 2010  |  August 24, 2010  |  August 17, 2010  |  August 10, 2010  |  August 3, 2010  |  July 27, 2010  |  July 20, 2010  |  July 13, 2010  |  July 6, 2010  |  June 29, 2010  |  June 22, 2010  |  June 15, 2010  |  June 8, 2010  |  June 1, 2010  |  May 25, 2010  |  May 18, 2010  |  May 11, 2010  |  May 4, 2010  |  April 27, 2010  |  April 20, 2010  |  April 13, 2010  |  April 6, 2010  |  March 30, 2010  |  March 23, 2010  |  March 16, 2010  |  March 9, 2010  |  March 2, 2010  |  February 23, 2010  |  February 16, 2010  |  February 9, 2010  |  February 2, 2010  |  January 26, 2010  |  January 19, 2010  |  January 12, 2010  |  January 5, 2010

To see views enlarged, click on the individual pictures...






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You saw this 59-year-old woman in the clinic last week and just looking at her and hearing a brief history, you made a plan for workup. You found the following:

Vision with best correction:  20/200 in each eye
Axial length measured with the A-scan:  OD 29 mm and OS 30 mm
Retinoscopy:  OD -15.00 and OS -17.00

The MRI was done and you studied the images that you see here.
Just to confirm the approximate onset of the esodeviation you asked the patient to bring in old pictures and you see that her eyes were aligned in her twenties and the ET was apparent about 20 years later.

1. What do you see on the MRI?

a. downward displacement of the lateral recti
b. herniation of the globe supero-temporally
c. a very large globe
d. a reason for the strabismus
e. all of the above

2. What is your diagnosis?

a. “falling eye” esotropia and hypotropia of high myopia
b. progressive external ophthalmoplegia
c. myasthenia gravis plus
d. lateral rectus palsy
e. none of the above

3. Which of the following is the most likely procedure to succeed in aligning the eyes?
a. large lateral rectus resection
b. sub Tenon’s steroid injection
c. medial rectus recession on an adjustable suture
d. joining the lateral and superior rectus muscles to achieve a more physiologic position of the lateral rectus and recession of the medial rectus in both eyes
e. none of the above

For answers to the above, click here on or after August 17, 2010.

 

 

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