Sensorial strabismus due to congenital toxoplasmosis. Is it an eso- or exotropia?

OBJECTIVE: To examine sensorial strabismus due to congenital toxoplasmosis to elucidate differences and similarities between cases with esotropia (ET) and with exotropia (XT). METHODS: Restrospective analysis of 49 patients treated between 2002 and 2007. Visual acuity, cycloplegic refraction, strabismus patterns, presence of nystagmus, site of scar, surgery performed and strabismus surgical outcome obtained were evaluated. RESULTS: Mean age: 5 years old. 25 patients had bilateral involvement: 10 had ET, 10 XT and 4 were aligned. 15/24 unilateral cases presented with XT, 7 ET and other 2 orthotropia. 6/8 patients with the right eye affected, manifest ET and 14/16 patients with their OS affected had XT. (P=0.01) CONCLUSION: In bilateral cases of ocular toxoplasmosis ET and XT are found in similar proportions; in unilateral cases, XT is more frequent and the left eye is affected in most cases by both the toxoplasmosis and the strabismus. Esotropia appears more frequently in cases where the right eye is so affected, whereas XT predominates in cases where the left eye is affected.

The importance of cyclotorsional changes in refractive surgery.

PURPOSE: To provide evidence of the importance of a precise record of torsional alterations in all patients about to undergo refractive surgery and particularly in patients with latent strabismus that may become decompensated due to the dissociation phenomenon produced during different surgical procedures that result in fixation loss. METHODS: Using 3D-VOG video-oculography, the authors analyzed the horizontal, vertical, and torsional movements of each eye after inducing fixation loss in one and both eyes in a patient with well-compensated dissociated vertical deviation (DVD). As the dissociated techniques, Posner maneuver and the placing of Bagolini filters with increasing densities by means of the Bielschowsky phenomenon, both pathognomonic of DVD. RESULTS: The authors observed not only horizontal and vertical alterations, but also cyclotorsional alterations which may even exceed 15 degrees depending on the resulting dissociation component. CONCLUSIONS: In view of the obtained results, the authors consider it important to conduct a meticulous study of ocular motility in all patients about to undergo refractive surgery, especially in the case of high astigmatism to rule out possible latent strabismus that may condition cyclotorsional alterations important in refractive surgery.