Management of XXXX limited to down gaze.

@entity1 @entity15170 @entity2194 @entity10818 @entity7205 @entity2895 @entity892
OBJECTIVE: To evaluate the usefulness of various optical and surgical treatment modalities in the treatment of @entity1 who were symptom free in the primary position of gaze yet had symptomatic @entity892 in the reading position (down gaze at near). @entity1 AND METHODS: A retrospective chart review was conducted to identify all @entity1 with @entity10818 I have treated who were symptom free in the primary position but had @entity892 in down gaze associated with vertically incomitant strabismus. Of 51 @entity1 identified, 32 were symptomatic in down gaze due to a @entity15170 associated with a unilateral inferior rectus muscle underaction. Twenty-two of these @entity1 had previously undergone recession of the affected inferior rectus muscle for treatment of @entity2194 ; four @entity1 , for correction of entrapment secondary to blow-out orbital fracture; and four @entity1 , for treatment of superior oblique muscle palsy. Two @entity1 had undergone prior surgery for superior oblique @entity7205 . Eight @entity1 had horizontal @entity892 associated with an A pattern, and eight @entity1 had horizontal @entity892 associated with a V pattern. Three @entity1 had vertical and horizontal @entity892 after partial recovery from @entity2895 . RESULTS: The treatment modalities were varied and individualized. Treatment consisted of optical management (20 @entity1 ), surgical management (21 @entity1 ), or a combination of both (10 @entity1 ). These treatment modalities resulted in comfortable single binocular vision for reading in 41 of the 51 @entity1 . Successful optical treatment consisted of Fresnel prisms (four @entity1 ), slab-off prisms (two @entity1 ), single-vision readers (seven @entity1 ), switch to nonprogressive bifocal lenses (three @entity1 ), and a high bifocal segment (16 @entity1 ). Successful surgical modalities included posterior fixation of the contralateral inferior rectus muscle (10 @entity1 ), surgery for A- or V- pattern strabismus (five @entity1 ), or bilateral inferior rectus muscle recession (six @entity1 ). CONCLUSION: @entity892 in the reading position frequently can be alleviated with a systematic approach that includes both optical and surgical modalities.
