Diagnosis and management of divergence weakness in adults
Section snippets
Patients and methods
We prospectively evaluated all patients diagnosed with divergence weakness at a single practice site during a 7-year period (1991–1997). Divergence weakness was defined as a comitant esotropia with homonymous diplopia at distance and fusion at near. Horizontal ductions and versions were normal, and the esotropia remained the same or diminished in lateral gaze. A maximum of 2 prism diopters (PD) of incomitance was allowed between left and right gaze for those patients with greater than 20 PD
Results
The findings in 17 patients with divergence weakness are summarized in Table 1. The average age of the patients was 72 years (range, 28–96 years), and all but the youngest patient were older than 62 years of age. The patients were followed for an average of 4 years after initial evaluation by the authors. The initial distance deviation ranged from 6 to 27 PD of esotropia (mean = 14 PD esotropia). The distance deviation was constant in all but the youngest patient, whose esotropia was
Discussion
The ocular motor findings in our patients were similar to those reported in previous series and remained stable in 13 of 17 patients.4, 10 Three patients had an associated small-angle comitant vertical strabismus, a finding that has previously been reported.11 Fusional divergence amplitudes were commonly reduced (median, 2 PD) compared with “average” fusional divergence amplitudes obtained by similar means (4 PD–6 PD).10, 12
Divergence weakness has been reported in association with many
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Concomitant esodeviations
Cited by (34)
A prospective study of treatments for adult-onset divergence insufficiency–type esotropia
2021, Journal of AAPOSCitation Excerpt :We did not compare success rates between surgery and prism cohorts, because none of the prism-treated participants had received prior treatment for DI-type esotropia, and 82% of surgical participants had previously received prism. Other case series have also reported high success rates of prism,6-9 and surgery,5,11,13-15 for the treatment of DI-type esotropia in adults. Previous studies have not incorporated standardized outcome measures along with a prospective study design.
Long-term evolution of age-related distance esotropia
2018, Journal of AAPOSCitation Excerpt :They also observed that the mean heterophoria value for distance fixation was exophoric except in their 71- to 80-year-old group, which was esophoric. Although the etiology of ARDET is still not clear, it is likely secondary to involutional changes within the orbit14; most notably, sagging and inferior displacement of the lateral rectus muscles and its pulleys, caused by tendon laxity due to degeneration.5-15 Recent studies of Chaudhuri and Demer16-18 have shown that sagging and bilaterally symmetrical downward displacement of the lateral rectus pulleys may symmetrically reduce supraduction and may cause esodeviation and horizontal diplopia at distance.
Treatment of age-related distance esotropia with unilateral lateral rectus resection
2014, Journal of AAPOSCitation Excerpt :Age-related distance esotropia may be managed using a variety of different techniques. Conservative measures include monocular occlusion and base-out prisms, but these are not always practical for larger deviations and may be cosmetically objectionable.1,5,7 A range of surgical options have also been used, including unilateral and bilateral medial rectus recession and lateral rectus resection, or a combination of the two.8-10
Age-Related Distance Esotropia
2006, Journal of AAPOSLateral rectus resections in divergence palsy: Results of long-term follow-up
2005, Journal of AAPOS
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The authors received no financial support for the study and have no financial interest related to the article.