Session: Poster session A

Case of congenital nystagmus and diplopia in young adult operated for esotropia

Introduction: Patient aged 30 years with consecutive exotropia, congenital nystagmus, amblyopia complained on permanent diplopia despite wearing full spectacle correction with prisms. Since birth he presented alternating esotropia, high hypermetropia (+6.5 Dptr), congenital manifest nystagmus. At age of 4 years esotropia corrected by recession of inferior oblique muscle and Faden-sutures on medial recti in both eyes. Few years later developed consecutive exotropia.

Methods:. Exotropia alternating -40 dptr, dominant left eye, lack of convergence in right eye. BCVA 0.3 in each eye. Full correction (+6.0) with added 7 prisms base-OUT both eyes for correction of unpleasant diplopia. To mention, prisms base-in were worsening diplopia in exotropia. Patient presented hypoplasia of maculas on OCT.

Treatment provided: - removal of Faden-sutures on medial recti in each eye. 

Results: A week after surgery and for 18 months so far - ortoforia, improvement of convergence with no diplopia and blockage of nystagmus at near. Binocular VA 0.4. No prisms needed. Full spectacle correction well tolerated.

Conclusions: recovery of convergence allows  to avoid dyplopia and decrease nystagmus due to it’s blockage in adults with consecutive exotropia after Faden-sutures on medial recti performent in childhood.