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Restrictive strabismus
Strabismus
Key Points
- •Restrictive strabismus is characterised by a positive forced duction test - passive rotation is restricted; this is the key test distinguishing it from paralytic strabismus
- •TED (inferior rectus most commonly affected) is the most common cause in adults; orbital floor fracture is second; paediatric trapdoor fracture (white-eyed blowout) is a surgical emergency requiring repair within 24–48 hours
- •In TED, always follow the sequential rehabilitation order: orbital decompression → strabismus surgery (recess only, never resect) → lid surgery; the sequence cannot be reversed
- •Duane retraction syndrome (Type I: limited abduction with globe retraction on adduction) - never resect the LR; MR recession is the procedure of choice for primary position esotropia
- •Teprotumumab (anti-IGF-1R) achieves ~70% diplopia response in active moderate-severe TED (OPTIC trial) and is now a key medical treatment before surgical intervention
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17 more sections are included with the Clinical plan.
- Definition
- Epidemiology
- Aetiology and causes
- Pathogenesis
- Classification
- Risk factors and associations