By Alfred Price

Each one book during this sequence contains common heritage, requisites, technical information, images color profiles of the featured plane.

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00D lens; may have high AC/A ratio. True Divergence Excess 54 55 XT > XT′ even after patch test; may have high AC/A ratio. • • • Correct any refractive error and give additional minus (to stimulate convergence), especially with high AC/A ratio. Consider base-in prism lenses to help with convergence. Muscle surgery if the patient manifests exotropia over 50% of the time and is older than 4 years old: bilateral lateral rectus recession; consecutive esotropia (postoperative diplopia) can be managed with prisms or miotics unless it lasts more than 8 weeks, then reoperate.

Rare before 10 years of age; slight female predilection. Symptoms often begin during teen years with asthenopia, difficulty reading, blurred near vision, diplopia, and fatigue. Common in neurodegenerative disorders, such as Parkinson's disease, and with traumatic brain injury; may rarely be associated with accommodative insufficiency and ciliary body dysfunction. Treatment consists of prismatic correction (often ineffective) or monocular occlusion. Bifocals can be more difficult for patients with convergence insufficiency to use and should probably be avoided.

Figure 2-9 • Same patient as shown in Figure 2-8, demonstrating inability to elevate right eye. • Muscle surgery for chin-up head position, large hypotropia in primary position, or poor fusion: inferior rectus recession for inferior rectus muscle restriction; Knapp procedure (elevation and transposition of 59 60 • medial and lateral recti to the side of superior rectus) for superior rectus muscle weakness. May require surgery to correct residual ptosis. Miscellaneous Strabismus Duane's Retraction Syndrome Congenital agenesis or hypoplasia of the abducens nerve (CN VI) with variable dysinnervation of the lateral rectus muscle; 20% bilateral, female predilection (3:2), affects left eye more often than right eye (3:1).

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