Eye patterns

The horizontal deviation varies in the primary position of the eyes, downward or upward gaze, regardless of whether the strabismus is concomitant or paralytic.

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Causes eye patterns

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Causes of V-pattern eyes

• Brown syndrome.
• Hyperfunction of the inferior oblique muscle associated with paresis of the fourth pair of cranial nerves.
• Hypofunction of the superior oblique and correspondingly hyperfunction of the inferior oblique in infantile esotropia and other childhood esotropias. Correct position of the eyes when looking up, often with pronounced esodeviation when looking down.
• Hypofunction of the superior rectus muscle.
• Hyperfunction of the external rectus muscle.
• Developmental anomalies of the facial skull with shallow orbits and drooping eye slits. Often pronounced exotropia when looking up and almost correct position of the eyes when looking down.

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Causes of A-pattern eyes

• Primary hyperfunction of the superior oblique muscle, often accompanied by exodeviation in the primary position.
• Hypofunction of the inferior oblique and/or paresis accompanied by hyperfunction of the superior oblique muscle.
• Hypofunction of the external rectus muscle.
• Hypofunction of the inferior rectus muscle.

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Diagnostics eye patterns

The V-pattern is reliably diagnosed if the difference in the angle when looking up and down is >15 D.

The A-pattern is reliably diagnosed if the difference in the angle between upward and downward gaze is >10D.

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Treatment eye patterns

Treatment of V-pattern eyes

Without oblique dysfunction:

1. V-pattern esotropia is corrected by bilateral recession of the internal rectus muscles and inferior displacement of the tendons.
2. V-pattern exotropia is corrected by bilateral recession of the lateral rectus muscles and upward displacement of the tendons.

Treatment of A-pattern eyes

Without oblique dysfunction:

1. A-pattern esotropia is eliminated by bilateral recession of the internal rectus muscles with their upward displacement.
2. A-pattern exotropia is eliminated by bilateral recession of the external oblique muscles with their downward displacement.