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Restrictive myopathy
Last reviewed: 23.04.2024
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From 30 to 50% of patients with endocrine ophthalmopathy suffer from ophthalmoplegia, which can be permanent. Restriction of the mobility of the eye initially associated with inflammatory edema and later - fibrosis. Intraocular pressure may increase when viewed upward due to compression of the fibrous-altered lower rectus muscle. Sometimes the rise in intraocular pressure is persistent because of the combined effect of fibro-modified extraocular muscles and increased vitro-orbital pressure.
There are 4 types of motor disorders (in order of decreasing frequency of occurrence).
- Limitation of mobility upwards due to contracture of fibrous lower rectus muscle, which can be taken as a paresis of the upper rectus muscle.
- Abnormal abduction, which can simulate paralysis of the sixth pair of cranial nerves.
- Limitation of mobility down due to fibrosis of the superior rectus muscle.
- Violation of the reduction due to fibrosis of the external rectus muscle.
[How to examine?
Treatment of restrictive myopathy
- Surgical
- indications: diplopia in the usual direction of gaze or when reading, with stabilization of the condition and stable angle of strabismus minimally for 6 months. Until then, the deviation can be facilitated by the use of prisms;
- goal: to achieve binocular vision in the usual direction of vision and reading. Restrictive myopathy, leading to strabismus, often makes binocular vision impossible in any position. However, over time, the binocular vision zone can expand as a result of increased ver- gences;
- the technique of recession of the lower straight line and / or the internal rectus muscle is better performed using adjustable seams (which is the most often done). The sutures are adjusted on the first postoperative day until the optimal position is obtained, and the patient is encouraged to develop binocular vision, considering with two eyes a distant object, for example a television screen.
- Introduction of toxin CI. Botulinum in the affected muscle in some cases effectively.