Dissociated vertical deviation is a common innervational disorder, found in 50%90% of patients with congenital esotropia and in other forms of strabismus cause the cause is unknown, but dvd appears to be associated with early disruption of binocular development. Introduction dissociated vertical deviation dvd is the elevation of one eye in response to a relatively decreased illumination in that eye andor in response to fixation with the other eye. Material and method the medical records of the patients that were diagnosed with infantile esotropia and followedup in the strabismus department of our clinic department of. Dissociated horizontal deviation after surgery for. Dissociated vertical deviation dvd is an innervational disorder found in more than 50% of patients with infantile esotropia and in other forms of strabismus. Abnormal head posture, eye position and binocular function. In 6 young adults with dvd, the simultaneous horizontal, vertical, and torsional eye movements for both eyes were recorded by using dualcoil scleral search coils. Interventions for dissociated vertical deviation ncbi. A, straight eyes during binocular viewing conditions. Dissociated horizontal deviation is defined as a change in horizontal ocular alignment, unrelated to accommodation, that is brought about solely by a change in the balance of visual input from the 2 eyes. Pdf dissociated vertical deviation and head tilts pauline. Alternating slow upward drifts are common and usually accompany congenital esotropia and latent nystagmus.
Dissociated vertical deviation dvd is an eye condition which occurs in association with a squint, typically infantile esotropia. Dsc includes dissociated vertical deviation dvd, dissociated horizontal deviation dhd, and dissociated torsional deviation dtd. It was first described by stevens as double vertical strabismus, other common names given to this anomaly are, alternating hyperphoria crone, anaphoria anatropia stevens. We thought that the abnormal head posture in dvd patients depended on the unstable vertical eye movement or binocular function.
Adult strabismus a case associated with dissociated. All patients had fine, intermittent asymmetric, pendulur. The results showed a very high incidence of abnormal visual evoked responses in patients with dissociated vertical deviation, while recordings from the. Dissociated vertical deviation go to academy store learn more and purchase. Anomalies such as dissociated vertical deviations and a and vpattern were equally well diagnosed by occlusion of either eye. Dissociated vertical deviation is a not uncommon strabismic syndrome characterized by upward deviation of an eye when occluded, with downward movement of. Vertical dome division and nasal projection pdf free. B, large left hyperdeviation immediately after the eye is covered and then uncovered. Eye movement recordings of six young adults with dvd were made with dualcoil scleral search coils under various conditions of fixation, illumination, and head. Dissociated vertical deviation american academy of. Purpose various causes of sursumduction in dissociated vertical deviation dvd have been reported. Dissociated vertical deviation and its relationship with. Determine whether deviation is greater in head tilt to the r or l.
The purpose of this study has been to elucidate the etiology and mechanism of dvd. The exact cause is unknown, although it is logical to assume it is from faulty innervation of eye muscles. Let us say that the deviation in our example is greater in right head tilt. Dissociated vertical deviation definition of dissociated. Pdf dissociated vertical deviation associated with duane. Dissociated vertical dissociationdvd with inferior oblique over action iooa duration. Patients with dissociated vertical deviation both unilateral and alternating, patients with congenital esotropia without dissociated vertical devia tion, and normal. Dissociated vertical deviation dvd has eluded explanation for more than a century. The association of anomalous head posture and dissociated vertical deviation does not seem to be appreciated, as evidenced bythe paucity of literature linking. Note that the right eye does not adopt a hypotropic position when the left eye drifts back to the midline.
Dissociative vertical deviation is a form of ocular misalignment in which a downward rotation by the higher eye to take up fixation in the primary position under conditions which prevent fusion is. Spontaneous upward turning of dissociated eye dvd syndrome excycloduction abduction latent nystagmus the upward excursion dissociated vertical deviation the excyclotorsion dissociated tortional deviation the lateral movement. To evaluate the results of unilateral inferior oblique anterior transposition ioat for markedly asymmetric dissociated vertical deviation dvd combined with inferior oblique overaction iooa. Figure 2 shows eye movement recordings of patient 4 when the nonfixing left eye is suddenly occluded. Dissociated vertical deviation dvd depends on the balance of visual inputs coming through the right and left eyes. Odisha journal of ophthalmology 2015 dissociated vertical. Dissociated exodeviation and vertical strabismus dissociated exo deviations are more or less similar. Asymmetrical vertical phorias indicating dissociated vertical. Bilateral superior rectus recession of 916 ml is effective.
Infantile strabismus and dissociated strabismus complex. Other dissociated deviation of eye movements short description. Dissociated vertical deviation british journal of ophthalmology. Dissociated vertical deviation linkedin slideshare. Dissociated vertical deviation dvd was described by george stevens in 1895 dissociated vertical deviation dvd is a poorly understood eye motility disorder of unexplained etiology 8. Nystagmus blockage syndrome results from the use of the convergence mechanism to block or abolish. Aim to investigate the development of dissociated vertical deviation dvd in infantile esotropia and its relationship with the infants age and the surgical intervention technique. Patients with dissociated vertical deviation both unilateral and alternating, patients with congenital esotropia without dissociated vertical deviation, and normal subjects were investigated. Translation find a translation for dissociated vertical deviation in other languages.
Analysis of the simultaneous vertical and torsional movements that occurred during the dvd response. All patients were followed for a postoperative period of at least six months, and 50% were followed for a period of three years or more. In this study, we report a case of dvd with sursumduction induced by psychological upset. Evidence of abnormal visual pathway projection on vertical motion, divergence, and the thermal wind balance in colddome meanders. Pdf dissociated vertical deviation dvd has eluded explanation for more than a century. However, the head in a dissociated vertical deviation dvd patient turns in various directions without any set pattern. Dissociated vertical deviation dvd is characterized by slow vertical drift of the non fixating eye when the other eye is fixating on a target. Superior rectus recessions for dissociated vertical deviation. Dissociated vertical deviation dvd is a wellrecognized type of upward drifting of one or both eyes, which can occur in children or adults. Now customize the name of a clipboard to store your clips. It is characterised by an increased angle of hyperdeviation of the nonfixating eye while patient is in the visual inattention state. Dissociated vertical deviation is an eye condition which occurs in association with a squint infantile esotropia.
Clipping is a handy way to collect important slides you want to go back to later. Dvd may occur alone or in combination with a true hyperdeviation. Case the patient was a 6yearold boy with a chief complaint of occasional sursumduction in the left eye. Pdf on may 1, 2003, huseyin bayramlar and others published. In the classical bielschowsky filter test the balance of visual inputs is altered by darkening the retinal image of the fixing eye with a filter. The dissociated eye not only elevates but excycloducts. Reversed fixation test as a means to differentiate between. Dissociated vertical deviation dvd is a poorly understood vertical deviation which may remain latent compensated or manifest decompensated.
The eye drifts upward spontaneously or after being covered. Asymmetrical dvd is treated with asymmetrical surgery. If it were a bilateral case in which dissociated vertical deviation and inferior oblique overaction were both present, and the dissociated vertical deviation wasnt too large, 15 or. Upon eye occlusion or inattention no corresponding hypotropia of fellow eye.
The deviation may be symmetrical or asymmetrical, and small or very large, measuring more than 20 prism diopters. Dissociated strabismus complex dsc includes dissociated horizontal, vertical, torsional deviation, latent nystagmus and subnormal binocularity. A dvd is not an overaction of a muscle, it is a dissociated movement of one eye only. Asymmetrical vertical phorias indicating dissociated vertical deviation in subjects with normal binocular vision. Dissociated vertical deviation dvd is a challenging condition to manage, largely due to a poor understanding of its underlying etiology and the. Thirtytwo eyes of 31 patients received superior rectus recessions for the treatment of dissociated vertical deviation dvd. Purpose a concomitant esotropia, presenting within the first 6 months of life, associated with a high incidence of dissociated vertical deviation, manifest latent. For a full diagnostic setup of patients with intermittent exotropia, occlusion of each eye separately is recommended in order to elicit maximal horizontal and vertical deviation. Recommend documents spasmus nutans and vermian agenesis.
As clinical manifestation, dsc is a comitant drift of both eyes. Dissociated vertical deviation dvd, which almost always shows a hypertropia of the affected eye, occasionally can manifest as a hypotropia, either unilaterally or bilaterally. For the treatment of dissociated vertical deviation dvd, recession of the superior rectus muscle, possibly on a hangback suture ie, without reattachment to sclera of 610 mm, is effective. Interventions for dissociated vertical deviation holmes. Unilateral inferior oblique anterior transposition for. The etiology and mechanism of dissociated vertical deviation dvd are explored. The effect of surgical intervention for dissociated vertical deviation. Odisha journal of ophthalmology 2015 91 squint dissociated vertical deviation dvd is one of the least understood forms of strabismus. Dissociated vertical divergence is an enigmatic disorder characterized by a slow ascent of 1 eye that is followed, after a variable interval, by a slow descent of the higher eye back to the neutral position.
1417 377 324 1110 658 830 1101 1317 258 1271 980 325 1530 130 1083 1254 1539 1521 1256 202 1233 270 1371 161 594 1068 1441 618 476 484 191 674 1010 485 1335 1071