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Case of the week 175  ( May 2014 )
 "A" pattern Exotropia


8 year old girl
Vision: fixes and follows well with both eyes
Refraction: OD -1.00 -1.00 x 90 degrees 
               OS -1.00 -0.50 x 90 degrees

Parents noted an exodeviation since early childhood. The girl’s general health is good and the eye examination is normal except for the exotropia.

   
 
 


"A" pattern Exotropia

One of the most valuable contributions in the second part of the twentieth century to the field of strabismus was the emphasis on what has come to be known as the A and V patterns of strabismus. Recognition and proper evaluation of horizontal strabismus that becomes incomitant in vertical gaze are paramount in effectively managing the ocular deviation. Exotropia with A pattern increases in downward gaze and decreases in upward gaze


The obvious mongoloid fissures suggest the possibility of pulley heterotopy contributing to the ‘A’ pattern where the patient is nearly orthotropic up and wide exotropic down. A logical surgical plan would be the following:
Recess both lateral rectus muscles 8.0 mm with 1/2 muscle width downshift


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