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Volume 50, 2000, p. 7

Symposium: Abduction Deficits in Strabismus

James D. Reynolds, M.D

Abduction deficits occur in a wide variety of very heterogenous strabismus disorders. These conditions can be as straight forward to diagnose and manage as the pseudo abduction deficit of a cross fixating congenital esotropia or as complex as myasthenia gravis.

The group includes the full spectrum of differential diagnostic categories within strabismus involving deviations that are comitant (pseudo abduction deficit) and non comitant (paralytic, restrictive and cocontraction). They include both congenital and acquired problems, isolated or associated with other ophthalmologic or systemic signs. In a broader scheme they are represented within the complete range of general diagnostic categories comprised of inflammatory, infectious, neoplastic, metabolic, traumatic, degenerative and iatrogenic conditions.

A suitable index of suspicion of the diagnostic possibilities involved in producing abduction deficits is critical to the proper work up, diagnosis and treatment of the individual patient. The therapeutic options within these diagnoses are also widely disparate involving observation and expectant management, antibiotics, steroids, disease specific medications, orbital surgery and, of course, a varied approach to extraocular muscle surgery.

This symposium will present an approach to the patient who presents with an abduction deficit, explain the features and pitfalls of prominent diagnoses within the group, and discuss management options. The reader should come away with an understanding of the individual conditions, but more importantly, a broader context or framework into which occasionally confusing signs and symptoms can be placed and appropriately diagnosed and managed.