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PHOTO ESSAY
Year : 2020  |  Volume : 68  |  Issue : 5  |  Page : 901-902

Association of pseudo-exotropia with true esotropia in cicatricial retinopathy of prematurity


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India

Date of Submission03-Jun-2019
Date of Acceptance18-Nov-2019
Date of Web Publication20-Apr-2020

Correspondence Address:
Dr. Dewang Angmo
Room No. 374, 3rd Floor, Dr. R.P. Centre for Ophthalmic Sciences, AIIMS, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1055_19

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Keywords: Macular drag, pseudo-exotropia, pseudo-strabismus, retinopathy of prematurity


How to cite this article:
Sethi A, Brar AS, Dhiman R, Angmo D, Saxena R. Association of pseudo-exotropia with true esotropia in cicatricial retinopathy of prematurity. Indian J Ophthalmol 2020;68:901-2

How to cite this URL:
Sethi A, Brar AS, Dhiman R, Angmo D, Saxena R. Association of pseudo-exotropia with true esotropia in cicatricial retinopathy of prematurity. Indian J Ophthalmol [serial online] 2020 [cited 2020 May 26];68:901-2. Available from: http://www.ijo.in/text.asp?2020/68/5/901/282964



Case 1

An 8-year-old boy presented with an outward deviation of either eye for the past 3 years, with a history of prematurity and laser retinopathy of prematurity (ROP).

The best-corrected visual acuity (BCVA) was 20/40 in either eye with -7.50 D of myopic correction. A nasally decentred light reflex with an apparent exotropia was evident on Hirschberg's test. However, the cover test revealed an in-to-out refixation movement suggestive of esodeviation which was measured to be 35 prism-diopters (PD) base out for distance and near. There was bilateral inferior oblique (IO) overaction with a significant V-pattern [Figure 1]a. The fundus examination showed regressed ROP with temporal macular drag, bilaterally [Figure 2]a.
Figure 1: Nine gaze clinical photographs of case 1 (a) preoperative pseudo-exotropia with inferior oblique overaction with V-pattern;

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Figure 2: Fundus photograph showing temporal macular drag (a) in case 1 and (b) in case 2

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A bilateral IO weakening procedure was planned to correct the V-pattern. The esotropia was left uncorrected to avoid worsening of the apparent exotropia. Post-operatively, the pattern and the elevation in adduction were reduced [Figure 1]b.

Case 2

A 6-year-old male presented with an outward deviation of either eye for the past 4 years with a history of laser ROP. With a bilateral refractive correction of -6.50D, he had a BCVA of 20/80 (Cardiff Acuity Cards). The Hirschberg's test showed a 15° nasally decentred light reflex, suggestive of exotropia but, a cover test revealed the in-to-out movement of the eye. There were no oblique overactions or patterns [Figure 3]. The fundus examination showed temporal macular drag with regressed ROP [Figure 2]b. Hence, a diagnosis of pseudo-exotropia with esotropia was made. The child was managed conservatively and the esotropia was left uncorrected.
Figure 3: Nine gaze clinical photographs of case 2 showing pseudo-exotropia

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  Discussion Top


Cicatricial ROP is known to cause temporal displacement of the macula and a pseudo-exotropia due to the increased disparity between the visual and the pupillary axes.[1],[2],[3] It may often be confused with true strabismus and is prone to misdiagnosis. Surgery, if planned, should aim at preserving good cosmesis and avoiding worsening of pseudo-strabismus.[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Scheiman M, Gallaway M, McKewicz L. Heterotopia of the macula (ectopic macula): An unusual presentation. Am J Optom Physiol Opt 1986;63:567-70.  Back to cited text no. 1
    
2.
Ng EY, Connolly BP, McNamara JA, Regillo CD, Vander JF, Tasman W. A comparison of laser photocoagulation with cryotherapy for threshold retinopathy of prematurity at 10 years: Part 1. Visual function and structural outcome. Ophthalmology 2002;109:928-34; discussion 935.  Back to cited text no. 2
    
3.
Alfieri MC, Magli A, Chiosi E, De Crecchio G. The Annette von Droste-Hulshoff syndrome. Pseudostrabismus due to macular ectopia in retinopathy of prematurity. Ophthalmic Paediatr Genet 1988;9:13-6.  Back to cited text no. 3
    
4.
Bianchi PE, Guagliano R, Salati R, Traselli GP, Trimarchi F. Esotropia and pseudoexotropia in acute ROP sequelae: Clinical features and suggestions for treatment. Eur J Ophthalmol 1996;6:446-50.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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