Haller Terra
From the W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
Am Orthopt J. 2015;65:40-3. doi: 10.3368/aoj.65.1.40.
An esodeviation that is greater at distance than near in an adult patient requires a full sensorimotor exam to rule out any cofounding neurological conditions. Many etiologies are described in the literature to cause an esodeviation that is greater at distance than near in adult patients and some exist in conjunction with a neurological condition. However, many adult patients present to the adult strabismus clinic with no other findings on exam and have a purely benign divergence insufficiency esotropia. A review of the literature on divergence insufficiency reveals a few attempts of classifying these entities, but none have been completely accepted.Recently benign non-neurological divergence insufficiency esotropia has been described as a resulting condition due to a mechanical etiology. Currently, the literature only describes a couple of different etiologies.Regardless of the etiology, these patients are quite symptomatic and present to the adult strabismus clinic with various complaints and require a thorough examination. The primary focus of the exam is to first rule out the need for further neurological work-up, but secondly, to also determine the best treatment option for the patient. To determine the best treatment plan, a thorough evaluation, including a sensorimotor exam with proper testing, can help. Many of these patients do very well with base-out prism management; however, some have decompensated to a larger angle and prefer surgical intervention. However, the focus of this paper will be on nonsurgical prism management of patients with divergence insufficiency that is not associated with any neurological disorder.
在成年患者中，远距离斜视度大于近距离斜视度的外斜视需要进行全面的感觉运动检查，以排除任何可能混淆的神经系统疾病。文献中描述了许多病因可导致成年患者远距离斜视度大于近距离斜视度，其中一些与神经系统疾病并存。然而，许多成年患者到成人斜视门诊就诊时，检查没有其他异常发现，仅有单纯的良性散开功能不全性内斜视。对散开功能不全相关文献的回顾显示，有一些对这些情况进行分类的尝试，但都未被完全接受。最近，良性非神经性散开功能不全性内斜视被描述为一种由机械性病因导致的病症。目前，文献中仅描述了几种不同的病因。无论病因如何，这些患者症状都较为明显，带着各种主诉到成人斜视门诊就诊，需要进行全面检查。检查的主要重点首先是排除进一步进行神经学检查的必要性，但其次，也要为患者确定最佳治疗方案。为了确定最佳治疗方案，进行全面评估，包括进行适当测试的感觉运动检查，可能会有所帮助。许多这类患者通过底向外棱镜治疗效果很好；然而，一些患者斜视度增大且失代偿，更倾向于手术干预。然而，本文的重点将是对与任何神经系统疾病无关的散开功能不全患者进行非手术棱镜治疗。
