MANAGEMENT OF DISSOCIATED VERTICAL DEVIATIO

Abstract

Dissoci:tted vertica l deviat ion ( DVD) is a syndrom e the co111ponents of which are : dissociated elevation .abduction . extorsion , l atent nystagmas a nd subnonn al binocul arity. The tenn dissociated st rabismus complex (DSC) can be used . TI1e exact ca use of DVD is not well known .So , many theories are assumed to describe

the eti oloh'Y . DVD is usua lly bilateral and asymmetric . However . it may be unilateral. It is characterized by Bielschowsky's phenomenon and it ignores Hering's law·. It may occur al one or associated with ot her fonns of strabismus especially congen ital esotropia. DVD may ca use head tilt and may be associated with lOOA. Treatment of DVD is usually conservative by accurate refracti ve prescription and treatment of amblyopia . Injection of Botulinum A toxin in the SR muscle may be used . Surgery is indicated on ly if there is disfiguring or visual symptoms . A vriety of surgical procedures have been advocated for DVD but none of them is optimal. SR recession combined with Faden procedure is recommended. Good results can be obtained wit h large SR recession using hang-back procedure.Bilateral 10 anteriorization with monocular graded 10 resection should be considered as the treatment of choice in patients with asymmetric DVD and IOOA.