The Eyes are the Windows of the Soul.

Medical Specialties such as Ophthalmology extend historically back to the beginning of recorded history. Before there was photography to record physical abnormalities of living creatures, there was art and artists who did the recording in their works. Fortunately, many such recordings have been preserved, usually in museums.

History of medicine: ocular disorders of the mona lisa (strabismus) and other famous paintings in the louvre, paris.

The History of Medicine and Medical Specialties such as Ophthalmology, and the Subspecialty of Strabology extend back to the beginning of recorded history. Before there was photography to record physical abnormalities of living creatures, there was art and artists who did the recording in their works. Fortunately, many such recordings have been preserved, usually in museums, such as the Louvre, in Paris, France.

Three Similar But Unique Cases Of Isolated Superior Rectus ExtraOcular Muscle (EOM) Palsy Strabismus, Presenting With Large Abnormal Head Tilts (Postures, AHP).

Purpose: To report 3 rare cases, seen over 15 years, of isolated superior rectus (SR) palsy in binocularly fusing pediatric patients presenting with appropriate head tilts.

Patients And Method: All 3 children, ages 11, 16, and 34 mos, presented with large right head tilts and secondary overactions of the right inferior oblique indicating LSR palsy. All 3 children received recessions of the antagonist left inferior rectus (LIR) 8 to 9 mm with 3 mm of nasal transposition to prevent exotropia in down gaze.

Further implications of probable changes in medial rectus muscle innervation after surgery for infantile esotropia.

Introduction: The conclusion that setting the eyes of an infantile esotrope (ET) straight with a successful bilateral medial rectus muscle reseccion (MROU) reduces the preoperative hyperinnervation of these muscles almost to normal may have special implications for the best principles of management of infantile ET not detailed in a recent paper by Mimms, III, Miller and Schoolfield.

Methods: The same 113 infantile esotropes who provided data for the exoshift under anesthesia study had previously provided data for a dose-response curve. A simple geometric calculation was done to determine the amount of medial rectus (MR) recession necessary to compensate for contracture, and this was substracted from the dose-response value to reveal the additional mm of recession required to the MR sufficiently down the length-tension curve to compensate for the preoperative MR hyperinnervation.

The exoshift under anesthesia correlates with probable changes in medial rectus innervation after surgery for infantile esotropia.

Purpose: To study the outward deviation of the eyes (exoshift) under anesthesia, in a variety of clinical settings in order to improve our understanding of how medial rectus recessions change alignment and innervation.

Methods: Pre-operative and intraoperative eye deviations were measured before surgery and under Stage 3 of general anesthesia using a modified Krimsky test in 5 groups: 1) Unoperated infantile esotropia (N=60); 2) Undercorrected infantile esotropia (N=27); 3) Corrected infantile esotropia with subsequent vertical deviations (N=17); 4) Superior oblique palsies without horizontal deviations (N=21); and 5) Late consecutive exotropia (N=16).

Results: Group 2 averaged half the esotropic deviation of Group 1 (19.

The influence of pulleys on the quantitative characteristics of medial rectus muscle recessions: the torque vector model.

Purpose: To develop a new pulley-based torque vector mathematical model for medial rectus muscle recessions and compare it based on known clinical characteristics, to the currently accepted nonpulley length-tension model.

Methods: The following quantitative characteristics of the results of bilateral medial rectus muscle recessions were chosen for study to see whether the new torque vector model or the classic length-tension model would better predict these characteristics: (1) larger bilateral medial rectus muscle recessions produce more effect per millimeter, with the dose-response curve approximating an exponential shape; (2) the exact location of the preplaced medial rectus muscle suture prior to muscle disinsertion in recessions has minimal effect on the postoperative ocular alignment; and (3) medial rectus muscle recessions of more than eight mm are likely to produce an early consecutive exotropia.

Results: Based on the documented location of the medial rectus muscle pulley, the change in the torque vector per millimeter of medial rectus muscle recession was calculated and shown to have an exponential shape.

Confirmed: there is no correlation between the insertional distance between the nasal limbus and the insertion of the medial rectus muscle--and the size of the strabismus angle in infantile esotropia.

Introduction: Historical systems of measuring the amount of surgical recession of the medial rectus muscles appropriate to be performed for a given size of angle of infantile esotropia, based upon relative recession measurement from the limbus might have proven to be better than relative recession measurement from the insertion--if a positive correlation were found between the size of the angle of the esodeviation and the distance between the insertion of the medial rectus and the nasal limbus. A search of the scientific literature since 1966 as listed in PubMed (National Library of Medicine, formerly Index Medicus) did not reveal any additional confirmatory study of this type in PubMed. We therefore undertook to perform such a study.

"Double elevator palsy" eye supraducts during stage II general anesthesia supporting hypothesis of (supra)nuclear etiology.

Background: Double Elevator Palsy (DEP) was originally given its name because the assumption was, that because the affected eye could not elevate in adduction or in abduction, there must be a paresis of both the Superior Rectus (SR) and the Inferior Oblique (IO). Later, it was thought that DEP was due to a paresis of the ipsilateral SR, since the SR is the main elevator of the eye in both adduction and abduction. Gradually, a group of observations accumulated that indicated that the SR was not paretic at all in DEP, leading to the concept that DEP is due to a unilateral deficit in a nucleus that functions to elevate one eye only, a unilateral center for upgaze.

Outcome of a surgical treatment protocol for late consecutive exotropia following bilateral medial rectus recession for esotropia.

Purpose: To describe a specific protocol for the surgical treatment of Late Consecutive Exotropia (LCXT) following bilateral medial rectus (MR) recessions, and to report the results of surgery, performed according to this protocol, in a series of 119 children followed 6 months to 15 years after surgery for consecutive exotropia.

Method: The senior author (JLM) performed a retrospective chart review of 15 years of his experience following a specific protocol for the surgical treatment of LCXT. In individual cases, following this protocol led to recessions of the overacting inferior oblique (IO) with anterior transposition if dissociated vertical deviation (DVD) was also present, weakening of the overacting superior oblique (SO) with simultaneous 10 mm recessions of the superior rectus (SR) with 3 mm of nasal transposition (to ameliorate DVD which might be aggravated by SO tenotomies), graded recessions of one lateral rectus (LR) 7.