Restrictive strabismus: diagnosis and management

Restrictive strabismus is a type of ocular misalignment with limitation of motility caused by intrinsic or extrinsic mechanical forces. The clinical spectrum of either purely or partially restrictive strabismus is very broad. Most cases are of congenital, traumatic, endocrine, post-paralytic or myopathic origin. The surgical treatment strategies are designed to correct abnormal head posture, to eliminate diplopia in primary and functional positions of gaze and to enhance aesthetic and psychosocial aspects of a patient's life.

The objective of this paper is to present a clinical approach to the diagnosis and evaluation of patients with restrictive strabismus and to propose a logical surgical approach to the correction of this type of ocular misalignment.

As representative of the broad spectrum of restrictive strabismus problems, twelve cases are presented and the preoperative and postoperative clinical finding are illustrated with photographs.

The clinical spectrum of either purely or partially restrictive strabismus is very broad. The clinical evaluation of patients with this problem must include a careful and detailed history, which is crucial to establishing the diagnosis and must also explore the patient's concerns. Analysis of fixation, head posture, and ocular alignment require both traditional and special examination techniques. Patient and surgeon expectations must be synchronized preoperatively. A variety of surgical strategies can be applied to improve head posture, eliminate diplopia, and improve cosmesis.