Workshop 7

by in  Workshop

Strabismus Surgery in Complex Neurologic Disease: Surgical Strategy and Outcomes

Gena Heidary, MD, PhD; Stacy Pineles, MD; Jason Peragallo, MD; Jane Edmond, MD; Mitch Strominger, MD; Linda Dagi, MD
Boston Children’s Hospital
Boston, MA


Purpose/Relevance: Strabismus occurs frequently in children and adults in the setting of neurologic disease such as brain tumor or cortical visual impairment.1-3 The purpose of this workshop is to discuss and evaluate the approach to strabismus surgery in patients who harbor complex neurologic disease.  We seek to highlight important considerations with respect to surgical strategy and discuss surgical outcomes in the context of these neurologic conditions.

Target Audience: Pediatric ophthalmologists and neuro-ophthalmologists

Current Practice: Ophthalmologists may not be familiar with the ophthalmic symptoms/signs suggestive of CNS disease, the significant morbidity of oculomotor dysfunction secondary to CNS disease, and the current literature regarding oculomotor outcomes in this context.

Best Practice: Ophthalmologists should recognize the clinical signs and the types of strabismus that are associated with these CNS conditions and be familiar with the pearls and pitfalls of strabismus management in the context of complex neurologic disease.

Expected Outcomes: The attendee will be empowered to recognize clinical signs suggestive of specific CNS diseases that affect ocular motor function and the pattern(s) of strabismus associated with these disease processes. The clinician will become aware of evidence based ocular motility outcomes for these patients thereby enhancing clinical management.

Format: Panel with case presentations, didactic lectures and question/answer period

Summary: The workshop will focus on topics such as surgical management of cranial neuropathies, hemifield slide- associated strabismus, acute comitant esotropia, and iatrogenic strabismus after treatment of brainstem and posterior fossa tumors. Each topic will be led by one of the authors with a case presentation followed by a didactic talk.  The talk will include a brief review of pertinent clinical findings associated with the condition, a discussion of surgical strategy/decision making, and any relevant literature regarding ocular motor outcomes in the context of each topic.

References: 1. Shalev and Repka.  Ophthalmol. 2000; 107:1880-1883.
2.         Peragallo JH, Velez FG, Demer JL, Pineles SL. J Neuroophthalmol. 2013 Mar;33(1):40-4.

  1. Binder NR, Kruglyakova J, Borchert MS. JAAPOS. 2016; 2016 Apr;20(2):121-5.
  2. Peeler CE, Edmond JC, Hollander J, Alexander JK, Zurakowski D, Ullrich NJ, Manley PE, Heidary G. Visual and ocular motor outcomes in children with posterior fossa tumors. J AAPOS. 2017 Oct; 21(5):375-379.
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