A Role for the Faden Operation in Paretic Strabismus

Abstract

Abstract: : Purpose: To identify a role for the Faden operation in enlarging the field of binocular single vision in the setting of paretic strabismus. Methods: Retrospective case series including five patients with longstanding unilateral or bilateral sixth nerve palsies who underwent medial rectus recession and Faden operation for symptomatic diplopia. Results: Five patients with sixth nerve palsies of varying etiologies were included in this study. Three patients had evidence of neoplasia while two had presumed microvascular causes. After obtaining stable measurements those with unilateral sixth nerve palsies underwent a contralateral medial rectus recession and Faden operation. The patient with bilateral sixth nerve palsies was treated with the above surgical correction several months following the injection of both medial recti with Oculinum. The patients show evidence of increased size of binocular single vision fields postoperatively as well as subjective improvement in diplopia. Conclusions: Obtaining adequate binocular single vision can be difficult in the setting of paretic strabismus. Although the Faden operation has historically been used in the setting of DVD, convergence excess esotropia, double elevator palsy, and nystagmus blockage syndrome, its role in paretic strabismus may be underutilized. An increase in binocular singularity is possible with this technique.

Keywords: binocular vision/stereopsis • strabismus: treatment • eye movements