title: Management of vertical deviations secondary to other anatomical abnormalities.
abstract: OBJECTIVE
  To review the surgical management of five vertical strabismus syndromes secondary to anatomical abnormalities. These syndromes are: 1) craniosynostosis; 2) "heavy eye syndrome" of high myopia; 3) Brown syndrome; 4) upshoot-downshoot in Duane retraction syndrome (DRS); and 5) antielevation syndrome after inferior oblique anteriorization.
  
  
  METHODS
  The syndromes are presented from evolving to well-accepted surgical management practices based on review of the current literature.
  
  
  RESULTS
  Surgical management techniques discussed include: 1) excyclotorsion of the muscle cones inducing elevation in adduction craniosynostosis, and surgery to stabilize the globe vertically in adduction in this situation; 2) loop myopexy to prevent prolapse of the elongated, highly myopic eye posteriorly between the superior and lateral recti; 3) superior oblique tenotomy and lengthening procedures to address inability to elevate the adducted eye in Brown syndrome; 4)Y-splitting of the lateral rectus to stabilize the adducted globe vertically in Duane retraction syndrome; and 5) re-recession of the anteriorized inferior oblique to a position posterior to the inferior rectus insertion in anti-elevation syndrome.
  
  
  CONCLUSIONS
  The surgeon can, through careful surgical management techniques, alter the form of anatomy in these conditions and thereby provide more normally functioning binocular systems.
authors: Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee 38103, USA.
authors: Natalie C
authors: NC
authors: Kerr
mesh_terms: D005124:Eye Abnormalities / Q000150:complications*; D005133:Eye Movements / Q000502:physiology; D006801:Humans; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D013285:Strabismus / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D015348:Vision, Binocular / Q000502:physiology