When Strabismus Takes An Interesting Twist


JB is a 12 year-old girl who began vision therapy with us recently due to difficulties she was having with double vision and headaches.  She had non-comitant strabismus with habitual, mild head tilt and face turn to the left, and a “V” pattern exotropia.  She was able to maintain single vision in her habitual head/neck posture, and the only remedy offered to her to date was strabismus surgery.  Her mother was looking for a non-surgical approach, and I told her that while I wasn’t opposed to surgery, we would see how far vision therapy could take her in spreading her fields of comitance and single vision.

We made good progress using prisms and a variety of optometric vision therapy procedures including vertical and horizontal vergence ranges with random dot stereogram targets.  Headaches were noticeably decreasing within two months and double vision lessening, but at our second progress evaluation JB’s mom mentioned that her pediatrician wanted her to try a second round of physical therapy for her scoliosis.  JB felt that the six months’ she spent in PT last year didn’t have any impact on her function or headaches, and her mother agreed. She felt it was probably more the negative office environment than the PT itself, and was interested in trying a different approach.  Mom then asked for my recommendation.

three_custom_gears_turning_13825I recalled that one of the participants at one of my vision seminars was a craniosacral therapist who claimed to have success with cases that seemed very much like what JB was experiencing.  JB’s mother was very interested in pursuing this.  In a quick perusal of the literature, there seems to be only one article that directly linked scoliosis with strabismus – published in the journal Spine in 2001, though that was in a visually impaired population.  I found in various sources the natural chicken vs. egg question as to whether scoliosis is the primary problem resulting in postural skews that induce paretic strabismus, or vice-versa.  This is the similar chicken vs. egg questions posed in primary vs. secondary torticolis, adaptive head postures, and paretic strabismus.

ChickenEgg

Our VisionHelp colleagues Drs. Carl Hillier and Bob Sanet have long extolled the applications of craniosacral therapy as practiced by the osteopathic physician, Dr. Viola Frymann.  An article in the Journal of Behavioral Optometry in 1999 by Kenneth Fry, P.T., addressed craniosacral therapy and the visual system.  I located several PTs who were schooled in the Upledger technique, and gave their names to JB’s mom.

We will continue to work with JB, expanding cyclofusional ranges and integrating that in head-to-toe fashion, but remain open-minded toward the possibilities of both craniosacral therapy and strabismus surgery aiding in the best outcome and long-term stability.

 

2 thoughts on “When Strabismus Takes An Interesting Twist

  1. A nice and important illustration of the possible intersection between optometry and osteopathy. Co-management with head injury as well musculoskeletal issues affecting the integration of vision with the body are two examples. While Upledger trained professionals can offer help, why not see a DO who generally has a much greater depth and breadth of medicine, anatomy and approaches to treatment? A listing of Osteopaths who practice this modality can be found at http://www.cranialacademy.org/index.html

  2. Excellent point, Barry. The reason I leaned toward a PT certified in CST/Upledger is that mother was more comfortable with this approach since it aligned with her pediatrician’s encouragement to re-visit PT. But a DO is an excellent choice, as I noted regarding the collaboration between Drs. Sanet and Hillier with Viola Frymann, D.O.

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