Our good colleagues and friends, Drs. Carl Hillier and Bob Sanet, have long advocated for closer collaboration between Optometry and Osteopathy. In particular they were influenced by a local osteopathic physician who was world-renowned, Dr. Viola Frymann. Her own website notes that to her detractors she was a medical heretic, who used “unproven methods” to produce seemingly medical miracles where others had failed. When the medical lobby in the state of California mounted a campaign to shut down the licensure of new osteopathic physicians. Dr. Frymann took her battle to save the osteopathic profession to the Supreme Court and won. Much more than being an effective activist, Dr. Frymann was a superb clinician. I was reminded of this last week while perusing a handbook on cranial osteopathy for children.
Here are some key comments from the handbook regarding strabismus:
- The concept that function alters structure is one of the basic osteopathic principles. At the same time, structure affects function.
- Medially, below and behind the end of the supraorbital margin of the front bone, is the trochlear fovea for the attachment of the cartilaginous pulley of the superior oblique muscle. This feature is of particular interest in understanding ocular dysfunction, since the frontal bone is frequently under stress from fetal positioning, difficult labor or trauma sustained by young children. Although most of this is not directly palpable, the supraorbital margin of the frontal bone is completely accessible, and its position should always be evaluated in strabismus.
- The location of the zygomatic bone makes it vulnerable to being struck during the course of childhood activities. This may in turn affect the diameter of the orbit and the functional balance of the EOM, particularly the lateral rectus.
- CN III, IV, and VI are subject to intracranial entrapment from osseous compression, membranous tension, ligamentous pull or the pressure of edema from venous congestion.
- The cranial dura mater lines the internal surface of every cranial bone, with a firm adhesion at the sutures, and extends outside the cranial cavity through for mania and fissures, forming tubular sheaths for the cranial nerves as they leave the neurocranium. This dural layer blends with the ocular sclera and adheres intimately to the common annular tendon of the four recti muscles. There is an anatomic continuity between the dura and the lining and structures of the eyeball and the EOM.
- Osteopathic examination and treatment are indicated to balance the bony components of the orbit and their relationship with other parts of the skull. Providing balance to the musculoskeletal and nervous systems improves the self-healing capacities of the body and contributes to the success of other treatments. Early treatment may positive impact the vestibulo-ocular reflexes and thereby the child’s posture.