Large Animal Neurology. Joe Mayhew

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11 Strabismus

Strabismus refers to abnormal deviation of the central axis of the eyeball. Loss of function of the extraocular muscles innervated by the oculomotor nerve should result in a lateral and slightly ventral strabismus. A medial strabismus should result with abducent nerve lesions. Finally, rotation of the globe such that the medial aspect of the pupil moves dorsomedial should result with trochlear nerve involvement. In each case, the eyeball cannot be moved out of the deviated position by movement and manipulations of the head and thus can be described as fixed strabismus (Figure 11.1). These are rarely seen alone as acquired syndromes in large animals. Both bilateral medial (convergent) strabismus, or esotropia, with exophthalmos (Figure 11.2), and lateral (divergent) strabismus, or exotropia, occur in cattle and are believed to be due to genetic brainstem nuclear defects.^1–9 An eyeball deviation, particularly when it stays in a ventral or dorsal position but can be made to move from that abnormal position with head movements, is seen frequently. Usually, this is due to lesions involving the vestibular system and is referred to as vestibular strabismus (Figures 11.3 and 11.4).^10–12 This may not be very evident with the head in a normal posture but usually is exaggerated when the muzzle is raised. Also, performing a fundic examination to focus on the position of the optic disc can assist in defining asymmetric positioning of the pair of eyeballs.

Figure 11.1 Although rarely encountered alone in large animals, a fixed strabismus in various abnormal positions occurs with lesions of the oculomotor, trochlear, and abducent nerves. The abnormal directions in which the eyeball is pulled due to lesions of individual cranial nerves III, IV, and VI, due to the lack of opposing muscle strength, are indicated here.

Figure 11.2 True, fixed, ventromedial strabismus (esotropia) is seen here from a dorsal view in a Holstein cow. Degrees of exophthalmos usually accompany this inherited disorder that occurs in several breeds of cattle. A brainstem nuclear defect is believed to cause this problem that may be accompanied by some degree of visual impairment (amaurosis).

      Congenital blindness from many diseases can be associated with abnormal eyeball positions and movements. Also, Appaloosa, miniature, Thoroughbred, and Paso Fino horses severely affected with inherited night blindness can have СКАЧАТЬ