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Hypotropia

MedGen UID:
101826
•Concept ID:
C0152208
•
Disease or Syndrome
Synonyms: Downward Ocular Deviation; downward ocular deviation; hyop - Hypotropia; hypotropia; Sunset Sign; sunset sign
SNOMED CT: hyop - Hypotropia (29491004); Hypotropia (29491004)
 
HPO: HP:0025584
Monarch Initiative: MONDO:0004897

Definition

A form of manifest strabismus (heterotropia) in which one eye is deviated downwards when both eyes are open. [from HPO]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVHypotropia

Conditions with this feature

Fibrosis of extraocular muscles, congenital, 2
MedGen UID:
356119
•Concept ID:
C1865915
•
Disease or Syndrome
Congenital fibrosis of extraocular muscles-2 (CFEOM2) is an autosomal recessive disorder in which affected individuals are born with bilateral ptosis and restrictive ophthalmoplegia with the globes fixed in extreme abduction (exotropia) (Wang et al., 1998, Nakano et al., 2001). For a general phenotypic description and a discussion of genetic heterogeneity of various forms of CFEOM, see CFEOM1 (135700).
See: Condition Record
Ophthalmoplegia, external, with rib and vertebral anomalies
MedGen UID:
1648445
•Concept ID:
C4748418
•
Disease or Syndrome
External ophthalmoplegia with rib and vertebral anomalies (EORVA) is characterized by congenital nonprogressive external ophthalmoplegia and ptosis, with torticollis and scoliosis developing during childhood. In addition, patients exhibit hypoplastic or missing ribs with fusion anomalies (Di Gioia et al., 2018).
See: Condition Record
Fibrosis of extraocular muscles, congenital, 2
Ophthalmoplegia, external, with rib and vertebral anomalies

Professional guidelines

PubMed

Supraequatorial displacement with lateral rectus myopexy for treatment of myopic sagging/heavy eye.
Merino P, Antón V, Chamorro M, Gómez de Liaño P, Yáñez-Merino J
Arch Soc Esp Oftalmol (Engl Ed) 2023 Oct;98(10):553-557. Epub 2023 Aug 28 doi: 10.1016/j.oftale.2023.06.021. PMID: 37648208
Diagnosis and surgical treatment of unilateral restrictive hypotropia and esotropia.
Lin Q, Man F, Wang N, Chen T, Yu G, Wang Z, Chang Q, Jiao Y, Zhao K
J AAPOS 2011 Feb;15(1):5-8. doi: 10.1016/j.jaapos.2010.09.019. PMID: 21397798
Brown's syndrome: diagnosis and management.
Wright KW
Trans Am Ophthalmol Soc 1999;97:1023-109. PMID: 10703149Free PMC Article

Recent clinical studies

Etiology

Strabismus in pediatric orbital wall fractures.
Bhate M, Adewara B, Bothra N
Indian J Ophthalmol 2023 Mar;71(3):973-976. doi: 10.4103/ijo.IJO_1929_22. PMID: 36872720Free PMC Article
Isolated inferior oblique pareses.
Nadeem S
Int Ophthalmol 2022 Oct;42(10):3165-3181. Epub 2022 May 18 doi: 10.1007/s10792-022-02316-3. PMID: 35583684
Strabismus in chronic progressive external ophthalmoplegia.
Kim JY, Yang HK, Kim N, Kim MJ, Cho SI, Seong MW, Park SS, Hwang JM
Acta Ophthalmol 2021 Mar;99(2):e274-e280. Epub 2020 Nov 15 doi: 10.1111/aos.14558. PMID: 33191655
Strabismus After Ahmed Glaucoma Valve Implantation.
Robbins L, Goseki T, Law SK, Nouri-Mahdavi K, Caprioli J, Coleman AL, Giaconi JA, Demer JL, Velez FG, Pineles SL
Am J Ophthalmol 2021 Feb;222:1-5. Epub 2020 Aug 17 doi: 10.1016/j.ajo.2020.08.019. PMID: 32818449
Diagnosis and surgical treatment of unilateral restrictive hypotropia and esotropia.
Lin Q, Man F, Wang N, Chen T, Yu G, Wang Z, Chang Q, Jiao Y, Zhao K
J AAPOS 2011 Feb;15(1):5-8. doi: 10.1016/j.jaapos.2010.09.019. PMID: 21397798

Diagnosis

Acute bilateral hypotropia and esotropia complex as first manifestation of multiple sclerosis: a case report.
Senda J, Hirao R, Maeda K, Amakusa Y, Hirunagi T, Katsuno M, Kawaguchi K
Nagoya J Med Sci 2023 Nov;85(4):822-827. doi: 10.18999/nagjms.85.4.822. PMID: 38155615Free PMC Article
An atypical case of myopic strabismus fixus.
Hou P, Liu L, Yang G
J AAPOS 2023 Aug;27(4):231-233. Epub 2023 Jun 21 doi: 10.1016/j.jaapos.2023.05.001. PMID: 37348674
Isolated inferior oblique pareses.
Nadeem S
Int Ophthalmol 2022 Oct;42(10):3165-3181. Epub 2022 May 18 doi: 10.1007/s10792-022-02316-3. PMID: 35583684
Fixation-linked nondissociated hypotropia: a report of 3 cases.
Matalia J, Anaspure H, Panmand P, Kowal L
J AAPOS 2014 Oct;18(5):498-500. Epub 2014 Sep 27 doi: 10.1016/j.jaapos.2014.06.015. PMID: 25266837
Diagnosis and surgical treatment of unilateral restrictive hypotropia and esotropia.
Lin Q, Man F, Wang N, Chen T, Yu G, Wang Z, Chang Q, Jiao Y, Zhao K
J AAPOS 2011 Feb;15(1):5-8. doi: 10.1016/j.jaapos.2010.09.019. PMID: 21397798

Therapy

Acute bilateral hypotropia and esotropia complex as first manifestation of multiple sclerosis: a case report.
Senda J, Hirao R, Maeda K, Amakusa Y, Hirunagi T, Katsuno M, Kawaguchi K
Nagoya J Med Sci 2023 Nov;85(4):822-827. doi: 10.18999/nagjms.85.4.822. PMID: 38155615Free PMC Article
Strabismus After Ahmed Glaucoma Valve Implantation.
Robbins L, Goseki T, Law SK, Nouri-Mahdavi K, Caprioli J, Coleman AL, Giaconi JA, Demer JL, Velez FG, Pineles SL
Am J Ophthalmol 2021 Feb;222:1-5. Epub 2020 Aug 17 doi: 10.1016/j.ajo.2020.08.019. PMID: 32818449
Surgical interventions for vertical strabismus in superior oblique palsy.
Chang MY, Coleman AL, Tseng VL, Demer JL
Cochrane Database Syst Rev 2017 Nov 27;11(11):CD012447. doi: 10.1002/14651858.CD012447.pub2. PMID: 29178265Free PMC Article
Interventions for dissociated vertical deviation.
Hatt SR, Wang X, Holmes JM
Cochrane Database Syst Rev 2015 Nov 20;2015(11):CD010868. doi: 10.1002/14651858.CD010868.pub2. PMID: 26587695Free PMC Article
The inferior oblique muscle adherence syndrome.
Kushner BJ
Arch Ophthalmol 2007 Nov;125(11):1510-4. doi: 10.1001/archopht.125.11.1510. PMID: 17998512

Prognosis

Initial Postoperative Alignment in Strabismus Related to Thyroid Eye Disease.
Ha SG, Kim SH
J Pediatr Ophthalmol Strabismus 2021 Jan 1;58(1):23-27. doi: 10.3928/01913913-20200910-04. PMID: 33495794
Strabismus After Ahmed Glaucoma Valve Implantation.
Robbins L, Goseki T, Law SK, Nouri-Mahdavi K, Caprioli J, Coleman AL, Giaconi JA, Demer JL, Velez FG, Pineles SL
Am J Ophthalmol 2021 Feb;222:1-5. Epub 2020 Aug 17 doi: 10.1016/j.ajo.2020.08.019. PMID: 32818449
"Yokoyama procedure" efficacy on non-highly myopic patients with acquired esotropia and hypotropia.
Serafino M, Scaramuzzi M, Villani E, Nucci P
Eur J Ophthalmol 2020 Jul;30(4):676-679. Epub 2019 May 20 doi: 10.1177/1120672119850684. PMID: 31106643
Nasal loop myopexy as a primary procedure to correct exotropia hypotropia complex in high myopia.
Ganesh SC DO DNB, Jayadev NA MS, Oguego N M Ophthal, Narendran K DO DNB, Rao SG MS
Strabismus 2019 Dec;27(4):223-229. Epub 2019 Oct 15 doi: 10.1080/09273972.2019.1676794. PMID: 31612771
Horizontal Deviations in Congenital Brown Syndrome.
Dotan G, Eiger-Moscovich M, Snir M, Ehrenberg M, Friling R
J Pediatr Ophthalmol Strabismus 2018 Mar 1;55(2):113-116. Epub 2017 Dec 19 doi: 10.3928/01913913-20171101-02. PMID: 29257185

Clinical prediction guides

Clinical features and refractive profile of Brown syndrome.
Khorrami-Nejad M, Akbari MR, Azizi E, Fareed Tarik F, Yousefi R, Masoomian B
Clin Exp Optom 2024 Aug;107(6):622-626. Epub 2023 Sep 27 doi: 10.1080/08164622.2023.2256323. PMID: 37759378
Extraocular muscle enlargement of indeterminate cause in pediatric patients: case series and literature review.
Gim Y, Jung JH
J AAPOS 2023 Aug;27(4):205.e1-205.e6. Epub 2023 Jul 8 doi: 10.1016/j.jaapos.2023.06.001. PMID: 37429539
Strabismus in pediatric orbital wall fractures.
Bhate M, Adewara B, Bothra N
Indian J Ophthalmol 2023 Mar;71(3):973-976. doi: 10.4103/ijo.IJO_1929_22. PMID: 36872720Free PMC Article
"Yokoyama procedure" efficacy on non-highly myopic patients with acquired esotropia and hypotropia.
Serafino M, Scaramuzzi M, Villani E, Nucci P
Eur J Ophthalmol 2020 Jul;30(4):676-679. Epub 2019 May 20 doi: 10.1177/1120672119850684. PMID: 31106643
Surgical interventions for vertical strabismus in superior oblique palsy.
Chang MY, Coleman AL, Tseng VL, Demer JL
Cochrane Database Syst Rev 2017 Nov 27;11(11):CD012447. doi: 10.1002/14651858.CD012447.pub2. PMID: 29178265Free PMC Article

Recent systematic reviews

Congenital Fibrosis of Extraocular Muscles: A Systematic Review and Meta-Analysis.
Van Swol JM, Myers WK, Nguyen SA, Wilson ME
J Binocul Vis Ocul Motil 2023 Apr-Jun;73(2):43-52. Epub 2023 Feb 13 PMID: 36780505
Surgical interventions for vertical strabismus in superior oblique palsy.
Chang MY, Coleman AL, Tseng VL, Demer JL
Cochrane Database Syst Rev 2017 Nov 27;11(11):CD012447. doi: 10.1002/14651858.CD012447.pub2. PMID: 29178265Free PMC Article
Interventions for dissociated vertical deviation.
Hatt SR, Wang X, Holmes JM
Cochrane Database Syst Rev 2015 Nov 20;2015(11):CD010868. doi: 10.1002/14651858.CD010868.pub2. PMID: 26587695Free PMC Article

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