A-Pattern Strabismus

-Vertically incomitant pattern strabismus is used to describe the type of strabismus wherein the amount of horizontal deviation changes during the excursion of the eye from upgaze to downgaze.
-It is a common association with many types of strabismus, especially infantile esotropia and intermittent exotropia

A-pattern
-When the eye converges as the eye moves from down to upgaze, it is termed as an A-pattern.
-In A-pattern esotropia: deviation is more in upgaze than in downgaze
-In A-pattern exotropia: deviation is more in downgaze than in upgaze
-The A-pattern is considered significant if the difference in horizontal deviation between the 2 gazes is ≥ 10 prism diopters.

Patient Work-up
-It is paramount to rule out a vertical pattern in every case of comitant strabismus, as management would be defined by the same.
-Apart from the basic strabismus work-up, the additional assessment needed in the presence of patterns is to look for:

Abnormal head posture:
-Chin elevation may be seen in A-esotropia
-Chin depression may be a feature in A-exotropia

-Orbital imaging may be considered in patients with craniofacial anomalies and in cases where the cause of the pattern cannot be identified.

SWIPE to see surgical management in A-pattern strabismus!

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