Adherence Syndrome: Description:
Restriction action of an ocular muscle owing to adhesions between the muscle and its fascial sheath.
Also called as fat adherence syndrome (FAS).
The fat adherence syndrome (FAS) is a severe form of the restrictive strabismus resulting from the adherence of orbital tissues to the globe of extraocular muscles and their attachments, for which no successful treatment currently exists.
The term fat adherence syndrome refers to progressive restrictive strabismus assoicated with the intrusion of extraconal orbital fat into the sub-Tenon's or episcleral space during surgery or following trauma. Scar formation occurs following all strabismus procedures. The formation of an adequate scar, in fact, is required for normal postoperative healing. However, abnormal scar formation, or normal scar formation that occurs after unplanned intraoperative events, may lead to undesirable surgical outcomes. Adherence syndromes occur following strabismus surgery and are due to fibrous scar formation that alters postoperative alignment and/or limits ocular rotations.
Inferior oblique adherence syndrome is characterized by a hypotropia in the primary position and limitation of elevation in adduction in an eye that has undergone inferior oblique weakening. There is always a mechanical restriction to elevation in adduction that can be confirmed with testing of passive ductions. When this condition was described initially, it was stated that it was more likely to occur after myectomy of the inferior oblique and that it was much less likely to occur after recession. Experience has confirmed that inferior oblique adherence syndrome could occur after any inferior oblique weakening that had been complicated by rupture of Tenon's capsule (intermuscular membrane) and prolapse of fat accompanied by hemorrhage. Dense scarring in the inferior temporal quadrant is the cause of inferior oblique adherence syndrome.
Diagnosis: It has been difficult to explore the actual etiology of this syndrome. Attempts to produce animal model of fat adherence syndrome have not been successful.
The incidence of fat adherence syndrome is very rate today. The number of cases decreased due to the recognization of the condition, and better understanding of the potential consequences of voilating posterior Tenon's capsule during surgery. Improvement in surgical techniques probably also contributes significantly to a reduction in the incidence of this complication.
The treatment of inferior oblique adherence syndrome presents a challenge. The surgical area should be dissected carefully and adhesions lysed until passive ductions are free. Appropriate yoke muscle surgery may be performed but persistence of some restriction is the rule, in spite of treatment.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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