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      Extraocular Muscles Tension, Tonus, and Proprioception in Infantile Strabismus: Role of the Oculomotor System in the Pathogenesis of Infantile Strabismus—Review of the Literature

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      Scientifica

      Hindawi Publishing Corporation

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          Abstract

          The role played by the extraocular muscles (EOMs) in the etiology of concomitant infantile strabismus is still debated and it has not yet definitively established if the sensory anomalies in concomitant strabismus are a consequence or a primary cause of the deviation. The commonest theory supposes that most strabismus results from abnormal innervation of the EOMs, but the cause of this dysfunction and its origin, whether central or peripheral, are still unknown. The interaction between sensory factors and innervational factors, that is, esotonus, accommodation, convergence, divergence, and vestibular reflexes in visually immature infants with family predisposition, is suspected to create conditions that prevent binocular alignment from stabilizing and strengthening. Some role in the onset of fixation instability and infantile strabismus could be played by the feedback control of eye movements and by dysfunction of eye muscle proprioception during the critical period of development of the visual sensory system. A possible role in the onset, maintenance, or worsening of the deviation of abnormalities of muscle force which have their clinical equivalent in eye muscle overaction and underaction has been investigated under either isometric or isotonic conditions, and in essence no significant anomalies of muscle force have been found in concomitant strabismus.

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          Most cited references 73

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          Is Open Access

          Clinical Uses of Botulinum Neurotoxins: Current Indications, Limitations and Future Developments

          Botulinum neurotoxins (BoNTs) cause flaccid paralysis by interfering with vesicle fusion and neurotransmitter release in the neuronal cells. BoNTs are the most widely used therapeutic proteins. BoNT/A was approved by the U.S. FDA to treat strabismus, blepharospam, and hemificial spasm as early as 1989 and then for treatment of cervical dystonia, glabellar facial lines, axillary hyperhidrosis, chronic migraine and for cosmetic use. Due to its high efficacy, longevity of action and satisfactory safety profile, it has been used empirically in a variety of ophthalmological, gastrointestinal, urological, orthopedic, dermatological, secretory, and painful disorders. Currently available BoNT therapies are limited to neuronal indications with the requirement of periodic injections resulting in immune-resistance for some indications. Recent understanding of the structure-function relationship of BoNTs prompted the engineering of novel BoNTs to extend therapeutic interventions in non-neuronal systems and to overcome the immune-resistance issue. Much research still needs to be done to improve and extend the medical uses of BoNTs.
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            Biological organization of the extraocular muscles.

            Extraocular muscle is fundamentally distinct from other skeletal muscles. Here, we review the biological organization of the extraocular muscles with the intent of understanding this novel muscle group in the context of oculomotor system function. The specific objectives of this review are threefold. The first objective is to understand the anatomic arrangement of the extraocular muscles and their compartmental or layered organization in the context of a new concept of orbital mechanics, the active pulley hypothesis. The second objective is to present an integrated view of the morphologic, cellular, and molecular differences between extraocular and the more traditional skeletal muscles. The third objective is to relate recent data from functional and molecular biology studies to the established extraocular muscle fiber types. Developmental mechanisms that may be responsible for the divergence of the eye muscles from a skeletal muscle prototype also are considered. Taken together, a multidisciplinary understanding of extraocular muscle biology in health and disease provides insights into oculomotor system function and malfunction. Moreover, because the eye muscles are selectively involved or spared in a variety of neuromuscular diseases, knowledge of their biology may improve current pathogenic models of and treatments for devastating systemic diseases.
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              The role of ocular muscle proprioception in visual localization of targets.

              The role of ocular muscle proprioception in the localization of visual targets has been investigated in normal humans by deviating one eye to create an experimental strabismus. The passively deviated eye was covered and the other eye viewed the target. With a hand-pointing task, targets were systematically mislocalized in the direction of the deviated nonviewing eye. A 4- to 6-degree error resulted when the nonviewing eye was offset 30 degrees from straight ahead. When the eye was deviated, the perceived "straight-ahead" was also displaced, by a similar amount, in the same direction. Since the efferent motor commands to the displaced and to the nondisplaced eyes are presumably identical by the law of equal innervation, the mislocalization of visual objects must be attributed to the change in proprioceptive information issued from the nonviewing, deviated eye. Thus proprioception contributes to the localization of objects in space.
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                Author and article information

                Journal
                Scientifica (Cairo)
                Scientifica (Cairo)
                SCIENTIFICA
                Scientifica
                Hindawi Publishing Corporation
                2090-908X
                2016
                23 February 2016
                : 2016
                Affiliations
                Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), University of Bologna, St. Orsola-Malpighi Teaching Hospital, Via P. Palagi 9, 40138 Bologna, Italy
                Author notes

                Academic Editor: Ángel M. Pastor

                Article
                10.1155/2016/5790981
                4781980
                27006860
                Copyright © 2016 Costantino Schiavi.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Review Article

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