Congenital Processes That Cause Incomitant Strabismus

Congenital cranial dysinnervation disorders or CCDDs comprise a group of complex strabismus disorders that result from aberrant innervation or dysinnervation of extraocular muscles. Historically, many CCDDs were thought to be the result of a primary myopathic process that generated incomitant strabismus. Our current understanding, which has been greatly enhanced by the identification of the genetic basis for many of these conditions, is that the underlying etiology for the CCDDs is a primary disruption of innervation of the extraocular muscles with consequent restrictive strabismus.1-3 The ability to recognize the salient clinical features of the CCDDs is essential for appropriate management both non surgical and surgical, for prognosis, and for work up of associated systemic findings when relevant.