# Ocular Motility Abnormalities in Ehlers-Danlos Syndrome: An Observational Study
## 3 Results  
### Orthoptic Evaluation  
The CLR at 33 cm appeared symmetrical in 58.5% of patients (N = 24). Moreover, this test showed an intermittent divergent deviation in 31.7% (N = 13), an intermittent horizontal deviation associated with a vertical deviation in 4.9% (N = 2), a manifest strabismus in 2.4% (N = 1) and a microstrabismus in 2.4% (N = 1) of patients. The CLR at 5 m appeared symmetrical in 85.4% (N = 35) of patients. This examination showed an intermittent exotropia in 2.4% (N = 1), a manifest strabismus in 2.4% (N = 1) and a microstrabismus in 9.8% (N = 4) of patients. The CT at 33 cm revealed orthphoria in 19.5% (N = 8), exophora in 22% (N = 9), intermittent exotropia in 43.9% (N = 18), exotropia in 2.4% (N = 1), esophora in 2.4% (N = 1), intermittent esotropia in 4.9% (N = 2) and esotropia in 4.9% (N = 2) of patients. The CT at 5 m revealed orthphoria in 75.6% (N = 31), exophora in 9.8% (N = 4), intermittent exotropia in 7.3 % (N = 3), esophora in 2.4% (N = 1) and esotropia in 4.9% (N = 2) of patients. The CT at 33 cm showed a vertical deviation in 65.9% (N = 27) of patients; in particular, 41.5% (N = 17) presented a right/left (R/L) and 24.4% (N = 10) a left/right (L/R) deviation. The CT at 5 m showed a vertical deviation in 24.4% (N=10); in particular, R/L was observed in 14.6% (N = 6) and L/R in 9.8% (N = 4) of patients. The Lang test showed an absence of stereopsis in 4.9% (N = 2) of patients. One of the patients revealed a microstrabismus and the other one presented a partially accommodative esotropia with an angle of 20 prismatic diopters (PD) measured at 33 cm and 40 PD measured at 5 m.  
All data regarding OM of the right eye (RE) and the left eye (LE) are summarized in Tables 1 and 2. Among our patients, 41.5% (N = 17) complained of diplopia, while 58.5% (N = 24) showed single binocular vision. Furthermore, 75.6% (N = 31) of patients reported tenderness during OM examination. Half of the diplopic patients presented pain in the upward gaze and in the right or left laterversion. The inferential analysis, reported in Tables 3 and 4, allowed us to evaluate the associations between the orthoptic parameters \begin{table}
\begin{tabular}{c c c c c c} \hline \hline
**Muscle** & **Severe Muscle Hyperfunction** & **Moderate–Mild Hyperfunction** & **Severe Muscle Hypofunction** & **Moderate–Mild Hypofunction** & **Normal Muscle Functioning** \\ \hline MR & 2.4\% (N = 1) & 12.2\% (N = 5) & 14.6\% (N = 6) & 29\% (N = 12) & 41.4\% (N = 17) \\ LR & 17.1\% (N = 7) & 26.8\% (N = 11) & 4.9\% (N = 2) & 2.4\% (N = 1) & 48.7\% (N = 20) \\ SR & N = 0 & N = 0 & 17.1\% (N = 7) & 24.4\% (N = 10) & 58.5\% (N = 24) \\ IR & N = 0 & N = 0 & N = 0 & N = 0 & 100\% (N = 41) \\ SO & N = 0 & 2.4\% (N = 1) & N = 0 & N = 0 & 97.6\% (N = 40) \\ IO & 24.4\% (N = 10) & 34.2\% (N = 14) & N = 0 & N = 0 & 41.5\% (N = 17) \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Ocular motility of the right eye. \begin{table}
\begin{tabular}{c c c c c c} \hline \hline
**Muscle** & **Severe Muscle Hyperfunction** & **Moderate–Mild Hyperfunction** & **Severe Muscle Hypofunction** & **Moderate–Mild Hypofunction** & **Normal Muscle Functioning** \\ \hline MR & 4.9\% (N = 2) & 7.3\% (N = 3) & 19.5\% (N = 8) & 29.2\% (N = 12) & 39\% (N = 16) \\ LR & 9.8\% (N = 4) & 28.4\% (N = 12) & 2.4\% (N = 1) & 2.4\% (N = 1) & 56\% (N = 23) \\ SR & N = 0 & 2.4\% (N = 1) & 17.1\% (N = 7) & 36.8\% (N = 11) & 53.7\% (N = 22) \\ IR & N = 0 & N = 0 & N = 0 & N = 0 & 100\% (N = 41) \\ SO & N = 0 & N = 0 & N = 0 & N = 0 & 100\% (N = 41) \\ IO & 9.8 \% (N = 4) & 19.5 \% (N = 8) & N = 0 & N = 0 & 70.7\% (N = 29) \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Ocular motility of the left eye. and the presence of diplopia and pain. Significant associations were observed between a Medial Rectus muscle (MR) deficit of the RE with pain (\(p\) = 0.020) and diplopia (\(p\) = 0.014). Furthermore, there was also a significant association between alteration of the Lateral Rectus muscle (LR) of the RE and the presence of eye pain (\(p\) = 0.004).