Professional Documents
Culture Documents
Ms. JayaRajini Vasanth Mphil, B.S (opt) Assistant Professor Optometry Ophthalmology Department Sri Ramachandra University
Classification of strabismus
A.
B. True strabismus: 1. Latent squint (heterophoria). 2. Manifest squint (heterotropia): - non- paralytic (concomitant). - paralytic (non- concomitant).
Visual axis: Line passes from the fovea to the point of fixation (object of regard). The normal visual axes (from both eyes) intersects at the point of fixation. Optical axis: It is the line passing through the centre of the cornea and meets the retina on the nasal side of the fovea Fixation axis: It is the line joining the fixation point and the centre of rotation
Angle kappa is the angle between visual (0ptical) axis and the anatomical (pupillary) axis.
As the fovea lies just temporal to the anatomical axis, a light shown into the cornea will cause reflex (on the visual axis) just nasal to the center of the cornea in both eyes (+ve angle kappa = 5).
In high myopia the, the fovea lies nasal to the optical axis. So, the corneal reflex lies temporal to the center of the cornea simulating esotropia. Negative angle kappa (myopia) leads to pseudoesotropia. Large positive angle kappa (hypermetropia) leads to pseudo-exotropia.
Pseudostrabismus
In young infants, strabismus must be differentiated from the more common pseudostrabismus
Pseudoesotropia as a result of a broad bridge of the nose. This is not a real eye crossing
Pseudo-deviations
Pseudo-esotropia Pseudo-exotropia
Epicanthic folds
HISTORY
Age of onset of deviation Is the deviation constant or intermittent? Is the deviation present for distance, near or both? Is it unilateral or alternating? Is it present only when the patient is inattentive or fatigued? Is it associated with trauma or physical stress? Old photographs Birth history Is there a family history of strabismus?. Are there any other medical problems? Headaches Is there a history of toxin or medication exposure?
VISUAL ACUITY
SENSORY EVALUATION
a - Prior to use of glasses b - Normal c - Left suppression/ amblyopia d - Right suppression/ amblyopia e - Diplopia
Qualitative tests for Stereopsis: Langs 2 pencil test Synoptophore Quantitative tests for Stereopsis: Random dot test TNO Test Langs stereo test
Frisby
Lang
MOTOR EVALUATION
Extra ocular muscles Cover test Corneal reflex test Hirschberg Krimsky Bruckner Dissimilar image test Maddox rod
Evaluation of Motility
Two principle methods of evaluating ocular motility are: 1. Observation of ocular ductions, which are the actual monocular movements of the eye. 2. Observation of binocular ocular alignment, using cover/uncover and alternate cover testing.
A- elevation d- adduction
B- depression Eextortion
C- adbuction F- intortion
Right esotropia (RET) Right exotropia (RXT) Right hypertropia (RHT)right hypotropia
Left esotropia (LET) Left exotropia (LXT) Left hypertropia (LHT)left hypotropia Alternating esotropia (ALT ET) Alternating exotropia (ALT XT)
E esophoria X exophoria RH right hyperphoria LH left hyperphoria E(T) intermittent esotropia X(T) intermittent exotropia RH(T) intermittent right hypertropia LH(T) intermittent left hypertropia
Hirschbergs test
Amount of deviation: note location of corneal light reflex 1 mm = 7 or 15
Reflex at limbus = 45
Hirschbergs Test
Normal
Used as an initial screen for strabismus How it works: Stand several feet in front of child with penlight shining at eyes Light reflection will be at the same point in each eye
Exotropia
Esotropi a
Krimsky Test
Asymmetric positions of the corneal reflex in the pupils of each eye are indicative of strabismus, which may be measured by placing a prism before the fixating eye until the reflection is similarly positioned in both eyes Base out prism for esotropia and Base in prism for exotropia This is the direct reading of the squint angle.
Bruckner Test
Is performed by using direct ophthalmoscope to obtain a red reflex simultaneously in both eyes. If there is strabismus , the deviated eye will have a lighter and brighter reflex than the fixing eye. Media opacities, Refractive errors, Strabismus
Measures heterophoria
Measure squint/misalignment Single prism/prism bar Primary position or in all positions of gaze