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1. Ocular Motility and Inervation 2. Strabismus 3. Enophtalmus and Exophtalmus

1. Ocular Motility
• The four rectus muscles:
– the superior, inferior, medial, and lateral rectus muscles.

• The two oblique muscles:
– the superior and inferior oblique muscles.



2. Strabismus .

Strabismus • Strabismus is defined as deviation of an eye’s visual axis from its normal position • There are two major types of manifest strabismus : – concomitant (nonparalytic) – incomitant (paralyticor restrictive)strabismus .2.

3 – 7. Approximately 5.a. . the disorder initially manifests it self within the first two years of life. Concomitant Strabismus • Strabismus is called concomitant or nonparalytic when the angle (or degree) of misalignmentis approximately equal in all directions of gaze • Epidemiology: occurs almost exclusively in children. In 60 – 70 % of all cases.2.4 % of all children are affected.

Pathophysiology • Deviation of the visual axis of the deviating eye causes objects to be projected to noncorresponding points on the retina • One would expect these patients suffer from constant double vision because the left and right eyes supply different information to the brain .


a.2. Concomitant Strabismus • Etiology : – Genetic factors – Uncorrected refractive errors – Insufficient fusion – Unilateral visual impairment – Others possible causes .

2. • Exotropia: Outward deviation of the visual axis. Concomitant Strabismus Forms: • Esotropia: Inward deviation of the visual axis.a. . • Cyclotropia: This refers to the rotation of one eye around its visual axis. • Hypertropia and hypotropia: Ocular deviation with one eye higher orlower than the other.


2.a. Concomitant Strabismus Symptoms: • Crossed eyes • Double vision (diplopia) • Eyes that do not align in the same direction • Uncoordinated eye movements (eyes do not move together) • Vision loss in one eye .

Incomitant Strabismus • Occur when the degree of misalignment varies with the direction of gaze • One or more of the extraocular muscles or nerves may not be functioning properly or normal movement may be mechanically restricted .b.2.

Incomitant Strabismus • Etiology – serious neurologic disorder. such as third cranial nerve paresis – orbital disease or trauma.b. such as the restrictive ophthalmopathy of thyroid disease .2.


2. Examination & Diagnosis • General Inspection • Corneal Light Reflex (Hischberg Reflex) • Cover and Uncover Test .c.

.1.2. General inspection: Having the patient look in the six cardinal positions of gaze may reveal whether the deviation is approximately the same in all fieldsindicating concomitant strabismus-or is significantly different in one field of gazeindicating a possible incomitant strabismus.c.c. Examination & Diagnosis 2.

Corneal Light Reflex .

c.c.2 Cover test – can be used on any patient over the age of 6 or 7 months. Examination & Diagnosis 2.2. – have the patient look at a fixation point – Cover the fixating eye and observe the other eye .


d Management Of Strabismus • Eyeglass Prescription • Surgery – Esotropia is corrected by a combined procedure involving a medial rectus recession and a lateral rectus resection – Exotropia is corrected by posteriorly a lateral rectus recession in combination with a medial rectus resection .2.


Enophtalmus 3.3.a. Definition A backward displacement of the eyeball into the orbit .

b. Enophtalmus 3.3. Causes • Orbital fractures (most frequent cause) – Blowout fracture not associated with an orbital – hematoma • Neurogenic causes – Horner’s syndrome (sympathetic palsy) – Paresis of the oblique ocular muscles • Atrophy of orbital tissue (symmetrical) – Senile atrophy of the orbital fat – Dehydration .

Definition • Exophthalmos is a bulging of the eye anteriorly out of the orbit .a. Exophtalmos 4.4.

Exophtalmos 4.4. Causes • Graves’ disease (most frequent cause) • Inflammatory orbital disorders • Vascular orbital disorders • Orbital tumors (slowly progressive) • Developmental anomalies .b.

c.4. Treatment • Surgical .