Shanti F Boesoirie. SpM(K).,MKes Strabismus Definition : Ocular misalignment, whether due to abnormalities in binocular vision or anomalies of neuromuscular control of ocular motility When the eyes become dissociated (not aligned) Strabismus The Advantages of Binocular Vision : Better visual acuity Exp. : - One eye 0,8 -- Both eyes 1,0 - One eye 1,0 -- Both eyes 1,2 Wider field of view Stereoscopic vision Normal condition of muscle balance Orthophoria producing single binocular vision Extra Ocular Muscles A TEAM OF SIX MUSCLES CONTROLS THE MOVE- MENT OF EACH EYE and BALANCING THE EYE THE RECTUS MUSCLE - MEDIAL adduction - LATERAL abduction - SUPERIOR supraduction - INFERIOR infraduction THE OBLIQUE MUSCLE - SUPERIOR intorsion - INFERIOR extorsion Single Binocular Vision Is a condition when retinal images from two eyes integrating into a single three-dimensional visual perception Prerequisites for binocular vision : Visual acuity of the two eyes after corrected are the same or slightly different and anisokonia not present Good coordination of eye muscles on the both eyes same direction of viewing Fusion capabilities of the brain Nomenclature of Strabismus Prefixes : Eso- : rotated nasally Exo- : rotated temporally Hypo- : rotated inferiorly Hyper- : rotated superiorly Incyclo-: torted nasally Exyclo- : torted temporally Nomenclature (Cont.) Suffixes : -phoria : A latent deviation that is controlled by the fusional mechanism so that under normal binocular vision of the eyes remain aligned Exp : Exophoria, Esophoria, etc -tropia : A manifest deviation that exceeds the control of the fusional mechanism so that the eyes are not aligned Exp. : Hypotropia, Esotropia, etc Classification of Strabismus According to fixation : Alternating : Spontaneous alternation of fixation from one eye to the other Monocular : Definite preference for fixation with one eye According to age of onset : Congenital prior of 6 months of age Acquired after 6 months of age Classification (Cont.) According to the type of deviation : Horizontal : Esodeviation or Exodeviation Vertical : Hyperdeviation or hypodeviation Torsional : Incyclodeviation or excyclodeviation Combined : Horizontal, vertical, and/or torsional Classification (Cont.) According to variation of the deviation with fixating eye : Comitant (concomitant) :does not vary with eye direction Incomitant : varies with eye direction Etiology of Strabismus Heterophoria : Muscle weakness : Congenital Acquired Muscle spasm Refraction anomalies Anomalies of anatomy of the eye muscle Etiology of Strabismus (Cont.) Heterotropia : Congenital : Eye muscle or neural anomalies Disturbances of accommodation Infection Trauma Head/brain neoplasm Specific eye disease that attack macula toxoplasmosis Clinical Symptom Subjective : Heterophoria : Blurred vision, especially when tired Headache after reading Heterotopia : Diplopia Eye ball’s range of movement limited Changing the position of the head Assessment of Strabismus Patient’s eye ball appearance (simplest methods) Corneal light reflex test : Hirschberg test Modified Krimsky’s method test Assessment (Cont.) Cover tests Cover-uncover test Alternate cover test Therapy of Strabismus Main goal of therapy Single binocular vision Other goal cosmetic reason Treatment : Congenital strabismus surgery as soon as possible Refraction disturbances correction Orthopic exercises Surgery Complication Amblyopia Cosmetic Head posture disturbances Amblyopia Definition : Unilateral or bilateral reduction of visual acuity (with best refractive correction) that cannot be attributed directly to the effect of any structural abnormality of the eye or the posterior visual pathway Caused by abnormal visual experience early in life Developmental Period of The Eye Period of development : Intra uterine development Period I : 0 – 6 months critical Period II : 6 months – 2 years Period III : 2 years – 5 years Period IV : 5 years – 9 years Period V : 9 years – 12 years Good development Macula lutea have to well trained by rays that straight focused onto macula, before 6 years old Types of Amblyopia Strabismic amblyopia Most common form Anisometropic amblyopia Isoametropic amblyopia Deprivation Amblyopia (amblyopia ex anopsia) Severity of Amblyopia Mild Amblyopia : Visual acuity : 0,6 or better Moderate Amblyopia : Visual acuity : 0,2 – 0,6 Severe Amblyopia Visual acuity : 0,1 – 0,2 Therapy of Amblyopia Goal of therapy : Normal visual acuity of both eye Perfect eye ball position of both of eye Streoscopic eye Prognosis of the therapy is depend on : Age onset of Amblyopia When the treatment begin Severity of amblyop Fixation type Patient’s compliance Therapy (Cont.) Principal of therapy train the amblyopic eyes with : Occlude fellow eyes (the health eyes) Cyclopegic on fellow eye (Penalization) CAM stimulator (still controversial) Recurrence 50%