STRABISMUS GALANG, MIGUEL PAOLO A.

GARCIA, MARTIN A.
STRABISMUS
- Any ocular misalignment, such that only one eve views the object of regard with the
correct vertical orientation
-The misalignment may be in any direction
-The amount of deviation is the angle by which the deviating eye is misaligned
- may be secondary to pathologic diseases (CN palsies, orbital masses, orbital
fractures, Graves’)
-4% of children, there is no “outgrowing”
MANIFEST VS. LATENT STRABISMUS
Manifest – presents under binocular viewing conditions
Latent – a deviation present only after occlusion of one eye
 FUNCTIONS OF THE OCULAR MUSCLES
Muscle Primary Action Secondary Actions
Lateral Rectus Abduction NONE
Medial Rectus Adduction NONE
Superior Rectus * Elevation Adduction, intorsion
Inferior Rectus Depression Adduction, extorsion
Superior Oblique Intorsion Depression, abduction
Inferior Oblique* Extorsion Elevation, abduction
SHERRINGTON’S LAW
-Synergistic muscles are those with the same field of action
-Muscles synergistic for one function may be antagonistic for another
-The EOMS, like skeletal muscles, show reciprocal innervation of antagonistic muscles

YOKE MUSCLES (HERING’S LAW)

-For movement of both eyes in the same direction, the corresponding agonist muscles
receive equal innervation
-Pair of agonist muscles with the same primary action are yoke pair
BINOCULAR VISION & SENSORY FUSION
Binocular vision – ability to combne the visual information from two eyes viewing the
same scene into a single image
Sensory fusion-process by which disparities between two images at corresponding
retinal points are overcomed to allow a single image to be perceived
SENSORY PHENOMENA
> Diplopia and Visual Confusion
Each fovea receives a different image, presence of true image from the fixing eye
and a false image from the deviating eye

>Suppression
A common sensory adaptation in childhood strabismus, avoiding diplopia and visual
confusion, and present only on binocular vision. The image seen by one eye
predominates and that seen by the other eye is suppressed due to the presence of
reduced visual sensitivity within the deviating eye  Suppression scotoma
> Amblyopia
Prolonged abnormal visual experience in a child under age of 7
>Eccentric Fixation
Nonpreferred eye  appears to be not looking and eccentric corneal light reflection
CLINICAL EVALUATION
Laterality
Direction
Duration
Frequency
Modifying factors
Associated symptoms
Past ocular history
Past medical history
Family History
EXAMINATION
Visual Acuity – 2 -3 years Allen pictures, Snellen tumbling E
5-6 years Snellen visual acuity testing

Determination of Refractive Error – cyclopegic refractive error

Inspection
Cover Testing
TREATMENT
Main objectives of treatment:
A. Reversal of Deleterious Sensory Effects
B. Best Possible Alignment
Dictum: Treatment is done as early as the diagnosis is made
Sensory correction > eye alignment
TREATMENT
GOALS: INITIAL IMPROVEMENT & MAINTENANCE OF IMPROVED VISUAL ACUI TY

> Occlusion Therapy

> Atropine Penalization
> Optical Devices
> Botulinum Toxin
> Orthoptics
> Surgery