Topic

#Squint

14 articles
  1. Articles 28 Sep 2021 7 min read

    Top-Ten-Must-Not-Forget-In-Strabismus-Evaluation

    1. External face features affecting the eye position Facial asymmetry and palpebral fissure shape changes alter the ocular position, possibly due to extra-ocular muscle heterotopy The common extra-ocular features affecting ocular position are craniosynostosis, hydrocephalus, facial fracture, mongoloid and anti-mongoloid slant, telecanthus, congenital superior oblique palsy (face fuller on the affected side), facial nerve palsy. 2. Head posture Head does what eye cannot do Look for abnormal head posture when a patient is reading best-corrected visual acuity with proper refractive correction. The target should preferably be at the eye level of the patient in order to avoid a false chin-up position Head tilt, turn, chin-up/down Head turn is the opposite side of the ear seen Measure with a goniometer Look for incomitant strabismus and nystagmus Keep patient’s head straight throughout the examination – eg. In patients with Duane syndrome, small change in head posture can cause large ocular

    Dr. Goura Chattannavar · Dr. Virangi Doshi · +1 other
  3. Students Gallery 2 Apr 2021 14 min read

    How to examine a case of strabismus ?

    There is no substitute to good history obtained at the start of the examination As history gives us a direction to look for, and find pertinent signs aiding in diagnosis and management. The various presenting complaints could range from abnormal head posture, deviation noticed by parents or friends, intermittent eye closure, double vision and so on. Some important points to be noted in patients with squint include, Family history of squint and wear of glasses (amongst parents, siblings and distant relatives) Personal history starting from birth history- Factors such as prematurity and birth weight, nature of delivery (normal/forceps/cesarean) Deviation – the age at which it was noticed, the direction of deviation (inward/ outward/ other) the eye deviated, constant or intermittent nature of deviation. Further, if deviation becomes more obvious when the child is inattentive, tired or ill. The diurnal or cyclic pattern if any also has to be noted. Any history of convulsion, illness or tra

    Dr. Sowmya R, MS,FMRF, FAICO · Dr. Prerana Tripathi, DO, DNB, FICO
  4. Articles 2 Apr 2021 10 min read

    Diplopia and Hess Charting

    Diplopia Charting Diplopia chart is the record of separation of the diplopic or double images in the nine positions of gaze. It can be plotted charted in patients who cooperate and can appreciate the double vision and with incomitant or comitant deviation. The method The patient should be comfortable with his head erect and should preferably be still throughout the examination. The test is preferably carried out in a dark room. Red glass is put in front of one of the eyes (red in front of right, R for R, is a convention). It is desirable to use Armstrong goggles since these are shaped to fit the orbital margin and therefore patient would be looking only through the colored medium. The examiner holds the torch (vertical source of light) at around ½ m or 1 m (It is important to mention the distance on the chart). This source of light could be horizontal if the complaint is of vertical separation of images The light is held directly in front of the patient at first. If the patient sees a

    Dr. Jitendra Jethani, MS, DO, DNB, FNB
  5. Articles 2 Apr 2021 12 min read

    Fun with Prisms in Ophthalmology

    What are prisms? Prisms are nothing but a portion of a refracting medium bordered by two plane surfaces that are inclined at a finite angle. Prisms have a thicker portion called the base of the prism and a tapering portion called the apex of the prism. Prisms are oriented with their apex towards the direction of deviation. What happens to light when it enters a prism? Light has particle and wave characteristics. When it travels through the thicker base of the prism, the particle form of light has to travel a longer distance than at the apex of the prism, this difference causes light to bend towards the base of the prism. The power of a prism to bend light is measured in prism diopters (PD). One prism diopter will shift light by 1 cm at 1m distance. Calibration of Prism Prisms made of glass are calibrated in Prentice position. They should be held with the back surface perpendicular to the line of sight. Plastic prisms and prism bars are calibrated by the angle of minimum deviation. They

    Dr. Manjula Jayakumar
  6. Students Gallery 1 Apr 2021 7 min read

    Ten Pearls in the Management of Paralytic Strabismus

    Paralytic strabismus is an incomitant strabismus resulting from complete (paralysis) or partial (paresis) motor deficiency of one or a group of extraocular muscles, which are supplied by the third, fourth or sixth cranial nerve. 1 History and basic examination Paralytic strabismus may be congenital or acquired. Careful history-taking will rule out an antecedent fever, trauma, neurological symptoms, or systemic illness in acquired cases. Patients complain of ocular deviation, limitation of ocular movements or abnormal head posture. Diplopia is usually a feature of recent-onset strabismus but congenital cases with spontaneous decompensation may also present with diplopia. Facial asymmetry can be noted in some congenital superior oblique palsy(SOP) with a head tilt. Visual acuity is usually preserved in isolated acquired paralytic strabismus. Amblyopia develops only in patients in whom paralysis occurs early and when the patient is unable to maintain binocular single vision in any gaze. F

    Dr. Karthika Bhaskaran · Dr. Pradeep Sharma
  7. Articles 1 Apr 2021 13 min read

    Duanes Retraction Syndrome Made Ridiculously Simple

    Synonyms: Stilling–Turk–Duane syndrome. Duane Retraction Syndrome is a type of congenital cranial dysinnervation which occurs in 1-4% of strabismus cases. It has varied presentation mostly involving variable horizontal duction deficits, with narrowing of the palpebral fissure and globe retraction on attempted adduction, occasionally accompanied by upshoot or down shoots Etiopathogenesis Various theories have been proposed earlier for the cause of DRS but currently, the most accepted theory is that of innervational anomalies which leads to all the features of DRS. It is considered to be a part of congenital cranial dysinnervation syndrome as it’s a developmental anomaly of the 6th cranial nerve or its nucleus leading to innervational deficiency of lateral rectus muscle which might be associated with secondary innervational abnormality with Medial rectus. The lack of normal innervations of lateral rectus was proved by electromyographic studies. It is also associated with paradoxical inne

    Dr. Prerana Tripathi, DO, DNB, FICO · Dr. Sowmya R, MS,FMRF, FAICO
  8. Articles 1 Apr 2021 10 min read

    Esotropia Made Simple for the Postgraduates

    As like other strabismus, esodeviation can be, True esodeviation Pseudo esodeviation A prominent epicanthic folds 1, 2 Negative angle kappa in high myopes. True esodeviation can be either comitant or incomitant 1,2 A. Comitant I. Accommodative esotropia. Refractive accommodative esotropia (normal AC/A ratio) Non Refractive accommodative esotropia (high AC/A ratio) Hypo accommodative esotropia (reduced NPA) Partially accommodative esotropia II. Non-accommodative esotropia Essential infantile esotropia Non-accommodative convergence excess Acquired esotropia Acute Onset esotropia Divergence insufficiency or paralysis Cyclic esotropia Recurrent esotropia III. Microtropia IV. Nystagmus blockade syndrome. B. Incomitant Paralytic - Neurogenic (VI nerve palsy) Nonparalytic- Myogenic (ocular myasthenia) A & V pattern syndromes Duane’s retraction syndrome Mechanical – restrictive esodeviation Congenital fibrosis syndrome Acquired Dysthyroid eye disease Trauma to the orbital wall Myositis (IOID)

    Dr. Sowmya R, MS,FMRF, FAICO
  9. Articles 1 Apr 2021 10 min read

    Ten Tips for Management of Nystagmus

    Nystagmus is defined as an involuntary rhythmic oscillation of one or both the eyes. Clinical assessment and eye movement recordings are important to diagnose and classify nystagmus. It is essential to have patience while examining a child, as anxiety often increases nystagmus. 1.Classification Physiological eye movements have to be differentiated from pathological eye movements. The older etiology-based classification of nystagmus is redesigned into characteristics-based new classification by CEMAS (Classification of Eye Movement and Strabismus). Infantile nystagmus syndrome (INS) is characterized by horizontal conjugate nystagmus, infantile-onset, accelerating slow phase, increase with fixation attempt, convergence dampening, and presence of null zone with decreased amplitude. Fusion maldevelopment nystagmus syndrome (FMNS) is characterized by decelerating slow phase, associated strabismus, a latent component with fast phase towards fixing eye and decrease in intensity with adduction

    Dr. Ramesh Kekunnaya · Dr. Mayank Jain
  10. Articles 1 Apr 2021 9 min read

    Ten Commandments in Squint Workup for Postgraduates

    Squint is the Ocular Imbalance in which visual axes of both eyes do not meet at the point of regard. It can be regarded as a form of One Eye Blindness since both eyes are not seeing simultaneously, with a squinting eye being suppressed. Hence strabismus must be treated with due care. Squint evaluation can be simplified by the following checklist. Every squint patient must undergo this checklist of 10 commandments so as to plan management. 1. Determine whether True squint or a Pseudosquint The architecture of face and orbit may give the impression of a person having an apparent deviation. Careful inspection of lids, adnexa, position of globes will reveal no actual squinting of eyes. Two important parameters to rule out Pseudosquint Hirschberg reflex will always be centered No redressal movement on cover test Epicanthus and broad nasal bridge - extra fold of skin on the medial canthus gives the appearance of esotropia. On pinching the nasal bridge, the squint will disappear. Facial asymm

    Dr. R Krishnaprasad · Dr. Sayali D Mahajan

Other topics

Review Vitreoretina Top Ten Series Tips & Pearls Made Easy Macular Diseases Cornea and External Eye Diseases Must Read Preferred Practise Pattern Learn from Masters Treatment Uvea and Intraocular Inflammation Case Discussion Cataract Surgery i-File Pediatric Ophthalmology Imaging Glaucoma Grand Rounds infection