Motor evaluation
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Motor evaluation. Sheela Evangeline K Co ordinators: Ms. Rizwana Mr. Kabilan. Case 1. Presentation. Age: 8 months Complaint of inward deviation of eye. History?. Onset: birth Alternating Family history – mother Not ass with shaking of eye ball Activities normal Birth history: normal.

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Motor evaluation

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Motor evaluation

Motor evaluation

Sheela Evangeline K

Co ordinators:

Ms. Rizwana

Mr. Kabilan


Case 1

Case 1


Presentation

Presentation

Age: 8 months

Complaint of inward deviation of eye


History

History?

Onset: birth

Alternating

Family history – mother

Not ass with shaking of eye ball

Activities normal

Birth history: normal


Evaluation

Evaluation

Gross motor evaluation : normal

Preference of fixating eye : alternating

Visual acuity : fixates light and toys monocularly

No nystagmus

Limitation of abduction

Cyclopleigic refraction: OU: +2.00DS

Modified Krimsky: 45 PD

Fundus: normal


Motor evaluation

What do you see?


Diagnosis

Diagnosis ?

Essential Infantile Esotropia


Management

Management?


Case 2

Case 2


Presentation1

Presentation

  • Age : 5 years

  • C/O inward deviation of eye


History1

History

  • Right eye – constant esotropia

  • No CNS abnormalities

  • Birth history : normal


Evaluation1

Evaluation

  • Vision ( with Leas)

    • OD: 6/12

    • OS: 6/9

  • PBCT:

    • Distance: 30 PD

    • Near: 40 PD

  • Comitant

  • No latent nystagmus, dissociated vertical deviation or smooth pursuit asymmetry.

  • Worth four dot test : OD: suppression

  • Cycloplegic retinoscopy

  • OU: +4.00/-0.50 × 180.

  • Slit lamp examination and fundus was normal


What will you do next

What will you do next ?

  • Raab’s plus 3 test

  • CT over glasses

    • Distance: ortho

    • Near: 5 PD esophoria

  • Vision with glasses

    • OD: 6/7.5

    • OS: 6/7.5


Diagnosis1

Diagnosis ?

Fully accommodative esotropia


Management1

Management


Partial accommodative esotropia

Partial accommodative esotropia


Case 3

Case 3


Presentation2

Presentation

Age: 11 yr

C/o outward deviation of left eye


History2

History

Onset : 1 yr of age

Constant


Evaluation2

Evaluation

Vision OD: 6/6 ; OS: 6/15

LXT for distance and near

PBCT:

Distance: 60 PD

Near: 40 PD

What will you do next ?


Motor evaluation

What pattern you see ?


Patch test

Patch test

Distance deviation remains higher than near deviation


Diagnosis2

Diagnosis

True divergence type Exotropia


Management2

Management


Case 4

Case 4


Presentation3

Presentation

  • Age: 9 years

  • C/o outward deviation of right eye

  • Left face turn

  • Limited eye movements


Evaluation3

Evaluation

  • Limited abduction

  • Retraction and narrowing of palpebral fissure on adduction

  • Widening on abduction

  • Leash phenomenon present


Diagnosis3

Diagnosis ?

Duane’s syndrome

Type 2


Case 5

Case 5


Presentation4

Presentation

  • Age: 27 years

  • S/p RD surgery at age of 14 yrs

  • c/o inward deviation of left eye since 2 years

    • More in alternate days

    • Ass with decreased vision


Evaluation4

Evaluation

  • Vision:

    • OD: 6/6

    • OS: 6/36

  • PBCT:

    • 60 PD on first day

    • 12 PD on second day


Diagnosis4

Diagnosis ?

Cyclic Esotropia


Management3

Management ?

  • A large recession of the left medial rectus and resection of the left lateral rectus

  • Safety glasses


Case 6

Case 6


Presentation5

Presentation

  • Age: 30 years

  • S/p RTA

    • Loss of consciousness

    • C/o double vision on awakening – says images are tilted

    • With chin down position diplopia disappears


Evaluation5

Evaluation

What do you see ?


Evaluation6

Evaluation

  • Slit lamp examination : normal


Fundus

Fundus

Characteristic!


Diagnosis5

Diagnosis ?

Bilateral superior oblique palsy

Which way would the images be tilted?  


Management4

Management

  • Surgery

    • Bilateral inferior rectus recession

    • Medial rectus down shift

    • Bilateral S.O. Harada-Ito

    • Bilateral inferior oblique weakening


Few more cases

Few more cases


C o squinting

C/o squinting


Diagnosis6

Diagnosis ?

Negative angle kappa


C o squinting1

Vision OU: 6/6

Hirschberg: 15deg ET

Cover test : ortho

C/o squinting


Diagnosis7

Diagnosis ?

Pseudo strabismus due to epicanthus


Thank you

Thank you


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