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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

Motor evaluation

Sheela Evangeline K

Co ordinators:

Ms. Rizwana

Mr. Kabilan



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



Diagnosis
Diagnosis ?

Essential Infantile Esotropia




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





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 ?



Patch test
Patch test

Distance deviation remains higher than near deviation


Diagnosis2
Diagnosis

True divergence type Exotropia




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



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



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




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



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