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Strabismus

Strabismus. Reza Nabie MD Nikookari Eye Hospital Tabriz. Normal Visual Development - Normal vision develops as a result of both genetic coding and experience in a normal visual improvement - 6 weeks: maintain eye contact react with facial expression

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Strabismus

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  1. Strabismus Reza Nabie MD Nikookari Eye Hospital Tabriz

  2. Normal Visual Development - Normal vision develops as a result of both genetic coding and experience in a normal visual improvement - 6 weeks: maintain eye contact react with facial expression - 2-3 months: interested in bright objects • 4 months: disconjugate eye movements should be eliminated

  3. Signs of actual poor visual development - Wandering eye movements - Lack of response to familiar faces and objects - Nystagmus - Staring at bright light - Forceful rubbing of eyes (oculodigital reflex)

  4. Strabismus Definition : Any misalignment of visual axes Eyes as a sensorimotor unit

  5. Tasks of Motor System : • enlarge the field of view • bring the image of object onto fovea • position the two eyes alignment

  6. Monocularity vs Binocularity

  7. Most Important Deficient Of Strabismus: Loss of single Binocular vision  • Amblyopia •  Stereopsis •  Contrast sensitivity •  Color sensation • Spatial uncertainty • Increased perception and reaction time •  Visual field •  Visumotor performance

  8. Benefits of Treating Strabismus • Functional • Psychosocial • Cosmetic

  9. Types of Strabismus • Paralytic: 6th, 4th, 3th palsy • Horizontal: ET, XT • Restrictive: Blow-out fracture, Graves • Strabismus Syndrome :Duane Mobius

  10. Types of Esotropia • Essential Infantil (Congenital) • Accommodative : • a.Refractive • b.Non-refractive(High AC/A ratio)

  11. Horizontal Strabismus • Essential Infantile (congenital) ET

  12. Characteristics: ◙ Most common deviation ◙ Onset by 6 mo ◙ FH of ET or strabismus ◙ Large angle ◙ No significant Refractive Error

  13. Treatment : • Surgery is mainstay of treatment • Amblyopia treated before surgery

  14. II) Accommodative ET Is secondary to hyperopia or overconvergence

  15. Refractive Acc.ET • Hyperopia • Blurred Vision • Accommodation • Clear Vision +Convergence • Esotropia

  16. Characteristics: • Hyperopia: Mean +3 • No ET with glass • Positive FH • Onset by 2-3 years • Treatment: Glass

  17. Non-Refractive Acc.ET Ratio of convergence to accommodation is abnormally high Accommodation Over-convergence ET During Accommodation

  18. Characteristics: • No Hyperopia or mild hyperopia • More ET at near than distance • Positive FH • Onset by 2-3 years Treatment: BifocalGlass

  19. III) Congenital XT

  20. Characteristics: ◙ rare ◙ CNS evaluation indicated ◙ Positive FH ◙ Large Angle ◙ Onset by 6 months ◙ No significant refractive Error Treatment: As Congenital ET

  21. IV) Intermittent XT

  22. Characteristics: ◙ Most common form of XT ◙ No amblyopia ◙ Positive FH ◙ Variable Angle ◙ Onset by 2- years ◙ No significant refractive Error Treatment:a Conservative if early periods b.Surgery if deviation significant

  23. Paralytic Strabismus • Etiology: • Trauma(most common) • Vascular accident • Tumors • CNS Infection • Vaccination

  24. Paralytic Strabismus I) Superior Oblique Palsy ◙ Hypertropia ◙ Torticoly

  25. II) Sixth nerve Palsy ◙ Esotropia ◙ Abduction deficient ◙ Face turn

  26. III) Third Nerve Palsy ◙ Large angle XT ◙ Globe fixed in Abduction ◙ Only abduction is seen ◙ Ptosis ◙ Dilated pupil

  27. Treatment of Paralytic Strabismus • Congenital Palsy :Surgery • Acquired Palsy : • May be improved spontaneously • If not improved after 6 months surgery may be needed

  28. Blow-out Fracture Restrictive Strabismus

  29. II) Grave’s (TRIO)

  30. Strabismus Syndromes • Duane Syndrome • Limitation of abduction • Normal or limited adduction • Globe retraction in adduction • May be Ortho , ET or XT

  31. II) Congenital Fibrosis

  32. III) Mobius syndrome

  33. IV)High Myopia

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