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Strabismus

Strabismus is defined as a misalignment of the eyes. Strabismus also called as squint.
Orthophoria – Implies as perfect ocular alignment without efforts.
Strabismus consists of two subgroups.
1.Hetrotropia – this is a manifest squint.
Esotropia – deviation of eye  towards inside.
Exotropia -- deviation of eye  towards towards outside.
Hypertropia-- deviation of eye   towards upside.
2.Hetrophoria—this is a latent ocular deviation. Eye alignment is maintained with fusional effort.
Esophoria – inward deviation of eye when fusion is disrupted.
Exophoria-- outward deviation of eye when fusion is disrupted.
Hyperphoria-- upward deviation of eye when fusion is disrupted.
Incyclophoria-- Intortional movement of eye when fusion is disrupted.
Excyclophoria-- Extortional movement of eye when fusion is disrupted.

Concomitant Strabismus
Esotropia
Exotropia
Non Comitantant Strabismus ( Paralytic)
Third Nerve Palsy
Forth Nerve Palsy
Sixth Nerve Palsy
Non Comitantant Strabismus ( Restrictive)
Duane’s Retraction Syndrome
Brown Syndrome
Double Elevator Palsy
Infantile Esotropia
A Pattern Deviations
V Pattern Deviations
Dissocited Vertical Deviations(DVD)
Dissocited Horizontal Deviations(DHD)
Restictive Thyroid Myopathy
 
 
How to examine a strabismus patient?
Management Of Eso Deviations
Complications Of Strabismus (Squint) Surgery
 
 
         
 
Infantile Esotropia
Clinical features:
1.Onset between birth and six months of age.
2. Large size (greater than 30 dioptres).
3. Stable size.
4. Either alternation or fixation preference may be present
5. Neurologically normal
6 The patient may or may not have any or all of the following associated conditions: Oblique muscle dysfunction, vertical incomitance, dissociated vertical deviation, asymmetric optokinetic nystagmus, torticollis. The patient may or may not have any or all of the following associated conditions: Oblique muscle dysfunction, vertical incomitance, dissociated vertical deviation, asymmetric optokinetic nystagmus, torticollis.
8. Initial alternation of the squint present with crossed fixation - i.e. the affected individual uses the left eye to look right and the right eye to look left.
9. Limited potential for binocular vision.
Differential Diagnosis
1. Sixth cranial nerve palsy
2. Primary Constant esotropia.
3. Duane's Syndrome .
4. Nystagmus Blockage Syndrome
5. Esotropia arising secondary to central nervous system abnormalities (in cerebral palsy for example).
 
Infantile Esotropia esotropia with right Oblique muscle overaction grade 4 ( Pic. Curtsey Dr Sudhir Singh)
Infantile Esotropia esotropia with right Oblique muscle overaction grade 4 ( Pic. Curtsey Dr Sudhir Singh)
 
Infantile Esotropia esotropia with left Oblique muscle overaction grade 4 ( Pic. Curtsey Dr Sudhir Singh)


Management

When to operate ?
Ing [1] and Helveston, [2] favour a prescribed approach often involving multiple surgical episodes whereas others prefer to aim for full alignment of the eyes.
According to Dutch study (ELISSS) [3] compared early with late surgery in a prospective, controlled, non-randomized, multicenter trial and reported that:Children operated early had better gross stereopsis at age six as compared to children operated late. They had been operated more frequently, however, and a substantial number of children in both groups had not been operated at all.
Surgical dose : you can calculate by SquintMaster Software.
Caution: If age of child is below 2 years then take measurement from limbus for recession as SquintMaster provide measurement from muscles insertion.


Reference:
1. Ing M.R.; Early Surgical Aignment for Congenital Esotropia; Ophthalmology, 1983; 90: 132-135
2. Helveston E.M.; Ellis F.D.; Patterson J.H; Weber, J.; Augmented Recession of the Medial Recti
3.Simonsz HJ, Kolling GH, Unnebrink K. Strabismus. 2005 Dec;13(4):169-99
 

 

 

Download Patient Case Sheet Performa In Word Format

 

References

 

Download Free Trial Version Of Strabismus Software "SquintMaster Software"

Salient Features Of SquintMaster Software

Designed and Developed By Dr Sudhir Singh ,M.S

  • Suggests diagnosis and sub type of deviations
  • Important tool for patient counseling
  • Suggests surgical options
  • Creates simulated image of deviations
  • With help of squint simulator and calculator user can calculate surgical dose ( Amount of surgery)
  • AC /A Simulator And Calculator
  • A V Patterns Simulator And Calculator
  • Parks 3 Step Test
  • Knapp's Classification
  • Simulator for ductions, versions and grades of oblique muscles over action
  • Classification and management of Duane's Retraction Syndrome
  • Management of third nerve palsy
  • Management of forth nerve palsy
  • Management of sixth nerve palsy
  • Management of Browns Syndrome
  • Management of double elevator palsy

 

 

 

 

 

 

 

 

 

 

 

 

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