|
|
|
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 towardstowards
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
AV
Pattern Management
Dissocited Vertical
Deviations(DVD)
Dissocited
Horizontal Deviations(DHD)
Restictive Thyroid Myopathy
|
|
|
Duane Retaction
Syndrome (DRS) is a , congenital
,rare , eye movement disorder most commonly
characterized by the inability of the
adduction. The syndrome was first described
by Jakob Stilling (1887) and Siegmund Türk
(1896), and subsequently named for Alexander
Duane who discussed the disorder in more
detail in 1905
Other names of Duane's Retraction Syndrome (
DR syndrome),
Eye Retraction Syndrome,
Retraction Syndrome
Congenital retraction syndrome and
Stilling-Turk-Duane Syndrome.
The characteristic features Duane's
Retraction Syndrome (As described by
Duane, ) of the syndrome are:
1.Limitation of abduction of the affected
eye.
2.Less marked limitation of adduction of the
same eye.
3.Retraction of the eyeball into the socket
on adduction, with associated narrowing of
the palpebral fissure (eye opening)
4.Widening of the palpebral fissure on
attempted abduction.
5.Poor convergence
6.A face turn to the side of the affected
eye to compensate for the movement
limitations of the eye(s) and to maintain
binocular vision.
Other features
7.upshoot of the affected eye on adduction.
More rarely, 'down shoots' can also occur.
8.Head movements to compensate for loss of
eye movement when attempting to view an
object outside of binocular viewing range
(which may be very narrow).
Huber's classification
Type I: Marked limitation of abduction
Type II: Limitation of adduction
Type III: Limitation of both adduction and
abduction
(Huber's classification system was based
upon electromyographical findings)
Brown's classification
Type A: Limited abduction and less limited
adduction.
Type B: Limited abduction but normal
adduction.
Type C: In which limitation of adduction is
greater than limitation of abduction, giving
rise to a divergent deviation and a head
posture in which the face is turned away
from the side of the affected eye.
(Brown classification is based upon clinical
observations)
Management
Plaese download free trial version of
SquintMaster software For management
Duane's Retraction Syndrome
|
Brown syndrome
1.Limited elevation in adduction, an
invariable sign, is the hallmark of Brown
syndrome.
2. Unaffected elevation in primary position
and abduction
3. Patients often present with compensatory
head-posturing, their chin up, and a
contralateral face turn to avoid the
hypotropia that increases in upgaze and gaze
to the
contralateral side of the affected eye.
4. Minimal or no superior oblique overaction
and positive forced ductions up and in are
present. The presence of even mild superior
oblique overaction should be regarded with
suspicion, since this finding is
inconsistent with Brown syndrome of superior
oblique
tendon etiology.
5. Widened palpebral fissure on adduction
6 Vision and stereo acuity usually normal
7 May or may not have downshoot of involved
eye in adduction
8.If the vertical deviation in primary
position is greater than 10-12 PD, consider
an inferior
oblique palsy, severe periocular scarring,
or a superior nasal mass; do not consider
Brown syndrome caused by a tight or
inelastic superior oblique tendon.
9. May be acquired or congenital
Brown syndrome Plus :
If Brown syndrome associated with superior
oblique over action
then it's called as Brown syndrome Plus
Grades of Brown syndrome ( By
Eustis,O'Reilly And Crawford )
Mild: Limited elevation in adduction but no
downshoot,no hypertropia in primary
position.
Moderate: Limited elevation in adduction
with downshoot, no hypertropia in primary
position.
Severe: Limited elevation in adduction with
downshoot, hypertropia in primary position.
Management: The most important indications
for surgery are the presence of chin
elevation and severe limitation of elevation
in adduction, which significantly interferes
with the quality of life.
1. Wright silicone tendon expander technique
(preferred method)
2. Superior oblique split tendon lengthening
technique
3. TenotomyPlaese download free trial version of
SquintMaster software For management
Duane's Retraction Syndrome
|
DOUBLE ELEVATOR PALSY
Double elevator palsy suggests that both
elevator muscles (the superior rectus
and inferior oblique muscles) of one eye are
weak, with resultant inability to
elevate the eye.
Clinical Features
1.Double elevator palsy is characterized by
reduced elevation in all positions of
gaze.
2.Patients often present with a chin-up
position to maintain binocular vision.
3. It may congenital or aquired
Pathogenesis Double elevator palsy may be
due to innervational problems
(supranuclear, nuclear, or infranuclear
abnormality); mechanical, restrictive
conditions in the orbit; or a combination of
factors.
Plaese download free trial version of
SquintMaster software For management
Duane's Retraction Syndrome
|
|
|
|
Download Patient Case Sheet Performa |
|
References |
|
|
|
Download Free SquintMaster
Software
Features Of SquintMaster A Unique
Strabismus
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
|
|
