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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  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

 

 
 
How to examine a strabismus patient?
Management Of Eso Deviations
Complications Of Strabismus (Squint) Surgery
 
         

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. Tenotomy

Plaese 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

 

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

 

 

 

 

 

 

 

 

 

 

 

 

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