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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
 
 
 
 
Exotrpoia With V Patterns
If exotropia is atleast 15 prism diopter more  in up gaze ( 25 degree up) than the down gaze (35 degree) then it called as V pattern exotropia.(Fig1,2,3)

Causes of V-pattern strabismus

  • Inferior oblique muscle overaction
  • Relative underaction of the superior oblique muscles
  • Hypoplasia  of the malar bones
  • Anti-Mongoloid lid slants
  • S-shaped contours of the lower lid

 

Management Of  V Pattern strabismus
Surgical treatment of Exotropia with V-pattern strabismus with oblique muscle over action
  • Lateral rectus muscle recessions with inferior oblique muscle weakening
  • Lateral rectus muscle recession with Medial rectus resection with inferior oblique muscle weakening

 

Surgical treatment of Exotropia with V-pattern strabismus without oblique muscle overaction
  • Exotropia with V-pattern - Bilateral lateral rectus muscle recessions with up shift
                                                           Or
  • Exotropia with V-pattern - lateral rectus muscle recessions with up shift + medial rectus muscle resections with down shift
                                          

 

Exotropia with V-pattern - Bilateral lateral rectus muscle recessions with up shift

Lateral  rectus muscle recessions with up shift + medial rectus muscle resections with down shift

Surgical treatment of Esotropia with V-pattern strabismus with oblique muscle over action
  • Medial rectus muscle recessions with inferior oblique muscle weakening
  • Medial rectus muscle recession with lateral rectus resection with inferior oblique muscle weakening

 

Inferior Oblique Weakening Procedure

Inferior Oblique Weakening Procedure

Surgical treatment of Esotropia with V-pattern strabismus without oblique muscle overaction

  •  Bilateral medial rectus muscle recessions with down shift
  •  Medial  rectus muscle recessions with down shift + lateral rectus muscle resections with up shift

 

Bilateral medial rectus muscle recessions with down shift

Medial  rectus muscle recessions with down shift + lateral rectus muscle resections with up shift

 

 
 
 

 

 

Download Patient Case Sheet Performa In Word Format

 

References

 

Download Free 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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