STRABISMUS

Posted by e-Medical PPT Sunday, September 23, 2012
Strabismus is a condition in which the eyes are not properly aligned with each other. It typically involves a lack of coordination between the extraocular muscles that prevent bringing the gaze of each eye to the same point in space and preventing proper binocular vision, which may adversely affect depth perception. Strabismus can be either a disorder of the brain coordinating the eyes or a disorder of one or more muscles, as in any process that causes a dysfunction of the usual direction and power of the muscle.

Why squint is important
● A squint may show that the acuity of the eye is impaired
● A squint may itself cause amblyopia in a child
● A squint may be a sign of a life threatening condition like retinoblastoma

CONCOMITANT(NON-PARALYTIC)
The movement of both eyes are full (there is no paresis) but only one eye is directed towards the fixated target.
The angle of deviation is constant and unrelated to the direction of gaze.
It is the common squint that is seen in childhood.
Under age of 6, it is rarely caused by serious neurological disease. It’s usually primary in this age group.
Strabismus arising later in life may have a specific and serious neurological basis.


Incomitant (paralytic)
The degree of misalignment varies with direction of the gaze.
One or more of the extraocular muscles or nerves may not be functioning properly, or normal movement may be restricted mechanically.
This type of strabismus may indicate either a nerve palsy or extraocular muscle disease.

Causes of isolated nerve palsies
Vascular disease..ex Dm, hypertension
Orbital disease…ex neoplasia
Trauma..most common cause of palsy of 4th,6th
Neoplasia… glioma
Raised intracranial pressure may cause a 3rd or 6th nerve palsy
Inflammation… sarcoidosis

Extraocular muscle disease
Dysthyroid eye disease
Myasthenia gravis
Ocular myositis
Ocular myopathy
Browns syndrome

Strabismus testing
Corneal inspection
Hirschberg corneal light reflex test
Cover-uncover test
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