ocular Deviations
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ocular Deviations Presentation Transcript

  • 1. Ocular Deviations
  • 2. Heterophoria
    • A deviation kept latent by the fusion reflex
  • 3. Heterotropia
    • A manifest deviation of the eyes
    • Strabismus
    • Squint
    • “ cock eyed”
  • 4. Heterophoria
    • Orthophoria: the visual axes remain in alignment when fusion is prevented
    • Esophoria: the visual axes converge from alignment when fusion is prevented
    • Exophoria: the visual axes diverge from alignment when fusion is prevented
  • 5. Clinical Records
    • It is not necessary to specify the eye as a phoria is “shared”
    • Record the size in ∆
    • Record the distance the test was performed
    • Distance 5SOP
    • Near 2XOP
  • 6. Esophoria
  • 7. Heterophoria
    • Orthophoria: the visual axes remain in alignment when fusion is prevented
    • Hyperphoria: one line of sight is higher than the other when fusion is prevented
    • Hypophoria: one line of sight is lower than the other when fusion is prevented
  • 8. Vertical Phorias
    • A right hyperphoria is the same as a left hypophoria
    • It is important to specify the eye
  • 9. Clinical Records
    • It is necessary to specify the eye in vertical phorias
    • Record the size in ∆
    • Record the distance the test was performed
    • Distance 5RHyperphoria
    • Near 2L/R
  • 10. Rotations
    • Excyclophoria: upper poles of the corneas deviate outwards when fusion is prevented
    • Incyclophoria: upper poles of the corneas deviate inwards when fusion is prevented
  • 11. Cyclodeviations
  • 12. Physiological Exophoria
    • At near it is usual for the phoria to be relatively more divergent than the distance phoria
    • Accommodative lag gives less drive through AC/A
    • Small XOP common at near
  • 13. Aetiology
    • Static or Anatomical
    • Kinetic or Accommodative
    • Neurogenic
    • Innervational
  • 14. Vergence system
    • Convergence insufficiency
    • Convergence Excess
    • Divergence insufficiency
    • Divergence excess
  • 15. Convergence Insufficiency
    • Distance 3XOP
    • Near 12XOP
    • Breaks from XOP to XOT
    • Orthoptic therapy helps
  • 16. Convergence Excess
    • Distance Rx typically hyperopic
    • Distance 4SOP
    • Near 18SOP
    • High AC/A ratio
    • Can be controlled with Rx
  • 17. Convergence Excess
  • 18. Divergence Excess
    • Distance 15XOP
    • Distance Intermittant XOT
    • Near 5XOP
    • Patient not aware when Strabismus present
    • Responds to orthoptic therapy
  • 19. Divergence Excess
  • 20. Divergence Insufficiency
    • Distance 8SOP
    • Near 2XOP
  • 21. Heterotropia
    • Incomitant
    • Concomitant
  • 22. Incomitant Strabismus
    • The angle of deviation varies with direction of gaze
    • Paralytic in origin
    • Angle of squint largest when eyes turned in direction of affected muscle
    • Assessment of ocular motility essential
    • Often need to be referred
  • 23. Incomitant Squint
  • 24. Abnormal Head Posture
  • 25. Concomitant Strabismus
    • Angle of deviation is constant for all directions of gaze
    • May be intermittant
    • Often an accommodative element (Donder’s squint)
    • Alternating strabismus
    • Congenital
    • Childhood
  • 26. Heterotropia
    • Esotropia: the visual axes converge from alignment
    • Exotropia: the visual axes diverge from alignment
  • 27. Esotropia
  • 28. Accommodative Esotropia
  • 29. Accommodative Esotropia
  • 30. Alternating Esotropia
  • 31. Exotropia
  • 32. Exotropia
  • 33. Clinical Records
    • It is necessary to specify the eye in strabismus
    • Record the size in ∆
    • Record the distance the test was performed
    • Distance 5RSOT
    • Near 2LXOT
    • Alt D & N, prefers R fix
  • 34. Heterotropia
    • Hypertropia: one line of sight is higher than the other
    • Hypotropia: one line of sight is lower than the other
  • 35. Hypertropia
  • 36. Hypotropia
  • 37. Clinical Records
    • It is necessary to specify the eye in strabismus
    • Record the size in ∆
    • Record the distance the test was performed
    • Distance 15RHyperT
    • Near 10LHypoT
    • Alt D & N, prefers R fix
  • 38. Clinical Tests
    • Cover test
    • Ocular motility
    • Additional tests as required
  • 39. Summary
    • Phoria or Tropia?
    • Tropia: incomitant or concomitant?
    • Incomitant: Old or New?
    • Work in a systematic manner