OCULAR MOTILITY DISORDERS DR. MANALI HAZARIKA SINGH
HETEROPHORIA ESOTROPIA EXOTROPIA
Misalignment , corrected by fusional capacity.
Esophoria, Exophoria, Hyperphoria, Hypophoria,
Cyclophoria – Incyclophoria & Excyclophoria
Overstimulation of convergence with accomodn hyperopia esophoria
Heterophoria - Symptoms
Asymptomatic, eyestrain, blurring , headache.
Manifest in conditions of fatigue.
Cover & Alternate cover test for heterophoria
Maddox rod test
fix on a point light in the centre of Maddox tangent
scale - 6 metres.
consists of many glass
rods of red colour set together
placed in front of one
eye with axis of the rod parallel to the axis of deviation
Maddox wing test
the amount of phoria for near
at a distance of 33 cm.
It is based on the basic principle of dissociation of fusion
by dissimilar objects.
Measurement of fusional reserve.
synoptophore or prism bar.
normal values of fusional reserve are as follows:
Vertical fusional reserve: 1.5°-2.5°
Horizontal negative fusional reserve (abduction
Horizontal positive fusional reserve (adduction
range) : 20°-40°
Treatment of phorias
Correct underlying refractive error
Exercising the weak muscle against prisms or by using synoptophore
Pen push ups
Prisms in spectacles
Misalignment of the eyes is apparent
Cyclotropia – Incyclotropia, Excyclotropia
Manifest strabismus may be- Intermittent, Constant, Monocular, Alternating Manifest squint is mainly of two types Non-paralytic or comitant – There is no primary muscle impairment Deviation is equal in all directions of gaze Paralytic or incomitant – One or more muscle is weakened Restriction of eyeball movement Deviation different in different directions of gaze
Adaptation to strabismus – May be sensory or motor Sensory adaptations- Suppression- Inhibition of an image from one eye when both eyes are open Abnormal retinal correspondence [ARC] – Here, non-corresponding retinal elements acquire a common subjective visual direction The fovea of the fixating eye is paired with a non-foveal element of the deviated eye. ARC allows some binocular vision Motor – This involves adoption of an abnormal head posture
TYPES OF ESODEVIATION
- Essential infantile
- Nystagmus & esotropia
- Manifest latent nystagmus
- Nystagmus blockage synd
TYPES OF ESODEVIATION
Refractive (normal AC/A)
Non refractive(high AC/A)
Non accommodative acquired esotropia
Spasm of near synkinetic reflex
PSEUDOESOTROPIA Pseudoesotropia due to wide bridge of the nose. The eyes are perfectly straight as evidenced by the central location of the camera flash in the pupil of each eye.
ESSENTIAL INFANTILE ESOTROPIA
Develops within 6 months of age
Large angle eso >30∆
Astigmatism , myopia – correction
Small angle eso- variable/ intermittent – hyperopic correction
Large angle eso – constant –
correct ref error
surgery before 24 months (Recession of both MR)
Convergent deviation assoc. with activation of accomodation reflex.
Onset – 6m – 7y
Intermittent at onset constant
Hereditary, trauma, illness
REFRACTIVE ACCOMODATIVE ESOTROPIA
Uncorrected Hyperopia (+4 TO +7D)
Insufficient fusional divergence
20 ∆ - 30 ∆
Refractive accommodative eso
Full cycloplegic correction of the hyperopia
Surgery – if eso fails to regain fusion with glasses or develops non accomodative component
NON REFRACTIVE ACCOMODATIVE ESOTROPIA
High AC/A Ratio
No Refractive Error
Esotropia Is Greater For Near
TREATMENT A: The esotropia at near viewing is eliminated (B) with the use of bifocals .
Neurological lesion – pons, treatment of intracranial hypertnsion , steroids
Base out prisms
SPASM OF NEAR SYNKINETIC REFLEX
Excess convergence, accomodn & miosis
Acute persistent eso alternating with ortho
Atropine / homatropine, plus lenses with significant hyperopia and bifocals.
Eso foll surgery for exo
Slipped or lost muscle
Base out prisms , lenses , miotics
+ ve pupillary axis is nasal to the visual axis
- ve pupillary axis is temporal to the visual axis.
A, When the observer places his or her eye in line with the light located on the subject’s line of sight, the reflection of that light appears displaced nasal ward on the cornea. B, When the examiner brings his or her eye and the light into line with the patient’s pupillary axis, the reflection of the light appears centered.
Controlled by fusion.
Detected – Alternate cover test – BSV interrupted.