After studying this you are able to investigate the paralytic strabismus

1. School of Medical and Allied Sciences
Course Code : BOPT6002 Course Name- Binocular Vision
Investigation in paralytic
strabismus
Prince Rajavat
B. Optometry , 3rd year
18SMAS1030036
Name of the Faculty: Miss. Harshita pandey Program Name:

2.  Paralytic strabismus
 Investigation tests
 Refrences
contents
Name of the Faculty: Miss. Harshita pandey Program Name:

3. Paralytic strabismus
• Paralytic strabismus is a type of incomitant strabismus, i.e.,
the deviations measured using the non-paretic eye fixing
(primary deviation) and the paretic eye fixing(secondary
deviation) are different. This can be congenital or acquired,
the latter being more common

4. Investigation
• History taking
• VA assessment
• Head postures
• Pupillary assessment
• Anterior and posterior segment assessment
• Identification and measurement of squint
1. Cover test
2. Hirshberg Test

5. 3. PBCT
4. Maddox rod test
5. Double Maddox rod test
6. Synaptophore
7. Diplopia charting and Hess charting

6. Confirmation test
• 3 step test
• FDT
• AFDT

7. History Taking
• Age of onset
• Probable cause
• History of diplopia
• Previous treatments
• Surgical history

8. Visual Acuity assessment and Head posture
• Vision is the prime important
factor in any patient presenting
with diplopia
• Patients assume a particular
head posture where the
diplopia is absent or minimum

9. Puppilary reflex ,AS and PS assessment
• Pupil should be assessed for size ,reflex, RAPD,
• Anterior and posterior segment should be checked for any pathology
is not present.
• Fundus also checked for any changes such as Vascularitis, Choroidal
changes,etc.

10. Identification and measurement of squint
• Hirshberg test
A person without squint will have the light reflex centered on the pupil
• Cover test
When the fixing eye is covered,the non-fixing eye takes fixing position
• EOM
Movement of EOM must be checked.

11. PBCT
• For measuring the deviation of eye,Prisms are used
• Base out for esotropia, Base in for exotropia
• Base up for hypotropia, base down for hypertropia
• Done for distance and near both.

12. Maddox rod test
• Done for both near and distance
• Measures deviation
Double Maddox rod test
• For finding cyclodeviation
• Red Maddox in RE & green Maddox in LE

13. Synaptophore
• Used to investigate the potential for binocular function in the
presence of a manifest squint
• To detect suppression
• The synaptophore can measure horizontal, vertical and torsional
misalignments simultaneously.

14. • Diplopia charting and Hess charting
• Crossed and uncrossed diplopia can be assesse
• The Hess/Lee chart findings arereflective of the natural history of
anyparalytic squint:
• 1. Paresis of the involved muscle
• 2. Overaction of the ipsilateral antagonist muscle
• 3. Underaction of the antagonist of the contralateral synergist, also
called inhibitional palsy

15. Confirmation tests
• Three step test .
• Parks used this information to devise a
three step test for differentiating the four vertically acting extra-ocular muscles,
• First step being to determine which eye is hypertropic in primary gaze,
• Second, which lateral direction has a worse hypertropia
• And the third, which sided head tilt has worse hypertropia

16. Force Duction test
• Topical anesthesia is used
• The limbal conjunctiva held with a toothed forceps,
• the patient is asked to rotate the eye in the direction of the palsied
muscle.
• Then passive force is used to see there is any restriction or paralysis
of extraocular muscles.

17. Active force Duction test
• All are same as FDT Except the passive force
• + The patient is asked to move the eye in the direction of palsied
muscle
• If examine felt any force then test is positive, else test is negative.

18. 1.Sharma P. Strabismus Simplified. NewDelhi. CBS Pub. 2013
2.Duke-elder S, WYber K. System of Ophthalmology vol. 6. Ocular motility and strabismus. St Louis. Mosby – Year Book Inc. 1973
3.Speilmann A. A translucent occluder to study eye position under unilateral or bilateral cover test. Am Orthopt J. 1986. 36: 65
4.Veronneau – Troutman S. Prisms in the medical and surgical treatment of Strabismus. CV Mosby Co. St Louis. 1994
5.Von Noorden, Burian H M. Binocular vision and ocular motility: Theory and management of strabismus. CV Mosby
Co. St Louis. 1974
6.Eds AL Rosenbaum, AP Santiago. Clinical Strabismus Management: Principles and Surgical Techniques Philadelphia. WB Saunder.
1999.
7. https://www.researchgate.net/publication/316748385_Clinical_Examination_of_Paralytic_Strabismus
References
Name of the Faculty: Mr. Vikas Shrivastava Program Name: