Especially for the undergraduates, squint made easy in terms and types.

1. Taher Eleiwa , MDTaher Eleiwa , MD

2. T Eleiwa MD BENHA OPH DEP

3. T Eleiwa MD BENHA OPH DEP
BEAUTYBEAUTY

4. T Eleiwa MD BENHA OPH DEP
BEASTBEAST

5. T Eleiwa MD BENHA OPH DEP

6. Framework
• Terminology and rules
• Types
• Scheme
T Eleiwa MD BENHA OPH DEP

7. Which is better?
Monocular Vs. Binocular vision
T Eleiwa MD BENHA OPH DEP

8. Terminology & Rules
• Rules:
– Movements serve the vision,so
• No vision=no movement
– Binocular vision= good refraction+clear
media+intact visual pathways+intact motor
pathways
T Eleiwa MD BENHA OPH DEP

9. Motor supply of the eye
• Extraocular muscles
– 4 recti
– 2 oblique
– 1 LPS
• Intraocular
– Ciliary (III para)
– Constrictor(III …)
– Dilator(sympathetic)
T Eleiwa MD BENHA OPH DEP

10. T Eleiwa MD BENHA OPH DEP
LR 6
SO4

11. T Eleiwa MD BENHA OPH DEP

12. T Eleiwa MD BENHA OPH DEP

13. Ductions
T Eleiwa MD BENHA OPH DEP

14. versions
LR 6
SO4
T Eleiwa MD BENHA OPH DEP

15. T Eleiwa MD BENHA OPH DEP

16. T Eleiwa MD BENHA OPH DEP

17. Vergence
• Convergence
• Divergence
T Eleiwa MD BENHA OPH DEP

18. V imp
Elevators?adductors?abductors?depressors?intortors?
T Eleiwa MD BENHA OPH DEP

19. Sherrington Vs Hering
Same eye(DUCTIONS)
Agonist  antagonist
reciprocal innervation
Both eyes(versions)
yoke ms=synergists
Equal innervation
T Eleiwa MD BENHA OPH DEP

20. Ocular alignment
• Normal relation () both visual axes in all
directions of gazes , so
– The target falls on both fovea(corresponding
points)
– The target is seen binocularly in a wider field
with depth perception
T Eleiwa MD BENHA OPH DEP

21. T Eleiwa MD BENHA OPH DEP

22. Synoptophore
T Eleiwa MD BENHA OPH DEP

23. Synoptophore
T Eleiwa MD BENHA OPH DEP

24. T Eleiwa MD BENHA OPH DEP
Tests for sensory anomalies
Worth four-dot test
a - Prior to use of glasses
b - Normal or ARC
c - Left suppression
Bagolini striated glasses
a - Normal or ARC
b- Diplopia
d - Right suppression
e - Diplopia
d - Small suppression scotoma
Worth 4 dot test

25. Extra definitions
Strabismus :mislaigned visual axes=HETERO…#
TROPIA=MANIFEST
PHORIA=LATENT
Normal subject is both orthotropic/phoric
Eso=in
Exo=out
Hyper=up
Hypo..
1ry angle of deviation Vs 2ry …..
T Eleiwa MD BENHA OPH DEP

26. Diplopia
T Eleiwa MD BENHA OPH DEP
XT = crossed

27. T Eleiwa MD BENHA OPH DEP

28. Confusion
T Eleiwa MD BENHA OPH DEP

29. Suppression  strabismic amblyopia.
eccentric fixation.
T Eleiwa MD BENHA OPH DEP
Worth 4 dot test

30. Corneal window reflex
Hirschberg’s test
• 1 mm=7 degrees= 15 prism
• At edge of pupil = 15
degrees
• At limbus= 45 degrees
• Eso/exo/hyper/hypo/incyclo/
excyclo deviation
T Eleiwa MD BENHA OPH DEP

31. • LT XT 45 degree
T Eleiwa MD BENHA OPH DEP

32. Prisms (BAD)
T Eleiwa MD BENHA OPH DEP
Krimsky testModified Krimsky test

33. Prism bar
T Eleiwa MD BENHA OPH DEP

34. Cover test
• Uses?
1. Evaluate
manifest
squint(uni vs
alternating)
2. Unmask latent
squint
3. With prism to
measure the
angle
T Eleiwa MD BENHA OPH DEP

35. Eso or exo?
Left or right or
alternating?
T Eleiwa MD BENHA OPH DEP

36. Maddox rod
1. Principle?
1. Dissociate binocular
vision for FAR
2. Unmask phorias
3. With tangent /prism to
measure the angle
4. Double Maddox for
cyclodeviation
T Eleiwa MD BENHA OPH DEP

38. Maddox wing
• Principle?
– Dissociate binocular vision for
near
T Eleiwa MD BENHA OPH DEP

39. T Eleiwa MD BENHA OPH DEP

40. T Eleiwa MD BENHA OPH DEP

41. Forced duction test(FDT)
T Eleiwa MD BENHA OPH DEP

42. Cover test
T Eleiwa MD BENHA OPH DEP

43. T Eleiwa MD BENHA OPH DEP

44. Apparent
• c/o; cosmetic
• o/e: the cause+ no deviation+free motility
• Ttt: reassure+cause
T Eleiwa MD BENHA OPH DEP

46. • Idea
• c/o: RDPV+Circumstances
– Intermittent course
• P; asthenopia
• V;blurred , double
• o/e: cause+unmask deviation+free motility
– Dissociate binocular vision by;
• Cover test, maddox rod and wing
T Eleiwa MD BENHA OPH DEP
Latent

47. T Eleiwa MD BENHA OPH DEP

48. • Ttt
– Cause
– Prism
– Surgery
T Eleiwa MD BENHA OPH DEP

49. T Eleiwa MD BENHA OPH DEP

50. Comitant
• Idea
– Binocular vision= good refraction+clear
media+intact visual pathways+intact motor
pathways
– Maldeveloped binocular vision
T Eleiwa MD BENHA OPH DEP

51. • c/o: cosmetic , no double(mcq)
• o/e: CAUSE(FUNDUS+media+refraction)
• +manifest constant angle of deviation
• +free motility
– +evaluate binocular vision:
» Cover testunilateral=strabismic amblyopia
» Synoptophore
» Worth 4 dot(suppression)
T Eleiwa MD BENHA OPH DEP

52. T Eleiwa MD BENHA OPH DEP

53. T Eleiwa MD BENHA OPH DEP

54. Eso or exo?
Left or right or
alternating?
T Eleiwa MD BENHA OPH DEP

55. • Ttt:
– Cause
– Build binocular vision
T Eleiwa MD BENHA OPH DEP

56. T Eleiwa MD BENHA OPH DEP

57. T Eleiwa MD BENHA OPH DEP

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60. Paralytic Squint
T Eleiwa MD BENHA OPH DEP

61. T Eleiwa MD BENHA OPH DEP

62. Forced duction
test(FDT)
T Eleiwa MD BENHA OPH DEP

63. Causes
• LMNL(3,4,6)
• Trauma,tumour,vascular
….etc
T Eleiwa MD BENHA OPH DEP

64. Password:
………….in direction of action of
paralysed muscle
T Eleiwa MD BENHA OPH DEP

65. • c/o:
– Diplopiaaaaaa(nausea, vomiting,vertigo,false
projection)in…………………..#
• o/e:
– Exclude restrictive causes by…….?
– Limited motility in…………..#
– Angle of deviation is max in…………..#
T Eleiwa MD BENHA OPH DEP

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69. 6 n palsy
T Eleiwa MD BENHA OPH DEP

70. 4th
n palsy
T Eleiwa MD BENHA OPH DEP

71. WOOG+
BOOT
T Eleiwa MD BENHA OPH DEP

72. III n palsy
• EOM except……..&……..
• Levator
• Sphincter pupillae
T Eleiwa MD BENHA OPH DEP

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75. Left oculomotor palsy
T Eleiwa MD BENHA OPH DEP

76. Dilated fixed pupil(DD)
T Eleiwa MD BENHA OPH DEP

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79. HessHess ScreenScreen
T Eleiwa MD BENHA OPH DEP

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81. T Eleiwa MD BENHA OPH DEP