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managment of strabismus

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managment of strabismus

  1. 1. MANAGEMENT OFMANAGEMENT OF STRABISMUSSTRABISMUS avav sharmasharma
  2. 2. Why We TreatWhy We Treat 1- Restore Stereopsis1- Restore Stereopsis 2- Prevent Amblyopia2- Prevent Amblyopia 3- Prevent Confusion and Diplopia3- Prevent Confusion and Diplopia 4- Appearance4- Appearance
  3. 3. Why We TreatWhy We Treat 1- Restore Stereopsis1- Restore Stereopsis Three dimensional vision..Three dimensional vision..
  4. 4. Why We TreatWhy We Treat 2- Amblyopia2- Amblyopia Amblyopia is the unilateral or bilateral decrease ofAmblyopia is the unilateral or bilateral decrease of Vision caused by form vision deprivation and/orVision caused by form vision deprivation and/or abnormal binocular interaction for which there isabnormal binocular interaction for which there is no obvious cause found by physical examinationno obvious cause found by physical examination of the eye.of the eye.
  5. 5. Why We TreatWhy We Treat 3- Confusion and Diplopia3- Confusion and Diplopia .Confusion is the simultaneous appreciation of two.Confusion is the simultaneous appreciation of two superimposed but dissimilar images caused bysuperimposed but dissimilar images caused by stimulation of corresponding points (usuallystimulation of corresponding points (usually foveae) by images of different objects.foveae) by images of different objects. . Diplopia is the simultaneous appreciation of two. Diplopia is the simultaneous appreciation of two images of one object. Jt results from a failure toimages of one object. Jt results from a failure to maintain binocular vision.maintain binocular vision.
  6. 6. Why We TreatWhy We Treat 4- Appearance4- Appearance
  7. 7. Treatment ofTreatment of heterophoriaheterophoria indicated inindicated in decompensated heterophoriadecompensated heterophoria (i.e., symptomatic cases).(i.e., symptomatic cases). 1. Correction of refractive error1. Correction of refractive error when detected is most important.when detected is most important.
  8. 8. 2. Orthoptic treatment.2. Orthoptic treatment. heterophoria without refractiveheterophoria without refractive errorerror not corrected by glassessnot corrected by glassess to improve convergenceto improve convergence insufficiency and the fusionalinsufficiency and the fusional reserve. Orthoptic exercises canreserve. Orthoptic exercises can be done with synoptophore.be done with synoptophore. Simple exercises to be carried outSimple exercises to be carried out at homeat home
  9. 9. synoptophoresynoptophore
  10. 10. 3. Prescription of prism in glasses3. Prescription of prism in glasses selected cases Prism is prescribedselected cases Prism is prescribed with apex towards the direction ofwith apex towards the direction of phoria , two-thirds ofphoria , two-thirds of heterophoriaheterophoria
  11. 11. 4. Surgical treatment.4. Surgical treatment. marked symptoms which are notmarked symptoms which are not relieved by other measures.relieved by other measures. strengthen the weak muscle orstrengthen the weak muscle or weaken the strong muscleweaken the strong muscle
  12. 12. TREATMENT OFTREATMENT OF CONCOMITANTCONCOMITANT STRABISMUSSTRABISMUS GoalsGoals achieve good cosmeticachieve good cosmetic correction, to improve visualcorrection, to improve visual acuity and to maintain binocularacuity and to maintain binocular vision.vision.
  13. 13. 1.Spectacles1.Spectacles full correction of refractive error,full correction of refractive error, every case.every case. improve visual acuity, mayimprove visual acuity, may correct the squint partially orcorrect the squint partially or completely (as in accommodativecompletely (as in accommodative squint).squint).
  14. 14. 2.Occlution therapy2.Occlution therapy Sensitive period during which theSensitive period during which the amblyopia can be cured is below 10amblyopia can be cured is below 10 years of ageyears of age #. occlusion of the normal eye to#. occlusion of the normal eye to encourage the use of the abnormal eyeencourage the use of the abnormal eye is the most effective treatmentis the most effective treatment
  15. 15. it should be ensuredit should be ensured that:that: Opacity in the media (e.g.,Opacity in the media (e.g., cataract), if any, should becataract), if any, should be removed first,removed first, Refractive error, if any, should beRefractive error, if any, should be fully correctedfully corrected
  16. 16. schedule for occlusion therapyschedule for occlusion therapy depending up on the age is asdepending up on the age is as below:below: Upto 2 years, the occlusionUpto 2 years, the occlusion should be done in 2:1, i.e., 2 daysshould be done in 2:1, i.e., 2 days in sound eye and one day inin sound eye and one day in amblyopic eye. At the age 3years,amblyopic eye. At the age 3years, 3:1At the age of 4 years, 4:1,3:1At the age of 4 years, 4:1, At the age of 5 years, 5:1, andAt the age of 5 years, 5:1, and After the age of 6 years, 6:1After the age of 6 years, 6:1
  17. 17. Duration of occlusion should beDuration of occlusion should be until the visual acuity developsuntil the visual acuity develops fully, or there is no furtherfully, or there is no further improvement of vision for 3improvement of vision for 3 months.months.
  18. 18. 3 preoperative orthoptic exercise3 preoperative orthoptic exercise 4 squint surgery4 squint surgery 5 postoperative orthoptic exercise5 postoperative orthoptic exercise
  19. 19. ManagementManagement ofof paralyticparalytic strabismusstrabismus 1.Treatment of the cause1.Treatment of the cause investigative work-up.investigative work-up.
  20. 20. 2.Conservative measures.2.Conservative measures. wait and watch for self-wait and watch for self- improvement to occur for aimprovement to occur for a period of 6 months, vitamin B-period of 6 months, vitamin B- complex as neurotonic; andcomplex as neurotonic; and systemic steroids for non-specificsystemic steroids for non-specific inflammationsinflammations
  21. 21. 3.Treatment of annoying3.Treatment of annoying diplopia.diplopia. occluder on the affected eye, withoccluder on the affected eye, with intermittent use of both eyes ,tointermittent use of both eyes ,to prevent suppressionprevent suppression amblyopiai.e. partial loss of visionamblyopiai.e. partial loss of vision ,in one eye,cortical supretion of,in one eye,cortical supretion of central vision to prevent diplopiacentral vision to prevent diplopia
  22. 22. .. . 4.Surgical treatment.. 4.Surgical treatment. in case the recovery does notin case the recovery does not occur in 6 months.occur in 6 months. provide a comfortable field ofprovide a comfortable field of binocular fixation,binocular fixation, strengthening of the paralysedstrengthening of the paralysed muscle by resection; andmuscle by resection; and weakening of the overactingweakening of the overacting muscle by recession.muscle by recession.
  23. 23. STRABISMUS SURGERY
  24. 24. Surgical techniquesSurgical techniques 1.Muscle weakening procedures1.Muscle weakening procedures include recession, marginalinclude recession, marginal myotomy and myectomy.myotomy and myectomy. 2.Muscle strengthening2.Muscle strengthening procedures are resection, tuckingprocedures are resection, tucking and advancement.and advancement.
  25. 25. 3.Procedures that change3.Procedures that change direction of muscle action. Thesedirection of muscle action. These include (a) vertical transpositioninclude (a) vertical transposition of horizontal recti to correct ‘A’of horizontal recti to correct ‘A’ and ‘V’ patterns (b) posteriorand ‘V’ patterns (b) posterior fixation suture (Faden operation)fixation suture (Faden operation) to correct dissociated verticalto correct dissociated vertical deviation; and (c) transplantationdeviation; and (c) transplantation of muscles in paralytic squints.of muscles in paralytic squints.
  26. 26. Steps of resectionSteps of resection 1.Muscle is exposed as for recession and the1.Muscle is exposed as for recession and the amount to be resected is measured withamount to be resected is measured with callipers and marked. 2.Two absorbablecallipers and marked. 2.Two absorbable sutures are passed through the outer quarterssutures are passed through the outer quarters of the muscles at the marked site. 3.Theof the muscles at the marked site. 3.The muscle tendon is disinserted from the scleramuscle tendon is disinserted from the sclera and the portion of the muscle anterior toand the portion of the muscle anterior to sutures is excised. 4.The muscle stump issutures is excised. 4.The muscle stump is sutured with the sclera at the original insertionsutured with the sclera at the original insertion site. 5.Conjunctival flap is sutured backsite. 5.Conjunctival flap is sutured back
  27. 27. Steps of recessionSteps of recession 1.Muscle is exposed by reflecting a flap of1.Muscle is exposed by reflecting a flap of overlying conjunctiva and Tenon’s capsule.overlying conjunctiva and Tenon’s capsule. 2.Two vicryl sutures are passed through the2.Two vicryl sutures are passed through the outer quarters of the muscle tendon near theouter quarters of the muscle tendon near the insertion. 3.The muscle tendon is disinsertedinsertion. 3.The muscle tendon is disinserted from the sclera with the help of tenotomyfrom the sclera with the help of tenotomy scissors. 4.The amount of recession isscissors. 4.The amount of recession is measured with the callipers and marked onmeasured with the callipers and marked on the sclera. 5.The muscle tendon is suturedthe sclera. 5.The muscle tendon is sutured with the sclera at the marked site posterior towith the sclera at the marked site posterior to original insertion. 6.Conjunctival flap isoriginal insertion. 6.Conjunctival flap is sutured back.sutured back.
  28. 28. thankuthanku

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