ocular Deviations

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ocular Deviations

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

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