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CONCOMITANT
STRABISMUSSITI MARIAM BINTI MOHD HAMZAH
A type of manifest
squint in which the
amount of deviation in
the squinting eye
remains constant in all
directions of gaze...
ETIOLOG
Y
• Binocular vision and coordination of ocular
movements are not present since birth but are
acquired in the earl...
ETIOLOG
Y
Sensory obstacles
• Refractive errors
• Prolonged use of
incorrect spectacles
• Anisometropia
• Corneal opacitie...
1. OCULAR DEVIATION
• Unilateral or alternating
• Inward deviation or outward deviation or vertical deviation
• Primary de...
2. OCULAR MOVEMENT
• Not limited in any direction
3. REFRACTIVE ERROR
• May or may not be associated
4. SUPPRESSION AND AM...
V esotropia
A esotropia
Convergent
squint
(esotropia)
Divergent
squint
(exotropia)
Vertical
squint
(hypertropia)
TYPE
S
• Denotes inward deviation of one eye and is the
most common type of squint in children.
• Unilateral or alternating
COVER...
1. INFANTILE ESOTROPIA
• Age of onset, usually 1-2 months, but may occur during first 6 months
of life
• Angle of deviatio...
2. ACCOMMODATIVE ESOTROPIA
• Occurs due to overaction of convergence associated with accommodation reflex
• 3 types
• Refr...
3. ACQUIRED NON-ACCOMMODATIVE ESOTROPIAS
• Includes all those acquired primary esodeviations in which amount of
deviation ...
• Characterised by outward deviation of
one eye while the other eye fixates
DIVERGENT
SQUINT
Types
– Congenital exotropia
...
EVALUATION
• History
• Examination:
- inspection
- ocular movements
- pupillary reactions
- media & fundus examination
- t...
TREATMENT
• Goals of treatments:
- To achieve good cosmetic correction
- To improve visual acuity
- To maintain binocular ...
• Squint surgery
– Should always be instituted after the
correction of refractive error, treatment of
amblyopia and orthop...
thank you
concomitant strabismus
concomitant strabismus
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concomitant strabismus

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concomitant strabismus

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concomitant strabismus

  1. 1. CONCOMITANT STRABISMUSSITI MARIAM BINTI MOHD HAMZAH
  2. 2. A type of manifest squint in which the amount of deviation in the squinting eye remains constant in all directions of gaze; and there is no associated limitation of ocular movements
  3. 3. ETIOLOG Y • Binocular vision and coordination of ocular movements are not present since birth but are acquired in the early childhood. • The process starts by the age of 3-6 months and is completed up to 5-6 years. Therefore, any obstacle to the development of these processes may result in concomitant squint.
  4. 4. ETIOLOG Y Sensory obstacles • Refractive errors • Prolonged use of incorrect spectacles • Anisometropia • Corneal opacities • Lenticular opacities • Diseases of macula • Optic atrophy • Obstruction in the pupillary area due to congenital ptosis Motor obstacles • Congenital abnormalities of the shape and size of the orbit • Abnormalities of extraocular muscles • Abnormalities of accommodation, convergence and AC/A ratio Central obstacles • Deficient development of fusion faculty • Abnormalities of cortical control of ocular movements, and hyperexcitability of the CNS during teething
  5. 5. 1. OCULAR DEVIATION • Unilateral or alternating • Inward deviation or outward deviation or vertical deviation • Primary deviation is equal to secondary deviation • Ocular deviation is equal in all directions of gaze CLINICAL FEATURES IN GENERAL
  6. 6. 2. OCULAR MOVEMENT • Not limited in any direction 3. REFRACTIVE ERROR • May or may not be associated 4. SUPPRESSION AND AMBLYOPIA • May be develop as sensory adaptation to strabismus • Amblyopia develops in monocular strabismus only and is responsible for poor visual acuity 5. A-V PATTERNS • May be observed in horizontal strabismus. • when this patterns associated, the horizontal concomitant strabismus becomes vertically incomitant
  7. 7. V esotropia A esotropia
  8. 8. Convergent squint (esotropia) Divergent squint (exotropia) Vertical squint (hypertropia) TYPE S
  9. 9. • Denotes inward deviation of one eye and is the most common type of squint in children. • Unilateral or alternating COVERGENT SQUINT
  10. 10. 1. INFANTILE ESOTROPIA • Age of onset, usually 1-2 months, but may occur during first 6 months of life • Angle of deviation is constant and fairly large (>30 degree) • Fixation pattern • Binocular vision does not develop and there is alternate fixation in primary gaze and cross fixation in the lateral gaze • Amblyopia in 25-40% cases • Treatment • Amblyopia treatment by patching the normal eye should always be done before performing surgery • Recession of both medial recti is preferred over unilateral recess-resect procedure • Surgery should be done between 6 months – 2 years; preferably <1 year
  11. 11. 2. ACCOMMODATIVE ESOTROPIA • Occurs due to overaction of convergence associated with accommodation reflex • 3 types • Refractive accommodative esotropia • Associated with high hypermetropia (+4 to +7D) • Fully correctable by use of spectacles • Non-refractive accommodative esotropia • Caused by AC/A ratio • Esotropia is greater for near than that for distance • Fully corrected by bifocal glasses with add +3DS for near vision • Mixed accommodative esotropia • Caused by combination of hypermetropia and high AC/A ratio • Esotropia for distance is corrected by correction of hypermetropia; and the residual esotropia for near is corrected by addition of +3DS lens
  12. 12. 3. ACQUIRED NON-ACCOMMODATIVE ESOTROPIAS • Includes all those acquired primary esodeviations in which amount of deviation is not affected by the state of accommodation 4. SENSORY ESOTROPIA • Results from monocular lesions in childhood which either prevent the development of normal binocular vision or interfere with its maintenance 5. CONSECUTIVE ESOTROPIA • Result from surgical overcorrection of exotropia
  13. 13. • Characterised by outward deviation of one eye while the other eye fixates DIVERGENT SQUINT Types – Congenital exotropia – Primary exotropia – Secondary exotropia – Consecutive exotropia Rare, almost present at birth May be unilateral or alternating and may be intermittent or constant exotropia Constant unilateral deviation which results from long- standing monocular lesions associated with low vision in the affected eye Constant unilateral exotropia which results either due to surgical overcorrection of esotropia, or spontaneous conversion of small degree esotropia with amblyopia into exotropia
  14. 14. EVALUATION • History • Examination: - inspection - ocular movements - pupillary reactions - media & fundus examination - testing of vision & refractive error - cover tests (direct and alternate) - estimation of angle of deviation - tests for grade of binocular vision and sensory functions • Direct Cover Test • confirms the presence of manifest squint • Alternate Cover Test • Reveals whether the squint is unilateral or alternate • Differentiates concomitant squint from incomitant squint i. Hirschberg corneal reflex test ii. The prism and cover test iii. Krimsky corneal reflex test iv. Measurement of deviation with synoptophore
  15. 15. TREATMENT • Goals of treatments: - To achieve good cosmetic correction - To improve visual acuity - To maintain binocular single vision • Treatment modalities: - spectacles with full correction of refractive error - occlusion therapy - preoperative orthoptic exercises - squint surgery - postoperative orthoptic exercises
  16. 16. • Squint surgery – Should always be instituted after the correction of refractive error, treatment of amblyopia and orthoptic exercises.  Basic principles:  These are to weaken the strong muscle by recession (shifting the insertion posteriorly) or to strengthen the weak muscle by resection (shortening the muscle).
  17. 17. thank you

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