Downloaded 44 times
Uploaded byTahseen Jawaid
Concomitant and Incomitant, AHP and Hess chart
This document discusses abnormal head posture, concomitant and incomitant strabismus, and Hess chart testing. It defines concomitant as having equal angle of deviation in all gazes, while incomitant deviation varies between gazes. Incomitant can be neurogenic from nerve palsies or mechanical from conditions like Brown syndrome. Abnormal head posture is a motor adaptation to maintain comfortable vision and includes face turns, chin elevation/depression, and head tilts. Hess chart testing uses red/green filters or mirrors to dissociate the eyes and identify muscle weaknesses or palsies.
More Related Content
Similar to Concomitant and Incomitant, AHP and Hess chart
Concomitant and Incomitant, AHP and Hess chart
- 1.
- 2. 1. CONCOMITANCE /INCOMITANCE 2. ABNORMAL HEAD POSTURE 3. HESS CHART
- 3. DEFINITIONS CONCOMITANT DEVIATION: Angleof deviation remain same in all directions of gaze and there is no limitation of ocular movements. INCOMITANT DEVIATION: Angle of deviation varies in different position of gazes and there is limitation of ocular movements. Secondary angle of deviation is greater than primary deviation
- 4. DIFFERENCIAL CRITERIA COMITANTDEVIATION INCOMITANT DEVIATION OCCURANCE More common Less common ONSET Usually congenital Usually acquired DEVIATION Primary angle is equal to secondary angle Secondary greater than primary angle MOVEMENT No limitation Limitation AHP None Present DIPLOPIA None Amblyopia CAUSE Hereditary Uncorrected refractive error Usually injury Vascular diseases DEPTH PERSCEPTION None due to suppression Present when do AHP
- 5. INCOMITANT DEVIATION NEUROGENIC MYOGENICMECHANICAL 3RDNERVE PALSY 6TH NERVE PALSY 4TH NERVE PALSY DOUBLE ELEVATOR PALSY DOUBLE DEPRESSIVE PALSY Myasthenia gravis Chronic Progressive External Ophthalmoplegia Orbital myositis Brown syndrome Duane syndrome Orbital injury Thyroid eye disease
- 6. INVESTIGATION CONGENITAL ACQUIRED PRESENTATIONUnacceptable cosmetic appearance symptoms of decompensation, Unaware of AHP. Diplopia and occasionally pain OCULAR MOTILITY Often full muscle sequlae Muscle sequlae not fully developed DURATION Longstanding Recent BINOCULAR FUNCTION Extended vertical fusion range Normal fusion range
- 8. ABNORMAL HEAD POSTURE: AHP is a motor adaptation and it is adapted in the interest of comfortable vision COMPONENTS OF AHP: Face turn towards right or left side Chin up or down Head tilt towards right or left shoulder ASSESMENT OF AHP: Compare ear is more visible Check whether eyes are level Observe chin from side
- 9. CAUSES OF AHP: OCULARCAUSES •Obtain BSV •Maintain BSV •Overcome symptoms •Improve visual acuity •Protect eyes •Separate diplopia in paralytic strabismus •Nystagmus NON OCULAR CAUSES: •Shyness •Habit •Deafness •Mental developmental delay •Arthritic condition •Non ocular torticollis(Contracture of Sterno- mastoid muscle. How to confirm either AHP is ocular or non ocular?
- 10. EXAMINATION OF COMPONENTSOF AHP FACE TURN: CHIN ELEVATION OR DEPRESSION HEAD TILT
- 11. AHP IN PARALYTICCONDITIONS: NEUROGENIC PALSIES: 3rd nerve palsy Complete Incomplete(divisional or isolated) 4th nerve palsy 6th nerve palsy MECHANICAL PALSIES: Brown syndrome Duane’s syndrome AV PATTERNS: A eso or V exo A exo or V eso NYSTAGMUS:
- 13. 1:Dissociation of theeyes by either : • Red and green goggles in case of hess • The mirror in case of lees screen 2:Foveal projection inn the presence of normal retinal correspondence : 3:Herring’s law and sherrington’s law: • Explain the development of muscle sequlae.
- 14. 1:Diagnosis of: U/a or o/a of eom. Mechanical or neurogenic palsy Congenital/long standing Acquired/recent palsy 2:planning of surgery and post-op effects of surgery 3:Monitoring of surgery Full muscle sequlae will include : E.g :sr u/a = io o/a :Ir o/a = so u/a
- 15. What isthe direction of the deviation eg: Eso, exo, hyper, hypo? What is the size of the deviation? Is the deviation concomitant or incomitant ? Is there a smaller field ? Which is the affected muscle(s) or nerve(s) ? Has the muscle sequelae spread to produce concomitance ? Is the aetiology mechanical or neurogenic ? Is there an a or v pattern ?