This document discusses congenital/essential infantile esotropia, which is a type of eye turning inward (esotropia) present from birth. Some key points:
- It affects around 0.1% of the population and is characterized by a large angle esotropia (>30 prism diopters), constant crossing of the eyes, and asymmetry in optokinetic nystagmus.
- Early surgery before 18 months of age results in better binocular vision outcomes compared to later surgery. Surgery involves recession of the medial rectus muscles, with multiple muscles recessed for larger angle deviations.
- Early alignment through surgery improves stereoacuity outcomes by making patients less likely to need
Visual Evoked Potential in Normal and Amblyopic Childreniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Electrophysiological assessment of optic neuritis: is there still a roleClare Fraser
Visual evoked potentials were once in the diagnostic criteria for Multiple Sclerosis, but have been left off the most recent criteria. However, there are newer techniques available which are still invaluable in the diagnosis of optic neuritis and its common mimics.
Cystinosis is a rare autosomal recessive lysosomal storage disease ,results from mutation in the CTNS gene located at 17p13.2
Estimated incidence reported to be 1 in 100,000–200,000 live births
Visual Evoked Potential in Normal and Amblyopic Childreniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Electrophysiological assessment of optic neuritis: is there still a roleClare Fraser
Visual evoked potentials were once in the diagnostic criteria for Multiple Sclerosis, but have been left off the most recent criteria. However, there are newer techniques available which are still invaluable in the diagnosis of optic neuritis and its common mimics.
Cystinosis is a rare autosomal recessive lysosomal storage disease ,results from mutation in the CTNS gene located at 17p13.2
Estimated incidence reported to be 1 in 100,000–200,000 live births
PURPOSE: To evaluate the clinical outcomes of implantation of Ferrara intrastromal corneal ring segments (ICRS) in patients with corneal ectasia after refractive surgery.
Krishna Eye Center, Mumbai is one of the eye hospital which is providing the best treatment for squint. It is having a best Hospital Infrastructure in Mumbai
Discussion of clinical approach to typical (demyelnating) and atypical optic neuritis (immune/inflammatory/infectious) optic neuritis with evidence-based review.
Target: Ophthalmologists/Neurologists
Optic Neuritis and OCT in Multiple Sclerosis neurophq8
An overview of the update in optic neuritis and the utility of OCT in multiple sclerosis presented at the MS perceptorship in Dasman Institute in April 13 , 2017
PURPOSE: To evaluate the clinical outcomes of implantation of Ferrara intrastromal corneal ring segments (ICRS) in patients with corneal ectasia after refractive surgery.
Krishna Eye Center, Mumbai is one of the eye hospital which is providing the best treatment for squint. It is having a best Hospital Infrastructure in Mumbai
Discussion of clinical approach to typical (demyelnating) and atypical optic neuritis (immune/inflammatory/infectious) optic neuritis with evidence-based review.
Target: Ophthalmologists/Neurologists
Optic Neuritis and OCT in Multiple Sclerosis neurophq8
An overview of the update in optic neuritis and the utility of OCT in multiple sclerosis presented at the MS perceptorship in Dasman Institute in April 13 , 2017
Optic Neuritis and OCT in Multiple Sclerosis neurophq8
This talk was given in the MS preceptorship day in Dasman Institute . It discusses the advances in the diagnosis of optic neuritis and value of optical coherence tomography in MS patients.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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2. Esotropia(Convergent Squint)..Cornea deviated nasally
4-5% of squint in gen population.
0.1% of population have CET
50% ocular deviations in paed age group are Esotropias
40% cong ET of all ET
4. Heredity: multifactorial genetic basis for
congenital esotropia.
suggested loci on regions 3p26.3-26.2 and
6q24.2-25.1 and may share alleles that
underlie Duane retraction syndrome
Unaffected parents are more likely to have
slightly deficient stereopsis, but do not have
OKN asymmetry.
5. pathogenesispathogenesis
Worths sensory concept. Inborn and
irreversible defect of fusion.
Chavasse mechanical concept. Neural
components necessary for normal
binocular vision are present in strabismic
individuals at birth, but the development
of fusion is eventually impeded by
abnormalities of optical input (eg,
monocular cataracts) or muscular output
(eg, cranial nerve palsies)
6. Certain risk factors .
prematurity, family history, perinatal or
gestational complications, systemic
disorders, use of supplemental oxygen as
a neonate, use of systemic medications.
Awareness of these risk factors can lead
to early detection and management of
esotropia
7. CETCET
Alignment is achieved by 4mths in the
normal infant and stereopsis can be
measured in the laboratory.
Early misalignment constant or intermittent
beyond 2-4 months is required to be sure of
the diagnosis of congenital ET.
OKN asymmetry present in all infants
becomes symmetrical by 6 months in the
normal. Patients with congenital ET retain
OKN asymmetry
8. What to be seen in a patient with
congenital esotropia? (Diagnostic
criteria)
* Neurologically normal 70% (except for
ET)
* Hyperopia less than +3.50 (A greater
hyperopia does not rule out congenital
ET)
* Esotropia (30-70PD ± nystagmus)
9. A special characteristic of congenital
esotropia - OKN asymmetry
Temporal to Nasal (T/N).Smooth
following, rapid and accurate Refixation
Nasal to Temporal (N/T).Jerky,
inaccurate movement with halting
refixation
10. Congenital ETCongenital ET
ET by 6 mths
> 30 D ET & Stable
Assymetry of OKN
Cross fixation
Abd restriction
No clinical CNS involement
Deviation same for D & N
Consistant features
11. Associated featuresAssociated features
IO overaction 60%,
nystagmus,DVD 50% > 1yr
Amblypoia (35%)
AHP
It can be associated with a systemic
disease such as Down’s syndrome,
albinism, cerebral palsy, or
hydrocephaly.1-4
16. Management goalManagement goal
To make the eyes as close to orthotropia
with normal vision,develop some fusion
to keep alignment
May require multiple surgeries
Alignment with 8-10d results in
monofixation syndrome …comfortable
surgical result
18. Non surgical interventionNon surgical intervention
Botulinum toxin
To postpone surgery
Not as effective as surgery
Spects
Acc ET
Prisms
Temp measure
Small angle
19. SurgerySurgery
40d ET at 4 mths will not resolve
spontaneously
Must be as done early as possible to get
binocular function.
Large deviation…..correction is more
ET + amb…more correction
Fusion potential must be undercorrected
20. timing of surgerytiming of surgery
Early surgery decreases the severity of DVD and
lowers the need for additional operation for DVD
oblique overaction. Yagasaki et al, Zak and
Morin
Early vs. Late Infantile Strabismus Surgery Study
(ELISS), children operated at age 6-24 months had
better gross stereopsis at age 6 years compared
with those operated on later
21. Surgical alignment before 18 mos. better
binocularity
will even better binocularity be achieved with
alignment before 12 mo.
The Pediatric Eye Disease Investigator Group
(PEDIG) in the Congenital Esotropia Observation
Study (CEOS) determined that ET of 40 diopters
or more present at 2 months persists until 7
months - diagnosis of congenital ET can be made
ET of less than 40 prism diopters or intermittent
ET at 2 mos. has a 50% chance of persisting at 7
mos.
22. Surgical options
Recession of both MR
Symmetrical or asymmetrical
No of muscles depends upon
amount of deviation
Weakening of IO
rece.wmv
23. Results to be expected fromResults to be expected from
surgery for CETsurgery for CET
Single muscle..Sparingly MR Recession
Small angle (10-15pd),fusion potential,diplopia
DRS
Possible OVER CORRECTION
24. RESULT TO BE EXPECTED FROM
SURGERY FOR CET
Cong ET 50pd
Adult ET 40pd
Equal vision
ET .>N more AC/A
+Oblique muscle for
AV,&IOOA
BMR Recession
Minimal 2.5mm MR for 15-
20pd
Maxim.7mm for 40pd
BLR Resection
Div insufficiency. 20pd .5mm
Res ET 40pd 9mm
R&R
CET ..poor vision one eye
2.5MR-5LR..20-25pd
5MR+9LR <1yr….50pd
7MR+10LR..>3yrs 50pd+
Two muscle surgery
Measurement from
insertion
27. Why does early alignmentWhy does early alignment
improve stereoacuityimprove stereoacuity
outcomes in CET?outcomes in CET?
patients with stereo less likely to need a 2nd
surgery [p=0.05] and less likely to have DVD (P
<.001).
CONGENITAL ESOTROPIA 27
30. Management of CETManagement of CET
Confirm diagnosis
Fixation
fusion
Amblyopia
Accomadation,Refraction
Associated features
Surgery as early as possible
depending on anesthetist readiness
Picture and text with reflection
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