Download to read offline
More Related Content
Similar to Esotropia -2 ( Accomodative Esotropia).pdf
Esotropia -2 ( Accomodative Esotropia).pdf
- 1.
- 2. Accommodation is theact of changing focus from distance to near Convergence is the additional occus during accommodationment of the MR muscles that Accommodation & convergence are closely linked in all individuals I are stable for each person Accommodative convergence amplitude is findmodel i convergence that & ALIA ratio is a method to measure relationship bu accommodation & convergence ① ACIA -3 - 5
- 3. AC/A Ratio Measurement -Gradient method y Heterophona amp method ↳ Use accommodative ↓ tages00 wear full optical consection ↳ Presi E alternate - to cover testing messure deviations
- 4. Accommodative Esotropia It is eotropia whichis caused by over convergence in response to accommodation It is chf by straight eye at rest a exotropic when accommodating . 3 types / I - Partially ↑ accommodative Reflective Non-refracture accommodative accommodative · uncorrected f wor . namally hypermetopra - 12 to >D)
- 5. Refractive refractive normal accommodative accommodative - & Refractivehyper accommodative Refractive Normal Accommodative Reflective normal accommodative has accommodation ↑ i I accommodative convergence Hypermetropia - asthenopic symptoms Esodeviation is same for near a distance AL/A ratio will be normal Responds well to myeloplegic conective spectacle No deviation detected I corrective spectacles for distance a near
- 6. ↓ Refractive hyperaccommodative Esotropes z success convergenceper diopter of accommodation & T8 Abnormal relationship ba convergence &accommodation Estimated AC/A ratio is higher Near deviction is more then distance deviation Residual sotropia noted men I full colected spectacles correct neer deviation by giving exter hypermetropic glasses for near.
- 7.
- 9. time onset - >2 to 3 years of Hypermetropia O usually 2 to GD Esphoria e Intermittent Esotropia t Ecotopia h ↓ Give child presents si historythat whe the I this focussing at near object ye Loss d Transient diplopes L hild racts by irritability a closing one eye
- 10. Treatment D opticalcorrection
- 15. ② Role of mistics -Not so common - > only in highly uncooperative pts ③ Amblyopia thropy
- 17. Non-refractive accommodative Esotropia No evidence of f error AbD relationship5/w accommodative convergence & diopter of accommodation /- Hyperaccommodative ↑ Hypoaccommodate Ab relationship b)w ↓ accommodative Weak existing accommodation a accommodation mergence Entre accommodation needed slight accommodatio i to overcome blueing Results in marked ↑ Increases accommodative convergence convergence (not coresponding to diopter of accommodation - > A4A ratio child over accommodates to see will always be higher) clearly for near No significant potropia for distance
- 18. ↓ ↓ Deniston miltbe more fer over-accommodation leads to near them for distance an Pee in accommodative ↓ convergence NPA NPC may se normal results in esotropia ↓ ACA ratio - D ↓ NPAGNPC may be abnormal
- 19. Management Bifocels - & Distant segment ofy the hypocyclope & Near segment isadded with a plus pener ranging from + 1. 25 to + 3 D spherical & The lens type chosen should be executive lenses The upper limit of the tower segment should bisest the pupil . The frame should fit sngly on the nocal bridge to I - prevent sliding IIt should not slide donen) connelling of parents is imp
- 20. 1- !# ( 6 0 8J #J 2 7 ) 3 ) G89+ 7 ) )) . ##B 6 3 ) G-$+ 6 7 (1 F 6 7 6 7 / ( ? G-$+ 2 . G8+ G$9+ G-$+ . 5 = 8$B /! - ) # 3 8+ 7 ? 9 G$B9 G8+ . C * 8$ + ' ? = 4/ 2 ,* 4 7 3C3 * * ! % $
- 22. ele of tim Maiogoal of prismis to maintain binocularityd i is Persis are used in hemanagement of pediatea ye are when these is a O Prisms can be incorporated into the spectacle less or - S used as a fresnel prism in a membrane Exercises Role of outhaptic - Orthoptic exercises may not be effective in young children ↑ Children who Cu understand double vision during squinting can be taught to relen their convergence z mechanem g
- 23. Use of drugs (Mintic) - I can bea tentcorary treatment option Mistics act on the ciliary Mo to induce miosis * accommodation E reduce accommodative 1 .. used in non ref high AC/A ratios convergence Prefered drugs echothiophate iodide or demecerian bromide surgeon should counsel parents about systemic X oculse se before pescribing miotics
- 24. Indications - Surgical Correction ↳ Necessary for larger deviationsthat cannot e corrected spectacles Done for high ALA natio detection Augmented Rimediah recession E posterior fination sutuee . because they can dampen accommodative accommodation convergence during
- 25. Partially accommodative Esotropia It has bothaccommodative men-accommodative component Non-accommodative component cannot be corrected I single vision or bifocal lenses Non-accommodative component is constant for both near distance vision I Early detection imp to prevent amblyopia Even i spectacles - there may be still recidual ↑ accommodative ecotropia D weal longed upated alternateover the needmay that are partially non-accommodative components in a partially accommodative sotropia -
- 26. a Clinical type /Infantile esotropicI orperodded accommodative Esotropia (by 2-3 yes of age) Decompensated accommodative esotropia T b superadded new accommodative sotropia (After priod of initial alignment cotropic again develops dif emperedded non accommodative factors Management I wearing spectacles I regularfellow up 2 Amblyopia should be treated rang patching Prsi's can be used for small deviations - Surgery is the choice if deviation exceeds Goph Surgery should be planned for non-accommodative part of deviation
- 27. 1 !# + 8 3 3*$ ) 3 * 3C3 %%# ! /* ) #8F . #1- % /* 7 @ . .* 3/ + 8%$ 6 , H 6 6 ( 2 6 1 3 % = - 8F+ -9 7 = 6 $ ! 1 + * . 8 # ' 1 6 : 3