Grand Rounds
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The document discusses the nature and management of comitant convergent and divergent strabismus. It covers factors to consider in evaluation such as age, angle of strabismus, and sensory adaptations. For management of convergent strabismus, it discusses approaches for fully accommodative esotropia, partially accommodative esotropia, convergence excess, and non-refractive esotropias. For divergent strabismus, it discusses divergence excess, near exophoria, and constant exotropia. Surgical correction is usually needed for large angle or non-accommodative deviations.
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- Characteristics include a foveal suppression scotoma in the deviating eye, reduced visual acuity in that eye, and anisometropia in nearly all cases. Microtropia can be classified as primary or secondary.
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Contact lenses require proper cleaning, disinfecting, and storage to maintain eye health. There are various types of contact lens solutions designed for different purposes, such as multipurpose solutions for cleaning, rinsing, disinfecting, and storing lenses, and hydrogen peroxide-based solutions for cleaning and disinfecting. Follow-up with an eye doctor and proper hygiene are important for safe contact lens wear.
disposable contact lenses
1. The document discusses the benefits of disposable contact lenses and frequent replacement programs (FRP) for providing healthier contact lens wear. It notes that consumers prioritize healthier lenses that do not cause infections or complications.
2. Disposable and FRP lenses are presented as ways to eliminate obstacles to successful contact lens wear like deposits, films, irritation and reduced comfort by replacing lenses frequently. They provide benefits like superior comfort, hygiene, and convenience.
3. The document outlines different types of disposable and FRP lenses available based on modality, wearing time, material, correction, and discusses their advantages over traditional lenses in promoting ocular health, satisfaction, and retention of contact lens wearers.
Examination protocol for binocular vision
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Ms. XYZ, a 14 year old female student, presented with gradual diminishing of vision in both eyes over the past 5 years. Her examination revealed pigmentary changes in the macula and peripheral retina bilaterally consistent with Stargardt disease. Genetic testing and counseling confirmed an autosomal recessive inheritance pattern from her parents' consanguineous marriage. She was referred for low vision rehabilitation including magnification devices for near and distance tasks. Stargardt disease causes progressive central vision loss due to mutations in the ABCA4 gene and accumulation of toxic byproducts in the retina.
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Strabismus
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Photorefraction
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Photorefraction is the newest retinoscopy technique
Its main application is the screening of infants and young children
Intermitent exotropia
1. Intermittent exotropia is characterized by periods of outward eye misalignment (exotropia) that intermittently switches to proper eye alignment (orthophoria).
2. There are several theories for the cause of intermittent exotropia including imbalances in convergence and divergence muscles, abnormal resting eye position, and uncorrected refractive errors.
3. Treatment involves correcting refractive errors, patching, orthoptic exercises, and surgery for larger or worsening deviations. The goal is to improve fusion and control of the exodeviation to prevent progression.
Refraction
This document outlines the process and key steps involved in performing a refraction exam, including: collecting a case history; performing objective and subjective refraction tests to determine sphere and cylinder values; evaluating binocular vision through tests of motor and sensory functions; prescribing glasses for both distance and near vision; and verifying binocular balance. Special considerations are discussed for non-presbyopic patients, prescribing prism, and potential referrals. The refraction exam procedure is described in detail over 32 pages.
ocular Deviations
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- Partially accommodative esotropia with both accommodative and non-accommodative components
- Non-accommodative esotropia including convergence excess, cyclical esotropia, and acquired forms
- Esotropia associated with high myopia or nystagmus is also discussed
Treatment options including refractive correction, orthoptic exercises, prisms, botulinum toxin, and surgery are mentioned for different types of esotropia.
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This document discusses various types of non-accommodative esotropia, including microtropia, near esotropia, distance esotropia, acute esotropia, secondary esotropia, consecutive esotropia, divergence insufficiency, cyclic esotropia, and high myopia esotropia. For each type, the document outlines typical presentation, clinical signs, and treatment approaches. The overall document provides an overview of different non-accommodative esotropia subtypes for ophthalmologists.
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This document discusses different types of esotropia (inward eye turning), including accommodative esotropia caused by uncorrected refractive errors, convergence excess esotropia caused by a high AC/A ratio, and early onset esotropia appearing before age 6 months. Accommodative esotropia is treated initially with corrective lenses, while convergence excess may require bifocals or surgery. Early onset esotropia often requires surgery by age 1-2 years to align the eyes, with risks of undercorrection, amblyopia, or development of dissociated vertical deviation. The document provides details on diagnostic criteria and management approaches for various forms of esotropia.
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This document discusses esotropia, or inward eye deviation. It defines concomitant and inconcomitant esotropia and describes various types including accommodative, refractive, and early onset esotropia. Accommodative esotropia is caused by excess convergence during accommodation. Refractive accommodative esotropia involves excessive hyperopia. Early onset esotropia develops within 6 months and involves a large, stable deviation. The document outlines signs, etiologies, and management including optical correction, miotics, and surgery for different types of esotropia.
ACCOMMODATIVE ESOTROPIA.pptx............
Accommodative Esotropia
Definition
Esotropia (ET) linked to accommodation
History
Onset 6 months - 7 years (average 2.5 years)
May be intermittent at onset, (sometimes precipitated by trauma or illness) becoming constant
Diplopia may occur but usually disappears as the patient develops suppression scotoma
Approximately 75% have a family history
Amblyopia common (50%)
No associated IOOA or DVDs
Classification
Accommodative
High AC / A
Mixed (most common)
Definition
Hypermetropia means that a high amount of accommodation (with a proportionate amount of convergence) is required to focus even on a distant target
Accommodation is associated with a dis-proportionately high amount of convergence
Hypermetropia
High AC / A
1.Fully accommodative
Esotropia (ET) fully corrected by full cycloplegic refraction
2. Partially / (Non)
accommodative
ET only partially corrected by full cycloplegic refraction (i.e. still ET for D&N)
Distance prescription corrects distance deviation but a deviation remains at near
CTD / N
ET Distance= ET Near (within 8Δ)
Straight Distance (after correction), ET Near.
ET for near may be reduced or eliminated by a +3.0 add
ET Distance < ET Near (by >8Δ)
i.e. When straight for distance with full cycloplegic correction will still have ET for near.
ET for near may be reduced or eliminated by a +3.0 add
Refraction
Hypermetropia (e.g. +3 to +10D)
Emmetropia (ranges from myopic to high hyperope)
Hypermetropia
AC / A ratio
Normal (e.g. 3-5)
High
High
Examination Structure
1. Visual Acuity (Best Corrected)
Amblyopia is common (50%, especially partially accommodative)
2. Spectacles
3. Inspection
Abnormal Head Position (AHP)?
Hirschberg (pupil margin=30Δ, limbus=90Δ) - Esotropia
(Lids normal)
(Pupils normal)
4. Cover-Testing
Comitant ET (Measure distance & near as an estimation of AC / A. An ET that is greater for near than distance suggests a high AC / A, but this can only be proven by formal testing- see below)
A) Without glasses: CTD, CTN
B) With glasses: CTD, CTN
(NB: Attempts may also be made to measure the AC / A ratio by the lens gradient method by cover-testing at near with and without +3D lenses)
5. Ocular Rotations
Full ductions (Exclude CNVI palsy) ± IOOA
DVD is uncommon
6. Stereopsis
7. Dilated Fundoscopy
8. Cycloplegic Refraction
Often Hypermetropic. Use:
Cyclopentolate 1%, (Phenylephrine 2.5%) or
Atropine 1% bd for 3 days prior if dark irides, amblyopic, unsure, unco-operative
Summary
Fully / Partially / Non-Accommodative ET with presumed Normal / High AC / A
Investigations
Most accommodative esotropias do not require further investigations. However, neuroimaging (MRI brain) should be considered when the presentation is atypical:
Acute onset
Older (>7yrs)
Incomitant i.e. abduction deficit
Diplopia, other neurological signs (e.g. CN VI, papilloedema, nystagmus)
No hypermetropia
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This document provides an overview of esotropia, or convergent strabismus, including its classification and types. It discusses accommodative esotropia in more detail. Accommodative esotropia can be refractive, caused by hyperopia, or non-refractive, caused by a high AC/A ratio. Treatment involves correcting refractive errors with glasses and potentially bifocals. Surgery such as medial rectus recession may be considered if the deviation is not fully corrected with optical correction alone. The document outlines different types of accommodative esotropia and their typical treatments.
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This document discusses esotropia, which is an inward turning of one or both eyes. It defines esotropia and describes the different types including accommodative esotropia, congenital esotropia, and microtropia. It outlines the causes, characteristics, diagnosis, and management of each type of esotropia. Some key points covered include the role of accommodation and refractive error in accommodative esotropia, the importance of early treatment for congenital esotropia to prevent amblyopia, and the use of occlusion therapy, refractive correction, surgery, and botulinum toxin injection in the management of esotropia.
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Differential diagnosis of DVD involves evaluating the vertical deviation of each eye during fixation and determining if the deviation is greater at distance. DVD is associated with conditions like infantile esotropia. Management focuses on establishing sensory fusion without vertical prisms first before considering prism or surgery. Prisms and surgery aim to eliminate sensory anomalies and address any primary vertical deviation component.
Management of esotropia.ppt
This document discusses the management of esotropia, a type of strabismus where the eyes turn inward. It describes the different types of esotropia including concomitant, accommodative, and inconcomitant esotropia. For treatment, it emphasizes correcting refractive errors and amblyopia first before considering surgery. For concomitant esotropia in young children, the initial surgery is typically recession of both medial rectus muscles. For accommodative esotropia, treatment involves correcting refractive errors or surgery depending on the severity. Management is tailored based on the specific type and cause of esotropia.
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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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.
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Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
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Grand Rounds
- 1. Grand Rounds
- 27. Intermittent:
- 38. Nature and Management of Comitant Divergent Strabismus
- 54. Investigation
- 58. Dissociated Vertical Deviation (alternating sursumduction) Stidwell, 1997
Editor's Notes
- The condition in which the patient sees not much and the practitioner nothing at all… ! It is always (or almost always) associated with strab, aniso or form deprivation in early life. Diagnosed when there reduced letter acuity, absence of pathology and when any ametropia is corrected. The results of pyschophysical studies & electrophysiological investigations suggest little primary retinal or LGN abnormality. Instead, the most profound effects of the amblyopic process are found in the striate cortex.