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Motor evaluation of squint part 1
The document outlines a comprehensive approach for assessing strabismus, detailing various clinical tests and their applications, such as Hirschberg, cover-uncover, and alternate prism cover tests. It emphasizes the importance of establishing a proper environment and using appropriate targets during examination to differentiate true squint from pseudo-strabismus. Additionally, it includes links for further simulation and reading materials related to strabismus evaluation.
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Motor evaluation of squint part 1
- 1. MOTOR EVALUATION OF STRABISMUS(part 1) Samhaa Mohammed Abd Elmoneim (FRCS Glasgow, Egyptian Fellowship, MSc.) Zagazig Ophthalmic Hospital (2021)
- 3. Before asking whatis Dx/ type of a squint, Ask about How do I examine and assess if patient has squint or not?
- 4. What we learnand practice today: • How to assess if there is ocular deviation or not using easy, quick and sensitive, objective clinical tests . • Simulate the steps and findings of each test in an organized, systematic, clear and proper way. • These tests confirm true squint (manifest/ latent) and exclude pseudo-strabismus.
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- 7. What you willassess 2. VA, cycloplegic Refraction, Amblyopia Assessment. 3. Inspection (pseudo causes, head posture) 4. Motor, deviation Evaluation (Hirschburg, cover/ uncover/ alternate cover, motility) 5. Sensory Evaluation (BSV: worth 4 dot, 4D base out prism, Maddox rod, Titmus…..) 6. Supplementary (eg: Bilschowsky 3 step, Hess, FDT, NPA, NPC....)
- 8. What you willassess
- 9. What you willassess 2. VA, cycloplegic Refraction, Amblyopia Assessment. 3. Inspection (pseudo causes, head posture) 4. Motor, deviation Evaluation (Hirschburg, cover/ uncover/ alternate cover, motility) 5. Sensory Evaluation (BSV: worth 4 dot, 4D base out prism, Maddox rod, Titmus…..) 6. Supplementary (eg: Bilschowsky 3 step, Hess, FDT, NPA, NPC....)
- 10. What tests wewill apply today Hirschburg Cover- uncover Alternate cover Alternate prism cover
- 11. Prerequisites before examination •Take your time to establish familiar environment with kids. • You have to be in the same level of patient • Correct any AHP abnormal head posture/ make head straight-ahead. • Use fixating (accommodating or distant) target in assessing motility (not penlight torch) • Cover/ uncover/ alternate cover/ motility assessment (in near/ far, with/ out glasses, in all gazes)
- 12. What tests wewill apply today Hirschburg Cover- uncover Alternate cover Alternate prism cover
- 13. Hirschburg test Penlight atdistance 50 cm Each 1mm = 7 degree = 15 PD
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- 17. Cover/uncover test Cover Assess tropia (manifest) Lookat uncovered eye Uncover Assess phoria (latent) Look at covered eye • Use fixating target, cover for few seconds • Start with covering orthtropic eye in case of manifest squint • Assess near/ far, with/ without glasses, in all directions
- 18. Alternate cover test •Use fixating target, cover for few seconds before shift (to allow time for the other eye to fixate) • Start with covering orthtropic eye in case of manifest squint • Assess near/ far, with/ without glasses, in all directions Assess tropia and phoria (dissociate binocular vision)
- 19. Alternate cover test •Use fixating (accommodating or distant ) target • Cover one eye then the other one then go back and forth several times (wait few seconds with cover before shift to allow time for the other eye to fixate) • Start with covering orthtropic eye in case of manifest squint • Assess near/ far, with/ without glasses, in all directions Assess tropia and phoria (dissociate binocular vision)
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- 21. Alternate prism covertest • Use fixating (accommodating or distant) target • Put prism infront of deviating eye in position (apex with deviation) • Cover one eye then the other one then go back and forth several times (wait few seconds with cover before shift to allow time for the other eye to fixate) • Assess near/ far, with/ without glasses, in all directions Assess tropia and phoria (dissociate binocular vision) + measure total angle
- 22. Pseudostrabismus Facial/ orbit/ lid/globe morphology Flat nasal bridge Epicanthal folds Small IPD -ve kappa angle in –ve errors Narrow palpebral fissure Enophthalmos Craniosynostosis (pseudo ET)
- 23. Pseudostrabismus Facial/ orbit/ lid/globe morphology Narrow lateral epicanthus Wide IPD, hypertelorism +ve kappa angle in +ve errors Ectopic macula Wide palpebral fissure Exophthalmos Craniosynostosis (pseudo XT)
- 24. Pseudostrabismus Facial/ orbit/ lid/globe morphology Narrow lateral epicanthus Wide IPD, hypertelorism +ve kappa angle in +ve errors Ectopic macula Wide palpebral fissure Exophthalmos Craniosynostosis (pseudo XT)
- 25. Pseudostrabismus Facial/ orbit/ lid/globe morphology Ptosis Lid retraction Facial assymetry Lid coloboma Craniosynostosis (pseudo HT, HypoT)
- 26. Now, Lets Practice (reportwhich test you miss and what you miss in each test) All previous tests are mandatory for comprehensive squint examination
- 27. Links for simulationand readings • https://www.aao.org/interactive-tool/strabismus-simulator • https://eyewiki.aao.org/Sensory_and_Motor_Testing • https://www.researchgate.net/publication/349348910_Bas ic_Examination_of_Strabismus • https://higherlogicdownload.s3.amazonaws.com/AAPOS/1 59c8d7c-f577-4c85-bf77- ac8e4f0865bd/UploadedImages/Documents/Iowa_Strabis mus_Notes_v2017c.pdf
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