Cover test
Prism cover test
Worth 4 dot test
Bagolini striated glasses
Synoptophore
Stereopsis tests
The aim is to assess:
- Ocular alignment
- Fusional reserves
- Stereopsis
- Retinal correspondence
Cover Test
The cover test is used to detect manifest
strabismus and latent strabismus.
It is performed at distance and near to check
for any phorias or tropias.
It provides information about:
- Direction of deviation
- Comitance
- Size of deviation
- Presence
It describes about the procedure of Hess charting. it serves as a great tool to understand the concepts involved. Suitable for optometry course. This is not a routine procedure but an important procedure which is used in diagnosis.
It describes about the procedure of Hess charting. it serves as a great tool to understand the concepts involved. Suitable for optometry course. This is not a routine procedure but an important procedure which is used in diagnosis.
Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/presbyopia-near-addition/❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤❤
Presbyopia and techniques of measurement
A fantastic presentation in the topic "Presbyopia and techniques of measurement"
A detailed information about presbyopia, techniques of presbyopic add determination and different correction methods.
Informative slide presentation on presbyopia for ophthalmology residents, ophthalmologists, optometrists, ophthalmic assistants, ophthalmic technicians, ophthalmic nurses, medical students, medical professors, teaching guides.
Presentation Contents:
--Introduction to presbyopia
-Types of presbyopia
-Risk factors
-Symptoms and signs
-Refractive error and presbyopia
-Methods of determining near add.
-Management of presbyopia
In a nutshell..
- The evaluation and management of presbyopia are important because significant functional deficits can occur when the condition is left untreated
- Undercorrected or uncorrected presbyopia can cause significant visual disability and have a negative impact on the pt.'s quality of life
- Finally, every tentative addition should be adjusted according to the particular needs of the patient
For Further Reading:
-Clinical Procedures in Optometry by J.D. Bartlett, J.B. Eskridge, J.F. Amos
-Primary Care Optometry by Theodere Grosvenor
-Borish’s Clinical Refraction by W.J. Benjamin
-Clinical Procedures for Ocular examination by Carlson et al
-American Academy of Ophthalmology
-Optometric Clinical Practice Guideline by American Optometric Association
-Internet
Follow me to get in touch with optometric and ophthalmic updates.
what is Duochrome Test, Why do we take Red and Green color only,
What is the Principal of Duochrome Test, Why Hyperopic Pt sees green better than red and vice versa
Gives a very brief review of how to evaluate a case of squint in day to day clinical practice. How to diagnose a basic abnormality of the movement of eye.
This presentation is a detailed description of how a patient should be examined in an oprthoptic clinic. it lists down all the investigations sequentially. the order of investigations mentioned is the best way to investigate a squint case.
Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/presbyopia-near-addition/❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤❤
Presbyopia and techniques of measurement
A fantastic presentation in the topic "Presbyopia and techniques of measurement"
A detailed information about presbyopia, techniques of presbyopic add determination and different correction methods.
Informative slide presentation on presbyopia for ophthalmology residents, ophthalmologists, optometrists, ophthalmic assistants, ophthalmic technicians, ophthalmic nurses, medical students, medical professors, teaching guides.
Presentation Contents:
--Introduction to presbyopia
-Types of presbyopia
-Risk factors
-Symptoms and signs
-Refractive error and presbyopia
-Methods of determining near add.
-Management of presbyopia
In a nutshell..
- The evaluation and management of presbyopia are important because significant functional deficits can occur when the condition is left untreated
- Undercorrected or uncorrected presbyopia can cause significant visual disability and have a negative impact on the pt.'s quality of life
- Finally, every tentative addition should be adjusted according to the particular needs of the patient
For Further Reading:
-Clinical Procedures in Optometry by J.D. Bartlett, J.B. Eskridge, J.F. Amos
-Primary Care Optometry by Theodere Grosvenor
-Borish’s Clinical Refraction by W.J. Benjamin
-Clinical Procedures for Ocular examination by Carlson et al
-American Academy of Ophthalmology
-Optometric Clinical Practice Guideline by American Optometric Association
-Internet
Follow me to get in touch with optometric and ophthalmic updates.
what is Duochrome Test, Why do we take Red and Green color only,
What is the Principal of Duochrome Test, Why Hyperopic Pt sees green better than red and vice versa
Gives a very brief review of how to evaluate a case of squint in day to day clinical practice. How to diagnose a basic abnormality of the movement of eye.
This presentation is a detailed description of how a patient should be examined in an oprthoptic clinic. it lists down all the investigations sequentially. the order of investigations mentioned is the best way to investigate a squint case.
strabismus , gaze , ocular movements , classification etc
presented by senior optometrist & orthoptician at Sagarmatha Choudhary Eye Hospital, SCEH, LAHAN (NEPAL )
He explain details about the binocular gaze , EOMs, etc & work up of a patient of squint etc.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
4. 1.History
Patient with ocular motility disorder present
for one or more of the following reason:
Manifest strabismus
Defective ocular movement
Nystagmus
AHP
Defective vision
Subjective symptoms
5. 1.History continue….
The reason for attendance must first be
established.
In children greater emphasis is placed on
obstetric history and developmental miles stone.
Where as the medical history can be of
paramount importance in adult.
6. 1.History continue….
a. Medical history:
The child general development
Recent illness and treatment
Any trauma to the head and face
Any systemic disease
b. Obstetric history
The mothers health during pregnancy
Delivery
The child birth weight
c. Family history
Parental consanguinity
Strabismus
Refractive error
7. 1.History continue….
e. Strabismus in children:
The Direction of strabismus
The age at which it was first noticed
Who noticed it
Whether the onset was gradual or sudden
Frequency of deviation (constant or intermittent)
Previous treatment, if any, and the type and results of such
treatment
f. Strabismus in Adults:
Cosmetic
Subjective symptoms
9. 2.Visual Acuity
Easy in adults or older children
Very difficult in infants.
But even than can be assessed by various
techniques
10. Normal visual development
From Alec. M Ansons and Helen Davis
The development of VA from birth to age three year
Age
New Born
I months
Visual Acuity
6/240
6/180 - 6/90
4 - 6 months
6/18 - 6/6
3 years
6/6
with single optotypes
11. Normal visual development
Age related VA estimated by test method
From Kenneth W. Wright
Technique
Birth
2 months
4 months
6 months
OKN
20/400
20/800
20/200
20/100
20/60
20-30 months
20/800
20/200
20/150
20/50
18-24 months
20/40
20/20
6-12 months
FPL
20/400
VEP
20/800
20/150
20/60
1 year
Age for 20/20
12. Age Indication For VA Tests
Age 0-6/12:
VEP ,FCPL, OKN, CSM, Objection to occlusion,
Catford Drum etc.
6/12 to 2 years:
100s & 1000s, Stycar balls, FCPL, Cardiff cards…
2 to 3 years:
Kay pictures, Illiterate E, Lea Symbol.........
3+ years:
Sheridan Gardener, Landolt C, Snellen , LogMar…….
13. CSM
The ability of each eye to fixate Centrally,
steadily, and Maintain fixation.
Centrally means foveal fixation
Steady means no nystagmoid movement
Maintain mean the ability of one eye to maintain
fixation when viewing is converted from a
monocular condition to a binocular condition.
15. 3.Ocular deviation
Detection of Strabismus can be made
through:
Observation of the patient appearance
Observation of the corneal reflex
The cover test
16. 3.Ocular deviation cont…
The cover test
It is an objective test which is the core stone of
investigation of strabismus.
Requires:
Pin torch
Occluder
Target for 33cm and 6m
17. 3.Ocular deviation cont…
The cover test can be used in two ways:
1) The cover /uncover in which one eye is covered
and the observer notes:
a) The movement of the uncovered eye to take
up fixation.
b) The position and movement of the covered
eye as cover is removed.
18. 3.Ocular deviation cont…
2) Alternate cover test in which both eyes are
covers alternatively the movement of the
covered eye is noted as the cover is changed
from one eye to the other.
It is more dissociative than cover/uncover test
19. 3.Ocular deviation cont…
Information provided by the cover test:
Direction of deviation
The difference in angle from near to distance
The effect of accommodation
Comitance and incometance
Estimation of VA
The speed of recovery in latent strabismus
Constant ,intermittent, unilateral or alternating
Latent nystagmus or latent component in manifest
nystagmus
DVD
A/V Pattern
20. 3.Ocular deviation cont…
Confirmation and measurement of strabismus:
1. Hirschberg
2. Krimsky
3. Prism cover test
4. Simultaneous PCT
5. Maddox rod
6. Double Maddox rod
7. Maddox wing
8. Major amblyoscope
9. Diagnostic occlusion
21. 1.Hirschberg
Used as an initial screen for strabismus
How it works:
At 33cm front of child with penlight shining at eyes
Light reflection will be at the same point in each eye
Normal
Exotropia
Esotropia
23. 2.Krimsky Test
This test is used to centralize the corneal
reflection in the squinting eye with
compared to the fixing eye.
24. 3.Prism Cover Test
Measure squint/misalignment
Single prism/prism bar
Primary position or in all positions of gaze
For near and distance
25. 4. SIULTANEOUS PCT
The prism is placed in front of the deviating eye
and a cover simultaneously introduced in front
of the fixing eye.
The aim is to neutralize the movement of the
squinting eye as the fixing eye is covered.
The test is performed with the same way by
increasing the strength of the prism until the
squinting eye did not move under the prism.
It grieves the estimation of tropia only.
26. 5.MADDOX ROD
Use of the Maddox rod
provides entirely subjective
method of measuring
horizontal, vertical and
torsional deviation . (Phoria)
Dissociation of the eye is
achieved by presenting a spot
light to one eye and a line
image to the other eye.
27. 6.Double MADDOX ROD
Torsional deviations:
Torsional deviation can be measured with
double Maddox rod.
The Maddox rod can be placed parallel in front
of both eyes better if have different color.
The patient is asked wither the both lines are
exactly align when placed parallel Maddox rod in
front of both eyes or vertical prism can be
introduced to separate the lines and than ask
28. 7.MADDOX WING
The Maddox wing dissociates the eyes by
means of two septa, so that the horizontal
and vertical measurement scales are
visible to the left eye and the right eye
sees the two arrows , one vertical to
indicate the horizontal measurement and
the other horizontal indicating the vertical
measurement for 33cm with correction.
Measurements are recorded in prism
dioptres
30. 9.DIAGNOSTIC OCCLUSSION
Diagnostic occlusion can be used to induce full
dissociation when it is thought that the maximum angle
of deviation has not been revealed.
Used in:
Intermittent exotropia.
To diagnose whether symptoms are due to hetrophoria.
To differentiate between real or apparent limitation of
abduction in children.
33. Muscle
Length of
active
muscle
(mm)
Origin
Anatomic
insetion
Direction innervation
of pull
Medial
Rectus
40
Annulus
Of zinn
5.5 mm from
Medical limbus
90o
Lower
CN III
Lateral
Rectus
40
Annulus
Of ainn
6.9 mm from
Lateral limbus
90o
CN VI
Superior
Rectus
40
Annulus
Of ainn
7.7 mm from
Superior limbus
23o
Upper
CN III
Inferior
Rectus
40
Annulus
Of ainn
6.5 mm from
Inferior limbus
23o
Lower
CN III
Superior
Oblique
32
Orbital apex Posterior to
above
Equator in
annulus of
Superotemporal
zinn
Quadrant
51o
CN IV
Inferior
Oblique
37
Behind
lacrimal
fossa
51o
Lower
CN III
Muscular area
near Macula
34. A way to remember
All obliques Abduct
All vertical Recti Adduct
All superior muscles Intort
All inferior muscles Extort
36. Ocular movements (terms)
Agonist muscle
Antagonist muscle
Yoke Muscles
Synergist
Laws of ocular motility
Sherrington law of reciprocal innervations
Hering Law of equal innervations
37. Full muscle sequelae will include
Primary paresis of the muscle
Over action of contralateral synergist
Contracture (O/A) of ipsilateral antagonist
Under action of contralateral antagonist (2ndry
inhibitional palsy)
40. H-PATTERN TEST
Instruction to the Px should be: “We are now going to assess how well your
eye muscles work together. I would like you to follow the target with your
eyes while keeping your head still. Let me know if you feel any pain on
eye movement or if you detect double vision at any time in the test.”
RSR
LSR
LIO
RIO
RLR
LMR
LLR
RMR
RIR
LIR
LSO
RSO
46. Three – Step Test
Superior oblique palsies are often diagnosed
using the three-step test.
There are eight cyclovertically acting muscles;
four work as depressor of the eye and four work
as elevators of the eye.
Four in each eye.
47. Step-1
Determine which eye is hypertropic by using the
cover test.
Step-1 narrows the number of possibly under
acting muscles from eight to four
e.g. Rt hypertropia:
This means that either the depressors of the Rt eye are weak
(RIR,RSO) or the elevators of the Lt eye are weak (LIO,LIR).
Draw an oval around them
49. Step-2
Determine whether the vertical deviation is
greater in Rt gaze or in Lt gaze.
e.g. in Lt gaze. This implicates one of the four vertical acting
muscles used in left gaze, the two possible muscles at this point
are either both intortors or both extortors. Draw an oval around
the four vertically acting muscles that are used in Lt gaze.
It may be either the RSO or LSR. These are the only muscles
circles twice.
51. Step-3
This step is also known as Bielschowsky head tilting
test, it involves tilting the head to the Right then to the
Left.
Head tilt to the Right stimulate intorsion of the Rt eye
(RSR,RSO) and extorsion 0f the L eye (LIR,LIO) and
vice versa.
e.g. in the same case suppose that the vertical deviation increases
to the Rt tilt. This implicates the four muscles that act vertically
in the R tilt position. Draw an oval around these muscles. Note
that the RSO is the only muscles that is surrounded by three
ovals.
54. Principle of test
1. Dissociation of the eyes by either:
Red and Green goggles in case of Hess.
The mirror in case of Lees Screen.
2. Foveal projection in the presence of normal retinal
correspondence.
3. Herring’s and Sherrington’s Law:
Explain the development of muscle sequelae.
55. Uses of Hess Test
1. Diagnosis of
Underaction or Overaction of EOM.
Mechanical or Neurogenic palsy.
A or V pattern
2. Planning of surgery and post-op effects of
surgery
3. Monitoring of condition.
58. 4.Ocular Movement
FDT force duction test:
The purpose of the force duction test is to
assess passive movement of the globe in case in
which active ocular movements are limited
either neurologically or mechanically.
59. 4.Ocular Movement
FGT force generation test:
The force generation test assesses the active
muscle force which enables eye movement to
take place.
The aim of the test is to calculate the potential
force in an apparently paralised muscle.
61. Investigation of BSV
It can be done through:
Bagolini Glasses
Worth 4 lights
Prism reflex test
4 ∆ Prism test
Stereo acuity tests
62. Bagolini glasses
Apparatus consists of a pair of plano- glasses
marked with fine parallel striation of 45o & 135o on
the other.
Line image is formed at 90o of striation.
63. Bagolini glasses
Test distance
Can be used at 6m & 33cm
Position of Gaze
Can be used in any desired gaze
Upward and downward gaze especially in
“A” &“V” pattern
64. Worth 4 light test
It consists of four circular lights
Two green lights
One red light
One white light.
65. Worth 4 light test
Test’s Phenomenon
Red light is seen through red filter.
Green light is seen through green filter.
White light is seen by both eyes.
66. Worth 4 light test
Results
1. 4 lights indicates BSV either normal or less usually
abnormal.
2. 2 lights are seen if left suppression is present.
3. 3lights are seen if there is right suppression.
4. 5 lights are seen if diplopia is present.
67. Prism reflex test
The prism is used to assess the motor system of the
patient.
A 15∆ to 20∆ is placed in front of one eye and
response of the other eye is seen.
A response should be obtained in infants aged 6
months and up ward.
68. Prism reflex test
Results
If all three movements are seen motor fusion is
present, however Asymmetry of movement should be
noted.
If the eye behind the prism fails to adduct then there
is a scotoma present in that eye.
If the other eye fails to recover then it indicates that
suppression prevented the recovery or lack of motor
fusion.
69. 4 ∆ Prism test
The main aim of the test is to prove the
presence of normal binocular single vision.
70. 4∆ Prism test
A 4∆ prism is placed in front of one eye and the
recovery is noted.
The strength of image moves the image a little bit in
the foveal area, if the recovery and movement is seen
then there is no scotoma present.
Prism can be used B.I, B.O, B.U & B.D.
72. Tests for Stereopsis
(Qualitative Tests)
Lang 2 pencil test
Method:
Pt places the pencils tip on the tip of the
examiner’s pencil.
Result:
It is a test mainly used for the detection of
gross stereopsis.
1.
74. Titmus Fly Test – Polaroid Vectograph
This test uses crossed Polaroid filters to present
slightly different aspects of the same object to
each eye. The test comprises of three sections:
•
The Housefly - which shows large disparities and
should be seen in depth by most subjects.
•
Circle Patterns – this section consists of patterns
containing four circles. One of the circles in the
pattern contains a graded disparity (crossed), so
that when it is viewed binocularly it is seen to
float in front of the others. The disparities of the
circles range from 800 to 40 secs of arc.
•
Animals – there are 3 rows of animals, one
animal in each row having a crossed disparity
which ranges from 400 – 100 secs of arc.
76. The Frisby Stereo-test
This is the only clinical test based on actual depth, where random
shapes are printed on three clear plastic plates of different
thickness.
The test does not require any form of dissociation.
Each plate has 4 squares of curved random shapes, and one
square contains a hidden circle that is printed on the opposite
surface. Disparities range from 600 to 15 secs of arc.
Care should be taken that neither the plates nor the Px’s head
move significantly during the testing procedure, as this may
provide monocular cues.
If the first plate is recognised successfully then the thinner plates,
which give smaller disparities, are presented in a similar fashion.
78. TNO
Each test plate consists of a stereogram in which the
images presented to each eye have been
superimposed and printed in complimentary colours.
The stereograms are viewed through a pair of red
and green filters.
The random dot stereograms have the advantage
that they completely eliminate monocular cues, the
patient is required to describe the shape which can
only be seen stereoscopically.
79. The TNO test has 7 plates.
The first four plates are for screening purposes, the disparities are large and
ungraded.
Plate I
2 butterflies are present, one can be seen
monocularly, the other is only seen in stereopsis.
Plate II
4 discs, 2 are seen monocularly two require
stereopsis.
Plate III
four hidden shapes (O, , ∆, ) are arranged around a
centrally placed cross
Plate IV
This is a suppression test. There are 3 discs, one
seen by the right eye, one by the left, and one is seen
binocularly.
Plate V-VII
Here the test items (Pac-man Shapes) are presented at 6
different disparities ranging from 15 – 480 secs of arc.
82. Lang
The test consists of vertical sections that are seen
alternately by each eye as they are seen through in-built
cylindrical lens elements.
Displacement of the random dots creates the disparity
which ranges from 1200 to 550 secs of arc.
The cards are held at the subject’s reading distance and he
or she is asked to name or point to the pictures.
84. Cycloplegia and retinoscopy
Accurate refraction in children usually requires
full cycloplegia.
Adequate cycloplegia for retinoscopy may be
obtained in 60 minutes following the instillation
of cyclopentolate 1% eye drops.
Below the age of three months mydriatics are
used in lower concentration to reduce the risk of
toxicity.
85. Refraction
The routine use of atropine for diagnostic
cycloplegia or mydriasis is unnecessary and may
cause harmful side-effects.
However, in patients with darkly pigmented
irides cyclopentolate may prove insufficient for
full cycloplegia and it may be necessary to use
atropine eye drops or ointment.
86. Correction of refractive error
Hypermetropia :
In all forms of esotropia, full correction of
hypermetropia is the treatment of choice.
In practice, a reasonable lower limit for spectacle
correction is + 1.50 dioptres (+ 3.00 ret. @ 2/3
metre).
When prescribing, 'full correction' means that
only the working distance is allowed for with no
subtraction for cycloplegia.
87. Refraction
Hypermetropia :
In esophoria full correction
In exophoria or tropia under correction
In children without strabismus the precise
indication for treatment of spherical errors is ill
defined and will depend on the age of the child
symptoms and the magnitude of the error.
88. Refraction
Myopia
In esophoria or tropia under correction
In exophoria or tropia full correction or even over
correction
High myopia (-6.00 D or more) may require correction
in infancy and moderate myopia (4.00 D or more) in
two year olds and older children.
Lesser degrees of myopia do not usually cause
problems in small children and prescription can be
based on subjective refraction over the age of six years.
Editor's Notes
Both eyes should be monitored simultaneously. Of particular interest are differences in the way each eye moves as they approach the limits of their field of fixation. These limits are explored when the fixation target is moved to the extremities of the ‘H’ pattern.