2015 strabismus and amblyopia

Strabismus & Amblyopia

Alvina Pauline D. Santiago, MDNovember 14, 2015ASMPH

http://www.slideshare.net/AlvinaPaulineSantiag/2015-asmph-strabismus-and-amblyopia

Orbital Apex

Annulus of ZinnNerve Supply

http://lms.ecco-org.eu

http://www.cambridgequestions.co.uk

Spiral of Tillaux

www.cybersight.org

Horizontal rectus muscles

Vertical rectus muscles

Oblique muscles

Superior obliqueInferior oblique

Inferior Oblique

❖ Origin: Shallow depression on orbital plate of maxilla

❖ Insertion: inferotemporal quadrant of sclera near the macula

Rangeen Shandran R. http://www.slideshare.net/RangeenChandran

Superior Oblique❖ Origin: Lesser wing of

sphenoid

❖ Functional origin: Trochlea

❖ Insertion: curved

❖ anterior: 12-14 mm behind limbus

❖ posterior 17-19 mm behind limbus

OM Patel, http://www.slideshare.net/ompatel9889

Blood Supply

❖ ciliary arteries also arise from these muscular arteries

❖ 7 branches

❖ 2 per rectus muscle except LR which receives only 1

OM Patel, http://www.slideshare.net/ompatel9889

EOM Concepts & Movements

❖ agonist muscles

❖ antagonist muscles

❖ yoke muscles

❖ synergistic muscles

❖ contralateral antagonist

❖ Ductions & Versions

❖ dextroversion

❖ levoversion

❖ dextroelevation

❖ levoelevation

❖ Dextrodepression

❖ Levodepression

❖ Vergence Eye Movements

❖ Convergence

❖ Divergence

Ocular Motility: EOM Movement

Laws of Ocular Motility: Hering’s Law

Laws of Ocular Motility: Sherrington’s Law

Strabismus

Strabismus Evaluation❖ Complete 5 point examination

❖ Gross

❖ Pupils

❖ EOM

❖ Intraocular Pressure

❖ Fundus evaluation

❖ Perform refraction

❖ Stereoacuity testing

❖ Strabismus Evaluation:

❖ Gold Standard: Alternate Prism Cover Test

Strabismus Evaluation: Hirschberg’s

Strabismus Evaluation: Bruckner Test

Strabismus Evaluation

❖ Cover Uncover Test

https://www.youtube.com/watch?v=f5HbIZi4u70

Strabismus Evaluation

❖ Alternate Cover Test

https://www.youtube.com/watch?v=U59OEkjoIGg

Strabismus Evaluation

From Rosenbaum & Santiago, Clinical Strabismus Managemenment 1999

Strabismus Evaluation: Torsion

From Rosenbaum & Santiago, Clinical Strabismus Managemenment 1999

From Rosenbaum & Santiago, Clinical Strabismus Managemenment 1999

Amblyopia Evaluation

❖ Fixation Preference

vonNoorden, Ocular Motility

Fixation Preference

Fixation Preference & Visual Acuity

Vision Assessment

Pre verbal Vision Test

❖ Allen cards

❖ Cultural bias

❖ “dated”

❖ Based on experience

❖ Lea symbols

❖ more universal

❖ Same in every culture

❖ Equal blurr

Visual Acuity Testing

Amblyopia PEDIG Studieshttp://www.slideshare.net/AlvinaPaulineSantiag/2015-amblyopia-pedig-v2

http://pedig.jaeb.org/Studies.aspx

http://www.abcd-vision.org/amblyopia/ats-pedig.html

❖ Amblyopia PEDIG Studies

❖ Amblyopia PEDIG Studies

❖ Amblyopia PEDIG Studies

❖ Amblyopia PEDIG Studies

❖ Amblyopia PEDIG Studies

❖ Amblyopia PEDIG Studies

Lessons learned from PEDIG❖ Atropine = patching

❖ 6 hours = full time

❖ 2 = 6

❖ 6 > 2

❖ Glasses alone works.

❖ If not, then glasses+patching.

❖ Teenagers benefit from patching.

Lessons learned from PEDIG

❖ Daily = weekly

❖ Near = far

❖ 2 hours works.

❖ Bangerter filter = patching

❖ Levodopa-carbidopa promising