Strabismus - Fundamentals of Clinical Ophthalmology.pdf

More documents

Recommendations

Info

STRABISMUS (a) (a) (b) (b) Figure 4.17 Developmentally determined aberrant innervation resulting in the Marcus Gunn jaw winking syndrome (c) Figure 4.16 nerve palsy Child (a–c) with left ptosis due to third tumour of nasopharynx, trauma, infections, (Gradenigo syndrome), and vascular malformation. Benign sixth nerve palsy of childhood can also occur in infancy when associated with febrile illness. It is transitory and recovers within weeks. 17–19 It is important to distinguish benign sixth nerve palsy from pontine glioma if it does not resolve within 6 weeks. Third nerve palsy This condition may be congenital. The palsy is usually unilateral but less commonly bilateral. The pupil may be spared and the condition may be associated with aberrant regeneration. Third nerve palsy is associated with ophthalmoplegic migraine in adolescent and early adult life as well as with posterior cerebral artery aneurysms or vascular malformations. Traumatic causes include uncal herniation in severe head trauma. 20,21,22 Recovery may be associated with aberrant regeneration and paradoxical movements (Figure 4.16). Another common developmental aberrant regeneration involves the miswiring between motor fifth nerve and eyelid movement from seventh nerve innervations of the orbicularis. It results in the jaw winking phenomenon (Figure 4.17). Superior oblique paresis Superior oblique paresis is relatively common in childhood (Figure 4.18). The weakness may be a true fourth nerve palsy but a significant number are due to developmental anomalies of the superior oblique muscle, particularly its tendon. The child usually presents later in infancy with a compensatory torticollis. There may be inferior oblique overaction and a positive Bielschowsky head tilt test (Figure 4.19). Approximately one quarter of superior oblique palsies are congenital. Some cases of apparent congenital fourth nerve palsy have been 38
CHILDHOOD ONSET OF STRABISMUS (a) (b) Superior oblique palsy R. eye (RSO) Mild RSO palsies Bielschowsky head tilt Palsy of right & left superior oblique if balanced palsies Primary position Eyes may remain straight in primary position Eyes may appear straight Head tilt: R R Hypertropia Right gaze Down to right If no strong preference for R. fixation Underaction of LSO Left gaze Down to left Underaction of RSO (c) N.B. If stronger to use preference for R. fixation, Left eye will be down Right eye will be straight. Bielschowsky head tilt… • the palsied R. eye will rise on head tilt R. • the palsied L. eye will rise on head tilt L. • if bilateral inferior oblique overaction results, in V pattern Figure 4.18 Superior oblique paresis. (a) Note the AHP with face turn left and head tilt left to maintain binocular single vision. (b) With head tilt to right (Bielschowsky head tilt test) the underacting right superior oblique muscle is unable to control the muscle imbalance. The right eye elevates and binocular single vision is broken down. Diagram (c) further illustrates unilateral weakness of the right superior oblique muscle. Diagram (d) demonstrates the findings anticipated in bilateral superior oblique weakness (d) 39
Page 1 and 2: Fundamentals of Clinical Ophthalmol
Page 3 and 4: Fundamentals of Clinical Ophthalmol
Page 5 and 6: © BMJ Books 2003 BMJ Books is an i
Page 7 and 8: CONTENTS Sequelae of strabismus in
Page 10: Preface This book has been written
Page 13 and 14: Foreword We should welcome the fine
Page 15: Section I Neurophysiological substr
Page 18 and 19: STRABISMUS dim reflex whereas the m
Page 20 and 21: STRABISMUS compared to the image on
Page 22 and 23: STRABISMUS Chiasm ON LGN ON M LGN P
Page 24 and 25: STRABISMUS Table 2.1 Actions of the
Page 26 and 27: STRABISMUS Table 2.2 Types of eye m
Page 28 and 29: 3 Consequences of breakdown of bino
Page 30 and 31: STRABISMUS Bifoveal fusion Normal B
Page 32 and 33: STRABISMUS • Secondly, in the bin
Page 35 and 36: Section II Strabismus in the decade
Page 37 and 38: 4 Childhood onset of strabismus Chi
Page 39 and 40: CHILDHOOD ONSET OF STRABISMUS indic
Page 41 and 42: CHILDHOOD ONSET OF STRABISMUS (a) (
Page 43 and 44: CHILDHOOD ONSET OF STRABISMUS In ad
Page 45 and 46: CHILDHOOD ONSET OF STRABISMUS may b
Page 47 and 48: CHILDHOOD ONSET OF STRABISMUS retin
Page 49 and 50: CHILDHOOD ONSET OF STRABISMUS (a) (
Page 51: CHILDHOOD ONSET OF STRABISMUS Figur
Page 55 and 56: Transient skew deviation CHILDHOOD
Page 57 and 58: CHILDHOOD ONSET OF STRABISMUS add w
Page 59 and 60: CHILDHOOD ONSET OF STRABISMUS Spasm
Page 61 and 62: 5 Adult strabismus Introduction The
Page 63 and 64: ADULT STRABISMUS Case example An ad
Page 65 and 66: ADULT STRABISMUS patient presenting
Page 67 and 68: ADULT STRABISMUS such as in older p
Page 69: Section III Management of strabismu
Page 72 and 73: STRABISMUS ● the pattern of the a
Page 74 and 75: STRABISMUS Figure 6.5 An example of
Page 76 and 77: STRABISMUS Sensory evaluation - bin
Page 78 and 79: STRABISMUS Normal R L Normal binocu
Page 80 and 81: STRABISMUS torsional deviations can
Page 82 and 83: STRABISMUS (a) (b) (c) (d) Figure 6
Page 84 and 85: 7 Therapy of strabismus Non-surgica
Page 86 and 87: STRABISMUS of the eye with good vis
Page 88 and 89: STRABISMUS other forms of non-surgi
Page 90 and 91: STRABISMUS (a) (b) (c) (d) (e) Figu
Page 92 and 93: STRABISMUS In attempting to elevate
Page 94 and 95: STRABISMUS drawn underneath the lat
Page 96 and 97: STRABISMUS Figure 7.7 Recession wit
Page 98 and 99: STRABISMUS MR MR LR LR LR LR MR MR
Page 100 and 101: STRABISMUS overacting in a V patter
Page 102 and 103:
STRABISMUS more persistent diplopia
Page 104 and 105:
STRABISMUS microscope. Inflammation
Page 106 and 107:
STRABISMUS Strabismus Malalignment
Page 108 and 109:
INDEX surgical correction 83-6 see
Page 110 and 111:
INDEX horizontal 54 “horror fusio
Page 112 and 113:
INDEX esotropia 31, 31 monofixation
Page 114 and 115:
INDEX oculocutaneous albinism 43 oc
Page 116:
INDEX vertical muscle surgery 83-6,
show all

Strabismus - Fundamentals of Clinical Ophthalmology.pdf

Create successful ePaper yourself

Delete template?

Save as template?