Diagnosis evaluation in strabismus

DIAGNOSTIC EVALUATION FOR STRABISMUS Ms. JayaRajini Vasanth Mphil, B.S (opt) Assistant Professor – Optometry Ophthalmology Department Sri Ramachandra University

Classification of strabismus ,[object Object],[object Object],[object Object],[object Object],[object Object]

Axes of the eye ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],- As the fovea lies just temporal to the anatomical axis, a light shown into the cornea will cause reflex (on the visual axis) just nasal to the center of the cornea in both eyes (+ve angle kappa = 5°).

In high myopia the, the fovea lies nasal to the optical axis. So, the corneal reflex lies temporal to the center of the cornea simulating esotropia. Negative angle kappa (myopia) leads to pseudo-esotropia. Large positive angle kappa (hypermetropia) leads to pseudo-exotropia.

Pseudostrabismus ,[object Object],[object Object]

Pseudo-deviations Pseudo-esotropia Pseudo-exotropia ,[object Object],Short interpupillary distance ,[object Object],[object Object],Positive angle kappa

HISTORY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

VISUAL ACUITY ,[object Object],[object Object],[object Object]

SENSORY EVALUATION ,[object Object],[object Object],[object Object]

Tests for sensory anomalies Worth four-dot test a - Prior to use of glasses b - Normal c - Left suppression/ amblyopia Bagolini striated glasses a - Normal or ARC b- Diplopia c - Suppression d - Right suppression/ amblyopia e - Diplopia d - Small suppression scotoma

Tests for Stereopsis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Tests for stereopsis Titmus ,[object Object],TNO random dot test ,[object Object],[object Object],[object Object],Lang ,[object Object],Frisby ,[object Object],[object Object],[object Object]

MOTOR EVALUATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Evaluation of Motility ,[object Object],[object Object],[object Object]

Monocular eye movements A- elevation B- depression C- adbuction d- adduction E–extortion F- intortion

Right esotropia ( RET ) Right exotropia ( RXT ) Right hypertropia ( RHT )right hypotropia Left esotropia ( LET ) Left exotropia ( LXT ) Left hypertropia ( LHT )left hypotropia Alternating esotropia ( ALT ET ) Alternating exotropia ( ALT XT )

E esophoria X exophoria RH right hyperphoria LH left hyperphoria E(T) intermittent esotropia X(T) intermittent exotropia RH(T) intermittent right hypertropia LH(T) intermittent left hypertropia

Cover test detects heterotropia ,[object Object],[object Object],[object Object]

Motility tests Tests versions and ductions Grades under/overaction Left inferior oblique overaction Left lateral rectus underaction

Hirschberg‘s test Amount of deviation: note location of corneal light reflex 1 mm = 7 ° or 15 Δ Reflex at border of pupil = 15 ° Reflex at limbus = 45 °

Hirschberg’s Test ,[object Object],[object Object],[object Object],[object Object],Normal Exotropia Esotropia

Modified Krimsky test ,[object Object],[object Object],[object Object]

Bruckner Test ,[object Object],[object Object],[object Object]

Dissimilar image tests Maddox wing Maddox rod ,[object Object],[object Object],[object Object],[object Object]

Measurements of ocular misalignment ,[object Object],[object Object],[object Object],[object Object],[object Object]

Prism Cover Test ,[object Object],[object Object],[object Object]

Diagnosis evaluation in strabismus

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