Heavy eye phenomena Flashcards
what are the features of heavy eye phenomena
study conducted found that the key features was a hypephoria or hypertropia
41 pts had more than 3dioptres of anisomyopia
lower eye = more myopic eye
ahp head tilt to lower more myopic eye
list 3 key features of heavy eye syndrome
- 68 anisomyopes
61% vertical deviation relating to the amoiutnof anisometropia
bsv is absent /poor if anisometropia is more than 6 diopters
amisoymopia is mostly axial (not lenticular)
list all the features of high myopia
unilateral high myopia
reduced visual acuity
amblyopia
hypotropia
exotropia
head tilt (side to the affected eye)
limitation of upgaze
psedopropotsis
increased axial length
myopic fundus
ptosis (not previously described)
what is the astrology of heavy eye syndrome
ateiology = axial anisomyopia
anatomical factors
size and shape of anisotropic eye
orbital anatomyabnromality
facial asymmetry caused by protrusion of more myopic side
how can axial myopia cause heavy eye syndrome
axial myopia
posterior segmented amorally distended
stretch vascular nerve structures
vertical muscle imbalance due to vascular rinsiffcineecy
higher levels of myopia - more abornlities in extraoculr muscles
how can biopsies cause heavy eye syndrome
increases intrsital connective tissue (interstitial connective tissue) = forming space
irregular muscle fibre edges
irregular muscle fibre structure
what is the management of heavy eye syndrome
maintain binocular function
ocular motility
prisms
decantation off lens
contact lenses
occlusion - amblyopia
what surgical management should be considered in heavy eye syndrome
eom surgery
must consider refractive error original refractive error
vertical deviation (hypotropia)
inferior rectus recession
knapp procedure
affected eye - highly myopic
how would a patient with heavy eye syndrome with facial asymmetry and proptosis be managed
unilateral orbital 2 wall decompression
improved psedvoprotposis
reduced hypotropia
later strabismus surgery for hypotropia
lateral strabismus surgery for hypotropia
outcome improved cosmesis and improved ocular alignment
what are the differential diagnoses for progressive et with myopia
- endocrine pathology
sagging eye syndrome
uncorrected hyperopic refractive error
high accomplishment/convergence/accom ratio
Duane syndrome
Myasthenia Gravis
thyroid eye disease
cranial nerve plays - (3rd, 4th, or 6th nerve palsy)
what are the features of progressive et with high myopia
very high myopia - more than 20 diopters
axial myopia
long axial length more than 27mm
staphlyoma
gradual onset et
progresses to strabismus fixus
unilateral/bilateral
what is staphlyoma
abnormal profusion of the oval tissue through a weak point in the eye ball
The protrusion is generally black in colour, due to the inner layers of the eye. It occurs due to weakening of outer layer of eye (cornea or sclera) by an inflammatory or degenerative condition.
what is the aetiology of progressive et with myopia
MRI evidence
LR shifts inferiorly (depression of globe & decreased ABDuction)
SR shifts nasally (ADDuction of the globe & decreased elevation)
Enlarged globe prolapses out of muscle cone superotemporally
Deviation = ET & HoT
Greater prolapse & muscle pathway displacement - greater limitations of OM
(Aoki et al, 2003)
what have mri findings shown about progressive et with high myopia
mri
herniation of globe
superotemporally
how might the lateral rectus and superior rectus be affected in the development of progressive et with high myopia
lateral rectus and Superior Rectus slip
age related changes of lateral rectus and superior rectus band
band of connective tissue
permits discolation of globe out of muscle tone
could be the cause of development
mri evidence shows this
what are the differential diagnosis for heavy eye syndrome et sagging eye syndrome
et for distance and or small hypotropia
limited elevation normal abduction
degenerative adrenal changes (adexnal0 tissues surrounding the eye ball, including eyelids , extraocular muscles), socket and tear system
mri shows- lateral rectus inferiorly
no glove displacement
what is the management of progressive et with myopia
history
orthoptic monitoring
prisms
refractive
occlusion
ahp
bt
surgery
stability
progression over time
prisms may be gradually increased over time
decantation of glasses lens
prismatic effect
what further examinations are important for progressive et with monitoring
mri imaging
course of eom
diagnosis
planning surgery
graded approach to surgery (extent and severity)
what surgical management is suggested for et with myopia
medial rectus recession and lateral rectus resection
large mr recession and lateral rectus recession
lateral rectus is sutured to sclera in ‘’ normal position’’
combining the lateral rectus and superior recrus muscles together restore globe positon into muscle tone
does surgery have a good prognosis for pts with surgery associated with myopia
intital success - but then Esotropia and ypotropia reoccur in the long term
case reports where extreme surgery has been performed yet deviation recurs
marked esotropia
what is congenital strabismus ficus
congenital
market et
amblyopia
large ahp (to fix)
extremely tight and fibroses medialrctus
+fdt
ateiology -possibly - CFEOM
what is the differential diagnosis for congenital strabismus fixus
infantile et
bilateral 6th nerve palsy
Duane syndrome
congenital fibrosis of the extraocular muscles
what is the management of the congenital strabismus fixus
fundus and media
correct refractive error - glasses or contact lenses
amblyopia
surgery
surgery -
liberal medial rectus recessions
augmented medial rectus recessions
jensen transpostion procedures
dinsert medial rectus
fix globe in abduction - traction sutures
discuss the investigation and possible aetiologies of a patient presenting with unilateral propotosis
possible ateiology - heavy eye phenomena
due to unilateral high myopia
facial asymmetry causes by protusion of the more myopic eye
axial anisyomyopia
pseduoptosis - due to a large globe occupying a normal globe
investigation - original refractive error important
investigate history and prior refractive error carefully
