Other Forms Of Strabismus Yo Flashcards
Recording of versions
Movement of both eyes in the same direction (conjugate)
- this can be seen in EOMs; also in saccades, pursuits
- record SAFE (smooth, accurate, full, extensive)
Recording of duction
Movement of one eye (with the others eye covered)
-when duction (range of motion in one eye) is incomplete, record as a % of normal. Judge the % that the patient achieves
-50% Abduction (50% abduction ability)
Ophthalmology way of recording duction
Underaction: minus
Overaction: +
Full and smooth: 0
Complete paralysis of a muscle grading
-4
0%
If the Wright later rectus only goes out half way
50% or -2 abduction
What are the ways to record duction
- percentage of ability
- number scale, 0 being ortho and 4 being no movement
- limited abduction (screening)
Uncrossed diplopia
Eso
Treat with BO
Crossed diplopia
Exo
Treat with BI
Fusion in worth 4 dot
See all 4
Suppressed OS worth dot
See two red
Suppressed OD in W4D
Three green dots below
Uncrossed diplopia W4D
3 green to left, two red to right
Crossed diplopia in W4D
Two red on left and 3 green on right
Red is to the right on Maddox Rod
Esophoria
MRD
Corneal reflex distance to the top lid margin
-measures ptosis
Tissues of the EOMs are abnormal and replaced with fibrotic tissue
Congenital fibrosis of EOMs (CFEOM)
Features of CFEOMs
- severely restricted eye movement, due to the severity/degree/variability of the fibrosis
- fibrosis can be generalized, affecting all muscles or just one
- involvement of one or both eyes, mainly both eyes
- ptosis
- abnormal heads postire (chi elevation)
- congenital or required
- autosomal dominant (present at birth)
- healthy patients
- poor bino vision
- natural course: stable, non-progressive
EOMs and vision in CFEOMs
- marked restriction of EOMs
- versions and functions similarly poor
- ptosis
- strabismus in primary gaze
- amblyopia can be present in young patients
- involvement of the eyes can be asymmetrical
- cosmesis issues
- social issues/occupation opportunities
- reduced stereopsis and poor bino vision
Management of CFEOMs
- amblyopia therapy
- difficult to treat with surgery to restore full range of motion (except when there is a large strabismus in primary)
- will require multiple attempts, if surgery is attempted, surgical outcome is unpredictable
- ptosis
- abnormal head posture
Why do we normally not do surgery on CFEOMs
Because never know what the outcome is. Hard to tell how fibrotic it is and how to fix it
