Strabimus Managment Flashcards
(40 cards)
Goal of strabismus
Fusion and alignment
How can we manage strabismus
- correction of refractive error
- added lenses
- prism (NRC)
- occlusion-for amblyopia or suppression treatment
- VT (accommodation, suppression, or vergence ranges)
- Botox
- surgery (large angle)
Strabismus prognosis
-the early the intervention after the onset, the lower the chance of sensory adaptation
Sensory adaptations
- amblyopia
- suppression
- anaomalous correspondence
Strab prognosis is worse with
Esotropia
ARC
Constant unilateral strabismus
Sensory adaptations
Amblyopia
Suppression
ARC
Importance of strab management
- to prevent debilitating consequences
- to improve quality of life
How could strab affect quality of life
Lower self esteem
Symptoms
Unable to perform hobbies or task
Appearance
Management for strab needed to
Offer better acuity
Offer some fusion
Provide better appearance (cosmetic goal)
Eliminate adaptations such as head turn or tilts, or anomalous correspondence
Correction of refractive error in strab
- to offer the best acuity for BV and clarity
- fully correct anisometropia and astigmatism
- full hyperopia easier to accept in younger children
- in older children, give the amount of plus that offer best alignment
Why would you not fully correct an older child
If not accepting full plus
Cutting plus on refractive error
Cut anisometropia by the same amount
- could take down the amount of plus in the future, as long as alignment is maintained
- follow up for VA, fusion and deviation
If someone has an esotropia, full or partial correction
Full
Cutting plus in someone with anisometropia and no strab
But by the same amount
Added lenses for strab
- additional alignment and fusion
- for example in children with high AC/A, addled lenses could offer affiiotnal alignment
- bisect the pupil in bifocal in younger children
- recommended full time wear
Where should the add be placed in kids with strab
Bisect the pupil
Added lenses for strab (plus or minus)
- added minus can be used in chidlren with IXT (since there is already some level of fusion)
- the accommodative drive is increased and the fusional vergence collapses the angle
- works very well in IXT kids
- do not want to over minus in cases of convergence insufficiency or presbyopia or accomodative problems
Prism for strab
- shift the image to the fovea
- prism can be fresnel or ground in
- do not over do it. Can try prism in cases with deviations as much as 16-18PD. Greater than this needs surgery because the deviation becomes visible
- for it to work, VA has to be good, no AC and/or suppression
When can fresnel prisms be used
In acute strab, but larger amounts can compromise the VA
What else could prism be good for
Also useful in anomalous head positioning in nystagmus, palsies, decompensatiyng phorias
VT for strab
- to improve fusional abilities, acommodation
- work on suppression
- has to be tailored to the patient
- may work well in patients with existing fusion
- works well with convergence insufficnicy, XT
- if not in a VT practice, you can refer
- can try home orthoptic programs as well
Botox for strab
- binds to nerve endings to interfere with ACH action
- there is a temporary paralysis of the muscles and there is some contracture of the opposing muscle, this could be permanent
- varying repsosne and improvement compared to surgery
- only have 4 randomized controlled trials on this
Referral for surgery for strab
- surgery to achieve close to normal alignment
- for large angles (more than 15PD)
Referral after addressing
- refraction correction
- the use of added lenses
- the use of prisms
- VT (as needed)
Why do we not want to give large amounts of prism in glasses
Because it will be too heavy
-above 15PD is too much
Surgery contraindicated for
Accommodative esotropes
Watch intermittent exotropia s that have good control
No surgery for smaller angles until every thing possible has been tried
Make sure the amblyopia is treated
VT can be done before nad after to build fusional vergences
