Strabismus

Question 1

Management of childhood strabismus

Answer 1

-Occlusive
=Conventional ‘patching’ treatment and pharmological treatment with atropine eyedrops

-Refractive
=Working with optometry to ensure children have correct glasses prescription

-Medical
=Children with significantly reduced vision –determine underlying cause (exposure, developmental, genetics)
=Cosmetic strabismus surgery
=Functional strabismus surgery

Question 2

Causes of adult strabismus

Answer 2

-3rd
-4th
-6th nerve palsies
-Myasthenia gravis
-Thyroid eye disease

Question 3

Describe the 3rd nerve palsy

Answer 3

-Supplied by the oculomotor nerve
-Signs: MR, LR, SR and IR, complete ptosis
-Superior division 3rd, inferior division 3rd, pupil involvement (rule out something sinister like aneurysm)

Question 4

Describe the 4th nerve palsy

Answer 4

-Supplied by trochlear nerve
-Signs: superior oblique only (under action of SO often find the IO overacts as unopposed), vertical strabismus of affected eye, vertical double vision

Question 5

Describe the 6th nerve palsy

Answer 5

-Supplied by abducens nerve
-Signs: lateral rectus only, restricted abduction in affected eye, estopia (commonly only in the distance), increase esotropia size looking towards affected side, horizontal double vision

Question 6

Other diseases/ conditions that cause double vision

Answer 6

-Myasthenia gravis (ptosis, variable strabismus, orbicularis weakness)
-Thyroid eye disease (EOM enlargement, Muller’s muscle overaction, increased orbital volume)

Question 7

Types of strabismus

Answer 7

-Esotropia
-Exotropia
-Hypotropia
-Hypertropia

-Manifest= all the time
-Latent= underlying (tired, unwell), eye strain