2015 strabismus and amblyopia
TRANSCRIPT
Strabismus & Amblyopia
Alvina Pauline D. Santiago, MDNovember 14, 2015ASMPH
http://www.slideshare.net/AlvinaPaulineSantiag/2015-asmph-strabismus-and-amblyopia
Orbital Apex
Annulus of ZinnNerve Supply
http://lms.ecco-org.eu
Horizontal rectus muscles
Vertical rectus muscles
Oblique muscles
Superior obliqueInferior oblique
Inferior Oblique
❖ Origin: Shallow depression on orbital plate of maxilla
❖ Insertion: inferotemporal quadrant of sclera near the macula
Rangeen Shandran R. http://www.slideshare.net/RangeenChandran
Superior Oblique❖ Origin: Lesser wing of
sphenoid
❖ Functional origin: Trochlea
❖ Insertion: curved
❖ anterior: 12-14 mm behind limbus
❖ posterior 17-19 mm behind limbus
OM Patel, http://www.slideshare.net/ompatel9889
Blood Supply
❖ ciliary arteries also arise from these muscular arteries
❖ 7 branches
❖ 2 per rectus muscle except LR which receives only 1
OM Patel, http://www.slideshare.net/ompatel9889
EOM Concepts & Movements
❖ agonist muscles
❖ antagonist muscles
❖ yoke muscles
❖ synergistic muscles
❖ contralateral antagonist
❖ Ductions & Versions
❖ dextroversion
❖ levoversion
❖ dextroelevation
❖ levoelevation
❖ Dextrodepression
❖ Levodepression
❖ Vergence Eye Movements
❖ Convergence
❖ Divergence
Ocular Motility: EOM Movement
Laws of Ocular Motility: Hering’s Law
Laws of Ocular Motility: Sherrington’s Law
Strabismus
Strabismus Evaluation❖ Complete 5 point examination
❖ Gross
❖ Pupils
❖ EOM
❖ Intraocular Pressure
❖ Fundus evaluation
❖ Perform refraction
❖ Stereoacuity testing
❖ Strabismus Evaluation:
❖ Gold Standard: Alternate Prism Cover Test
Strabismus Evaluation: Hirschberg’s
Strabismus Evaluation: Bruckner Test
Strabismus Evaluation
❖ Cover Uncover Test
https://www.youtube.com/watch?v=f5HbIZi4u70
Strabismus Evaluation
❖ Alternate Cover Test
https://www.youtube.com/watch?v=U59OEkjoIGg
Strabismus Evaluation
From Rosenbaum & Santiago, Clinical Strabismus Managemenment 1999
Strabismus Evaluation: Torsion
From Rosenbaum & Santiago, Clinical Strabismus Managemenment 1999
From Rosenbaum & Santiago, Clinical Strabismus Managemenment 1999
Amblyopia Evaluation
❖ Fixation Preference
vonNoorden, Ocular Motility
Fixation Preference
Fixation Preference & Visual Acuity
Vision Assessment
Pre verbal Vision Test
❖ Allen cards
❖ Cultural bias
❖ “dated”
❖ Based on experience
❖ Lea symbols
❖ more universal
❖ Same in every culture
❖ Equal blurr
Visual Acuity Testing
Amblyopia PEDIG Studieshttp://www.slideshare.net/AlvinaPaulineSantiag/2015-amblyopia-pedig-v2
http://pedig.jaeb.org/Studies.aspx
http://www.abcd-vision.org/amblyopia/ats-pedig.html
❖ Amblyopia PEDIG Studies
❖ Amblyopia PEDIG Studies
❖ Amblyopia PEDIG Studies
❖ Amblyopia PEDIG Studies
❖ Amblyopia PEDIG Studies
❖ Amblyopia PEDIG Studies
Lessons learned from PEDIG❖ Atropine = patching
❖ 6 hours = full time
❖ 2 = 6
❖ 6 > 2
❖ Glasses alone works.
❖ If not, then glasses+patching.
❖ Teenagers benefit from patching.
Lessons learned from PEDIG
❖ Daily = weekly
❖ Near = far
❖ 2 hours works.
❖ Bangerter filter = patching
❖ Levodopa-carbidopa promising
