non-surgical management of squint

7/29/2019 Non-Surgical Management of squint

http://slidepdf.com/reader/full/non-surgical-management-of-squint 1/16

Non-Surgical Management

Of Squint

Dr Anumeha



It comprises of:

Optical correction

Orthoptic treatment

Medical treatment



Optical correction:By

• Refraction and proper prescription of glasses• Use of prisms

It

• Provides sharp, well focused and fused images• Corrects and maintains accomodation and

convergence mechanisms



A) Proper cycloplegia : to assess correct

refractive status.

By Fully relaxing accomodation using atropine 1%ointment

B) Proper prescription: by retinoscopy giving full

correction. Regular 6 months checkups for visionand annual retinoscopy

C) Use of bifocals: in high AC/A ratios bifocals

are required with additional near adds

Min add required is tested in steps of 0.5D till the

convergence excess for near is controlled.



D) Use of over minus glasses: in cases if

intermittent exotropia in under 5yrs old children.

Uses accomodative convergence for controllingexodeviation.

For convergence insufficiency type of exotropia

inverse bifocal with minus for near is required.



Use of prisms

Advantage:

• In small angle deviations,residual or conservative deviation after surgery

• Small vertical deviations can also be

managed.Usually upto 7-8pd prisms over eacheye can be toleratedwith glass prism and with

FRESNEL prisms upto 25-30pd

• Can be used in combined hori and vert

deviations by using prisms rotated obliquely• Used in fusional convergence insufficiency



Disadvantages:

• Undesirable optical aberrations

• Deterioration of quality of vision

• Glasses become heavy

• Plastic and Fresnel prisms not available easily

and are expensive.



Orthoptic treatment:

Indications:

• Combating suppression

• Improvong fusional vergences and

establishing stereopsis

• T/t of amblyopia

• Managing ARC



Combating suppression by anti-suppression

exercises

Basic principle is to bring the fovea out of

suppression by diff stimulations types

Some methods are:

A) Red filter: over dominant eye.

B) Cheiroscope

C) Pigeon-cantinnet stereoscope

D) synaptophores



Treatment of amblyopia:

Diff modalities are:

• Occlusion

• Penalization

• Pleoptics

• Red filter T/t

• Cam vision stimulation

• Active vision therapy

• Medical T/t



Types of occlusions:

• Total

• Partial• Part/ full time

• Maintenance

Total occlusion: by

• Direct skinpatch

• Spectacle patch

• Doyne’s occluder

• Pirate patch

• Contact lenses



Partial occlusion:

This degrades vision of the normal eye so that amblyopic

eye has the advantage.here layers of transparent tapesare used on back surface og glasses over the dominanteye.

Period of occlusion:

• Full time- for 2days/week upto 2 yrs old

3 days/week upto 3 yrs old

4 days/week upto 4 yrs old

5 days/week upto 5 yrs old6 days/week for 6 yrs old n above

This is alternatedwith one day of occluding amblyopic eyewhen dominant eye is opened



Part time : diff waking hours of the day on basis

of age of child

Follow up :

Occlusion course is indicative till vision keeps

improving or the vision doesn’t improve on twoconsecutive monthly visits which is termed

occlusion failure.



Penalization

• Optical: over correct with plus glasses

• Pharmacological: using cycloplegics

• Partial

also termed as distance and near penalization

Pleoptics therapy

Red filter treatment

Fusional exercises



Medical treatment

o Miotics in accommodative esotropia: reduction of the

accommodative effort and as increase in depth of focus.besttemporary modality in children who r too small to wear glasses

o Levodopa-carbidopa: facilitate neurotransmission atsynapsespresent in retina and visual cortex

o Botulinum toxin A chemodenervation:

As inj in EOM made under EMG control.injected at the junction of ant2/3 and post 1/3,a crackling sound is heard which quietens themoment the whole dose is injected.

Effect starts immediately and peak action is in 5-7 days and durationvaries from 2-4 months

non-surgical management of squint

Documents