DOCSLIB.ORG

Adult Strabismus Overview Common Types Esotropia Exotropia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Adult Strabismus Overview Common Types Esotropia Exotropia Gregory Ostrow, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 Overview • Common Types of Strabismus • Indications for Strabismus Surgery • Common Procedures Adult Strabismus • Psychosocial Benefits Gregory Ostrow M.D Pediatric Ophthalmology and Adult Strabismus Scripps Clinic Medical Group 3811 Valley Centre Drive San Diego, CA 92130 Esotropia Common Types Exotropia www.scripps.org/clinicrss Scripps Conference Services & CME www.scripps.org/conferenceservices 1 P: (858) 652-5400 E: [email protected] Gregory Ostrow, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 • There are many different Indications for Strabismus presentations of strabismus Surgery • Most can be corrected surgically Classically Taught Benefits of Other Benefits Strabismus Surgery • Develop binocular vision • Improve visual • Restore binocular vision field • Eliminate diplopia • Eliminate torticollis www.scripps.org/clinicrss Scripps Conference Services & CME www.scripps.org/conferenceservices 2 P: (858) 652-5400 E: [email protected] Gregory Ostrow, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 Insurance accepted indications Surgical Procedures for strabismus surgery •Diplopia • Weaken (recession) • Asthenopia (eye strain) • Strengthen (resection or tuck) • Any misalignment of the eyes that • Alter vector forces (transposition) cannot be corrected non-surgically – this is where some prodding is occasionally required Recession (weakening) www.scripps.org/clinicrss Scripps Conference Services & CME www.scripps.org/conferenceservices 3 P: (858) 652-5400 E: [email protected] Gregory Ostrow, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 Resection (tightening) Psychosocial Benefits of Strabismus Surgery www.scripps.org/clinicrss Scripps Conference Services & CME www.scripps.org/conferenceservices 4 P: (858) 652-5400 E: [email protected] Gregory Ostrow, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 Patients benefit from Psychosocial aspects of strabismus study. strabismus surgery even if Satterfield D, Keltner JL, Morrison TL there is no hope of providing Arch Ophthalmol 1993; 111:1100-5. improved binocular vision or visual field CONCLUSIONS: Psychosocial difficulties are a problem for teenagers and adults. Correction of strabismus in the older teenager or adult may offer them improvement in psychosocial functioning. cos·met·ic P Pronunciation Key (k z-m t k) n. 1.A preparation, such as powder or a skin cream, designed to beautify the body by direct application. adj. Strabismus surgery is NEVER 1.Serving to beautify the body, especially the face and hair. “cosmetic” re·con·struc·tive P Pronunciation Key (r k n-str k t v) adj. 1.Relating to or characterized by reconstruction. 2.Serving to rebuild, restore, or correct the appearance and function of defective, damaged, or misshaped body structures or parts: reconstructive surgery. Surgery to provide normal anatomy or physiology is While there are many “normal” RECONSTRUCTIVE. appearances for human facial Cosmetic surgery makes an features, body types, etc., there appearance more “beautiful” is only one normal alignment status for human eyes ….. Orthotropia (straight) www.scripps.org/clinicrss Scripps Conference Services & CME www.scripps.org/conferenceservices 5 P: (858) 652-5400 E: [email protected] Gregory Ostrow, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 Strabismus occurs secondary to an abnormality in binocular Strabismus surgery corrects an vision abnormal alignment secondary to abnormal physiology (binocularity) How do people view people with strabismus? Attentiveness Communication Skills PersonalityCompetency Traits Tested Dependability Results Emotional Stability Honesty Overall, the strabismic faces were Humor judged significantly more negatively, Intelligence across 11 descriptive characteristics, than the non-strabismic face. Leadership Ability Organizational Skills Sincerity www.scripps.org/clinicrss Scripps Conference Services & CME www.scripps.org/conferenceservices 6 P: (858) 652-5400 E: [email protected] Gregory Ostrow, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 Nobody is too old, has too poor vision or has had too many strabismus surgeries to not be allowed to have straight eyes. www.scripps.org/clinicrss Scripps Conference Services & CME www.scripps.org/conferenceservices 7 P: (858) 652-5400 E: [email protected] Jose Quiceno, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 US Population age 65 and over Refractive IOL in 70 60 Cataract Surgery 50 40 Jose Ivan Quiceno 30 MD 20 Scripps Clinic Medical Group 10 0 1900 1990 Est 2010 Est 2030 Do not underestimate the importance of Do not underestimate the importance of Custom Cataract Surgery good intermediate vision Custom Cataract Surgery Aspheric IOL Toric IOL Multifocal IOL Accommodative IOL The Problem – Spherical Optics AsphericAspheric IOLIOL Spherical aberration occurs when light rays are over- refracted at the periphery of a lens system, resulting in a region of defocused light which can decrease image quality. www.scripps.org/clinicrss Scripps Conference Services & CME www.scripps.org/conferenceservices 1 P: (858) 652-5400 E: [email protected] Jose Quiceno, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 The Solution – Aspheric Optics Ocular spherical aberration Light Rays Anterior corneal positive SA is +0.275 Young (19y/o) crystalline lens has a negative SA -0.275 Older eyes crystalline lens increases + SA Aspheric optics align the light rays to compensate for Aging (72y/o) SA of the crystalline lens is +0.15 positive corneal spherical aberration, resulting in enhanced image quality. Design Objective Correction of Spherical Aberrations Design considerations for the IOL: SN60WF: -0.200 negative spherical aberration Induce negative Spherical Aberrations with ZA9003: -0.275 negative spherical aberration the lens to compensate for positive corneal LI61AO: Zero spherical aberration Spherical Aberrations Quality of vision is deteriorated considerably by astigmatism. No astigmatism ToricToric IOLIOL 1.0 D astigmatism 2.0 D astigmatism www.scripps.org/clinicrss Scripps Conference Services & CME www.scripps.org/conferenceservices 2 P: (858) 652-5400 E: [email protected] Jose Quiceno, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 Cylinder Distribution Treatment Options for Astigmatism 40 N 10,411 Glasses or Contacts 35 Patient dependent 30 Cosmetic / Lifestyle issues 25 Moderate 20 1.0 - 2.0 D % 25% Cylinder Incisions 15 Severe >2.0 D Lack precision 10 10% Unpredictable outcomes 5 Increased risk 0 Regression <.5 <1.5 <2.5 <3.5 Cylinder (D) Limited treatment range Toric IOL Treatment Options for Astigmatism Design Characteristics Design Ideal Treatment Posterior toricity Precise and Toric axis marks Accurate AcrySof® Natural Single-Piece platform Dimensions Predictable Outcomes Overall length: 13.0 mm Optic diameter: 6.0 mm Delivery Permanent Monarch II or III Injector C Cartridge Safe and Convenient Cylinder Powers SN60T3-T5 Toric IOL Cylinder Power Cylinder Power Model IOL plane Corneal Plane SN60T3 1.50 1.03 SN60T4 2.25 1.55 SN60T5 3.00 2.06 www.scripps.org/clinicrss Scripps Conference Services & CME www.scripps.org/conferenceservices 3 P: (858) 652-5400 E: [email protected] Jose Quiceno, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 IOL Alignment 3 Step Procedure: I. Gross alignment II. Removal of OVD III. Final alignment Intraocular lenses for Presbyopia Lens Comparisons Diffractive apodized IOL SN6AD3 SN6AD1 Add Power: +4.0 D Add Power: +3.0 D Spectacle Plane: +3.2 D Spectacle Plane: +2.5 D Range: +10.0 D to +34.0 D Range: +10.0 D to +34.0 D A-Constant: 118.9 A-Constant: 118.9 www.scripps.org/clinicrss Scripps Conference Services & CME www.scripps.org/conferenceservices 4 P: (858) 652-5400 E: [email protected] Jose Quiceno, M.D. Scripps Clinic/Scripps Green Hospital Grand Rounds Wednesday, Mar. 18, 2009 Anatomy of the Apodized Apodization Diffractive Technology Gradual reduction or Central 3.6 mm apodized blending of the diffractive diffractive step heights. structure Optimally manages light Step heights energy delivered to the decrease peripherally from retina as it distributes the 1.3 micron 1.3 – 0.2 microns appropriate amount of step light to near and distant Anterior A +4.0 D at lens aspheric plane equaling focal points, regardless optic +3.2 at spectacle of the lighting situation. plane Designed to improve Outer refractive image quality zone Anatomy of the Apodized Anatomy of the Apodized SN6AD1 Design Characteristics Diffractive Technology SN6AD1 Design Characteristics Symmetric Anterior Apodized Utilizes existing IQ ReSTOR® IOL +4.0 D Diffractive Optic Biconvex 13.0 mm platform with identical asphericity, energy distribution profile, 6.0 mm 6.0 mm and shape factor Modified add power from +4.0 D to +3.0 D – 9 diffractive steps vs. 12 diffractive steps Anterior Aspheric Optic – Slightly wider step spacing to modify the add power Four Generations of Accommodative IOL Accommodative Lens “accommodative” lens technology proved to be safe & effective by the Food & Drug Administration Uses the natural focusing ability of the eye. Provides a single focal 1st Generation 2nd Generation 3rd
Load more

Recommended publications
  • Management of Vith Nerve Palsy-Avoiding Unnecessary Surgery
    MANAGEMENT OF VITH NERVE PALSY-AVOIDING UNNECESSARY SURGERY P. RIORDAN-E VA and J. P. LEE London SUMMARY for unrecovered VIth nerve palsy must involve a trans­ Unresolved Vlth nerve palsy that is not adequately con­ position procedure3.4. The availability of botulinum toxin trolled by an abnormal head posture or prisms can be to overcome the contracture of the ipsilateral medial rectus 5 very suitably treated by surgery. It is however essential to now allows for full tendon transplantation techniques -7, differentiate partially recovered palsies, which are with the potential for greatly increased improvements in amenable to horizontal rectus surgery, from unrecovered final fields of binocular single vision, and deferment of palsies, which must be treated initially by a vertical any necessary surgery to the medial recti, which is also muscle transposition procedure. Botulinum toxin is a likely to improve the final outcome. valuable tool in making this distinction. It also facilitates This study provides definite evidence, from a large full tendon transposition in unrecovered palsies, which series of patients, of the potential functional outcome from appears to produce the best functional outcome of all the the surgical treatment of unresolved VIth nerve palsy, transposition procedures, with a reduction in the need for together with clear guidance as to the forms of surgery that further surgery. A study of the surgical management of 12 should be undertaken in specific cases. The fundamental patients with partially recovered Vlth nerve palsy and 59 role of botulinum toxin in establishing the degree of lateral patients with unrecovered palsy provides clear guidelines rectus function and hence the correct choice of initial sur­ on how to attain a successful functional outcome with the gery, and as an adjunct to transposition surgery for unre­ minimum amount of surgery.
    [Show full text]
  • Iris Mammillations: Significance and Associations
    IRIS MAMMILLATIONS: SIGNIFICANCE AND ASSOCIATIONS 2 l NICOLA K. RAGGEL2, 1. ACHESON and A. LINN MURPHREE Los Angeles and London SUMMARY mammiform (nipple- or teat-like) protuberances. Iris mammillations are rarely described, distinctive Iris mammillations are an occasional finding with few previous reports. They are most commonly villiform protuberances that can cover the iris. In the l--6 majority of reported cases they are unilateral and found in association with melanosis oculi, with or sporadic, and are seen in association with oculodermal without periocular skin involvement in a naevus of melanosis. In past literature and current clinical Ota. They are thus often less precisely referred to as practice they are frequently confused with tbe iris iris melanosis, a term which should best be reserved nodules seen in neurofibromatosis type 1. Their clinical for increased pigmentation of the iris, irrespective of significance is not established, although it has been the presence of iris elevations overlying the pigmen­ 7 suggested that iris mammillations may be an external ted areas. This is supported by the rare descriptions sign of ocular hypertension or intraocular malignancy. of iris elevations in the absence of any increased iris We report a series of 9 patients between the ages of 3 pigmentation?,8 and 28 years with iris mammillations. The mammilla­ Iris mammillations are usually unilateral, often tions appear as regularly spaced, deep brown, smooth, presenting as heterochromia iridis. Occasional bilat­ 7 conical elevations on the iris, of uniform height or eral cases have been described. ,8 Iris mammillations increasing in height as the pupil margin is approached.
    [Show full text]
  • Strabismus: a Decision Making Approach
    Strabismus A Decision Making Approach Gunter K. von Noorden, M.D. Eugene M. Helveston, M.D. Strabismus: A Decision Making Approach Gunter K. von Noorden, M.D. Emeritus Professor of Ophthalmology and Pediatrics Baylor College of Medicine Houston, Texas Eugene M. Helveston, M.D. Emeritus Professor of Ophthalmology Indiana University School of Medicine Indianapolis, Indiana Published originally in English under the title: Strabismus: A Decision Making Approach. By Gunter K. von Noorden and Eugene M. Helveston Published in 1994 by Mosby-Year Book, Inc., St. Louis, MO Copyright held by Gunter K. von Noorden and Eugene M. Helveston All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the authors. Copyright © 2010 Table of Contents Foreword Preface 1.01 Equipment for Examination of the Patient with Strabismus 1.02 History 1.03 Inspection of Patient 1.04 Sequence of Motility Examination 1.05 Does This Baby See? 1.06 Visual Acuity – Methods of Examination 1.07 Visual Acuity Testing in Infants 1.08 Primary versus Secondary Deviation 1.09 Evaluation of Monocular Movements – Ductions 1.10 Evaluation of Binocular Movements – Versions 1.11 Unilaterally Reduced Vision Associated with Orthotropia 1.12 Unilateral Decrease of Visual Acuity Associated with Heterotropia 1.13 Decentered Corneal Light Reflex 1.14 Strabismus – Generic Classification 1.15 Is Latent Strabismus
    [Show full text]
  • Treatment of Younger Patients with Accommodative Esotropia
    Treatment of Younger Patients with Accommodative Esotropia xianjie liu The First Hospital of China Medical University Yutong Chen The First Hospital of China Medical University Xiaoli Ma ( [email protected] ) Research article Keywords: Accommodative esotropia, Treatment, High AC/A ( accommodative convergence to accommodation ratio ), Amblyopia. Posted Date: March 3rd, 2019 DOI: https://doi.org/10.21203/rs.2.428/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/14 Abstract Background: Accommodative esotropia (AET) is a common disease during childhood. In this literature review, we analyze and discuss the different methods of treatment for Accommodative esotropia. Methods: Articles about accommodative esotropia from 2007 to 2017 were retrieved from the PubMed database. We study the articles by title/abstract/all elds, after applying the inclusion and exclusion criteria, nally 9 articles were retained. We compared the effectiveness between these approaches to treatment. Results: All the refraction methods had an effectivity rate of > 50%. The bifocal lenses group showed a higher failure rate (15.58%) than the single-vision lenses group (5.19%). Extraocular muscle surgery can signicantly decrease deviation in patients who have AET with a high AC/A ratio (95.24%,71.30%,78.40%). After Botulinum toxin injection, the residual deviation was signicantly lower than that before the injection (90.44%) and this rate held stable until 12 months after the injection (85.71%) and then decreased to 71.43% at 18 months. The effectivity rate in the prism builders group (surgery with prism group) was signicantly higher than that in the prism non-builders group 100% vs.
    [Show full text]
  • Classification of Strabismus
    Classification of strabismus Pr Dr Monique Cordonnier Université Libre de Bruxelles Most prominent feature to have in mind = BINOCULAR VISION potential ? Yes or No If the strabismus was present during the first 6- 8 months of life, there is no This potential means that potential for treatment (……) may restore normal binocular binocularity, warranting vision stability and avoiding recurrences Binocular vision = eyes are like wheels on the rails of a railtrack 1 What is BINOCULAR VISION ? 1. Normal - Bifoveolar fixation with normal visual acuity in each eye, no strabismus, no diplopia, normal retinal correspondence, normal fusional vergence amplitudes, normal stereopsis. 2. Subnormal (abnormal) – 1 or more of the following; anomalous retinal correspondence, suppression, deficient to no stereopsis, amblyopia, decreased fusional vergence amplitudes. 3. Absence of Binocular Vision - no simultaneous perception, no fusion, no stereopsis Besides, the classification of strabismus is based on a number of features including : . The relative position of the eyes . The time of onset (=clue for binocular vision potential), . Whether the deviation is intermittent (=clue for binocular vision potential) or constant . Whether the deviation is comitant (supranuclear cause) or incomitant (nuclear or infranuclear cause, clue for binocular vision potential if the eyes are straight in one position) . According to the associated refractive error (accommodative strabismus) 2 Most common types of strabismus in children Supranuclear causes Paralytic, muscular or
    [Show full text]
  • Surgical Treatment of Esotropia Associated with High Myopia: Unilateral Versus Bilateral Surgery
    Eur J Ophthalmol 2010; 20 ( 4): 653 - 658 ORIGINAL ARTICLE Surgical treatment of esotropia associated with high myopia: unilateral versus bilateral surgery Yair Morad, Eran Pras, Yakov Goldich, Yaniv Barkana, David Zadok, Morris Hartstein Department of Ophthalmology, Assaf Harofeh Medical Center, Tel Aviv University, Zerifin - Israel PUR P OSE . To compare unilateral versus bilateral surgical treatment of esotropia associated with high myopia. METHODS . This retrospective study comprised patients who underwent surgery for esotropia with high myopia performed by the first author (Y.M.) between 2003 and 2008. Surgical results and complica- tions were compared between patients who underwent unilateral versus bilateral surgery. RESULTS . Nine patients were identified with average age of 44.9 years (range 8–70 years). All had bilate- ral high myopia (average –13.35 D, range –9.00 to –17.50 D) and esotropia of 20–75 diopters, together with hypotropia in 5 cases. Bilateral displacement of the lateral rectus inferiorly and superior rectus medially was demonstrated in each patient by computed tomography scan of the orbits and by ob- servation during surgery. Five patients underwent bilateral surgery and 4 underwent unilateral surgery. After an average follow-up of 29 months (range 4–47 months), 4/5 patients who underwent bilateral myopexy achieved good results with postoperative esotropia of less than 8 diopters, as opposed to 2/4 patients who underwent unilateral surgery. No complications were noted. CON C LUSIONS . Bilateral superior and lateral rectus myopexy is the preferred method of surgical correc- tion of esotropia associated with high myopia. Additional unilateral or bilateral medial rectus reces- sion is probably not indicated in most cases.
    [Show full text]
  • Strabismus Developing After Unilateral and Bilateral Cataract Surgery in Children
    Eye (2016) 30, 1210–1214 © 2016 Macmillan Publishers Limited, part of Springer Nature. All rights reserved 0950-222X/16 www.nature.com/eye CLINICAL STUDY Strabismus developing R David, J Davelman, H Mechoulam, E Cohen, I Karshai and I Anteby after unilateral and bilateral cataract surgery in children Abstract Purpose To evaluate the prevalence and common in children with poor final visual risk factors of strabismus in children acuity. undergoing surgery for unilateral or bilateral Eye (2016) 30, 1210–1214; doi:10.1038/eye.2016.162; cataract with or without intraocular lens published online 29 July 2016 implantation. Methods Medical records of pediatric Introduction patients were evaluated from 2000 to 2011. Children undergoing surgery for unilateral The rate of strabismus associated with cataract or bilateral cataract with at least 1 year of in children has been reported to range from follow-up were included. Children with 20.5 to 86%.1 Strabismus is more prevalent in ocular trauma, prematurity, or co-existing children who have been operated for cataract systemic disorders were excluded. The than in the general pediatric population.2–8 following data were evaluated: strabismus Moreover, it occurs more frequently in patients pre- and post-operation; age at surgery; with unilateral than bilateral cataract.1 The post-operative aphakia or pseudophakia; association between timing of surgery or the use and visual acuity. of intra ocular lens (IOL) with development of Results Ninety patients were included, 40% strabismus is still not fully understood. had unilateral and 60% had bilateral cataracts. The main purpose of this study is to evaluate Follow-up was on average 51 months (range: the prevalence and risk factors of strabismus 12–130 months).
    [Show full text]
  • Refraction of 1-Year-Old Children After Atropine Cycloplegia R
    Br J Ophthalmol: first published as 10.1136/bjo.63.5.343 on 1 May 1979. Downloaded from British Journal of Ophthalmology, 1979, 63, 343-347 Refraction of 1-year-old children after atropine cycloplegia R. M. INGRAM From the Kettering and District General Hospital, Kettering SUMMARY The refractions of 1648 children aged 11 to 13 months are reported. Atropine % was used for cycloplegia. 11 83% of the children had bilateral hypermetropia of +2O00 or more D. 13-23 % of them had + 1 50 or more D astigmatism in one or both eyes, and 6 5 % had anisometropia. Anisometropia was significantly (P=0-000 001 %) associated with bilateral hypermetropia, but even more significantly (P=0000000 4%) associated with astigmatism of +1 50 or more D in one or both eyes. Cyclopentolate was used in our pilot study (Ingram month of their birth, but some children born late et al., 1979) for reasons of convenience, but its in the month were refracted early in that month cycloplegic effect has not been proved (Davidson, and others, for one reason or another, attended 1976). Atropine is accepted generally as the most during the following month. Thus their ages ranged efficient cycloplegic drug, and the true range of from 11 to 13 months inclusive. refractions at age 1 year would be more accurately All the refractions were carried out by the recorded after 'atropinisation'. This is a report of author. When cycloplegia was obviously incomplete, the refractions of 1648 1-year-old children examined for example, the pupils were mobile or when the after 'full atropinisation'.
    [Show full text]
  • COMMON EYE COMPLAINTS July 15, 2004 Vatinee Bunya
    4/24/2018 They have a lazy eye… Be Specific!! Esotropia vs. Pseudoesotropia Eyes crossing (esotropia) Eyes drifting (exotropia) Head turn Droopy eyelid Vision concerns 1 4/24/2018 www.aapos.org/terms/conditions/49 Vertical strabismus Ocular torticollis Nystagmus Finding their null point Strabismus Fusion or less strain Ptosis Chin up to see below lids Refractive Error Squinting equivalent Amblyopia Amblyopia Three main reasons for amblyopia Refractive Greater than 2 lines difference in visual ○ high myopia/hyperopia or acuity or obvious preference for fixation in anisometropia non-verbal Strabismic Induced tropia test ○ Esotropia or exotropia or hypertropia ○ Take 12 pd base down over both eyes Deprevational ○ Symmetric response= no preference ○ Cataract, corneal opacity, vitreous ○ Asymmetric response= amblyopia hemorrhage, ptosis, hemangioma 2 4/24/2018 Their eyelid is swollen… Amblyopia Treatment Force brain to use weaker eye Fix underlying etiology (give glasses, fix strab remove cataract,etc) Patch Atropine Occluding CL Fog glasses No-No arm braces Super glue Management Stye/Chalazion Stye vs. Chalazion Warm compresses Lid hygiene Erythromycin vs. Maxitrol/Tobradex Surgical excision Cellulitis Can they open their eyelids on their own? Preseptal vs. Can you get the eyelids open? Postseptal Cellulitiss 3 4/24/2018 Treatment Orbital cellulitis Results from Antiobiotics Local resistance patterns Spread of contiguous sinus disease (most common) ○ 75-85% of cases are chronic sinusitis (acute 0.5-3%) Check blood cultures first ○ Most commonly ethmoid aircells To drain or not to drain? Traumatic violation of the orbit (implantation of Worrisome optic neuropathy foreign bodies) signs Trans-septal spread of preseptal cellulitis Abscess within orbit Metastatic hematogenous spread to orbit ○ not subperiosteal ○ Valveless orbital veins Treatment failures Dental abscess to orbit Orbital cellulitis My child’s eye is red… Common organisms Staphylcoccus Aureus Streptococcus species Anaerobic If <4 years old consider H.
    [Show full text]
  • Ophthalmic Manifestations in Childrens Presenting with Down Syndrome
    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 20, Issue 6 Ser.1 (June. 2021), PP 30-33 www.iosrjournals.org Ophthalmic Manifestations in Childrens Presenting With Down Syndrome Dr. Jitendra Kumar1, Dr.Romil Gupta2, Dr. Dr. Praveen Kumar Naik Hasavath3 1. Associate Professor & Head, Dept. of ophthalmology, MLB Medical College Jhansi, India. 2Junior Resident, Dept. of ophthalmology, MLB Medical College Jhansi, India. , 3 Junior Resident, Dept. of pediatrics , MLB Medical College Jhansi, India. Corresponding author: Dr. Jitendra Kumar Abstract Purpose - To study the ophthalmic manifestations in childrens presenting with Down syndrome. Methods- This was a prospective observational study that involved 30 eyes of 15 childrens of Down syndrome presenting with low visual acuity, strabismus, nystagmus, blephritis, large epicanthal folds, nasolacrimal duct obstruction , etc. Results-There were 9 males and 6 females and the age group taken was 1 to 10 years. Most common presentation in down syndrome patients is low visual acuity ( <6/18 ) in 74% patients followed by strabismus in 68 % patients , nystagmus in 52% patients , upward slanting palpaberal fissure in 51% patients , blephritis in 34% patients, nasolacrimal duct obstruction in 32% patients ,brushfield spots in 14% patients. Most common refractive error in down syndrome children is myopia in 46% patients followed by astigmatism in 32% patients and hyperopia in 22% patients. Fundus finding are rare in downs syndrome patient but include cupping of disc and optic atrophy. Other features of down syndrome are cerebral palsy, autism , hypertelorism, flat nasal bridge, alopecia and macroglossia. Conclusion - Down syndrome is common genetic disease presenting usually with multiple systemic features.
    [Show full text]
  • Sixth Nerve Palsy
    Advances in Ophthalmology & Visual System Mini Review Open Access Sixth nerve palsy Mini review Volume 8 Issue 1 - 2018 Among the ocular motor nerve palsies sixth nerve palsy is the most Smita Kapoor, Rajesh Prabu, Swarna common followed by fourth nerve and third nerve. Acute palsies can Udayakumar pose a diagnostic and therapeutic challenge to the ophthalmologist. University Sankara Eye Hospital, India Abducens nerve is susceptible to damage due to various intracranial pathologies. This is because of its long intracranial path, its angle at Correspondence: Smita Kapoor, University Sankara Eye the petrous tip of the temporal bone and non-flexibility of the path Hospital, Sathy Road, Coimbatore, India, Tel 9566632262, between the brainstem and the meningeal entrance site. Various Email causes include infections (meningitis, varicella zoster), trauma (head Received: January 03, 2018 | Published: January 18, 2018 injury), neoplasms (chondroma, metastasis), systemic disorders (atherosclerosis, leukaemia) and iatrogenic (post spinal anaesthesia). Sixth nerve palsies can occur in both adults and children. Those occurring in adults above the age of 40 years are most commonly caused by atherosclerosis and microangiopathies like hypertension and diabetes mellitus. Patients with acute sixth nerve palsy present with incapacitating diplopia. Ocular motility in these cases improves rectus muscle transposition procedure for treating paralytic strabismus in 94% of the patients by six months spontaneously. In general, at in 1908. Several modifications to his procedure were described by the onset of an isolated sixth nerve palsy in a vasculopathic patient, O’Connor, Jensen, Knapp, Carlson and Jampolsky. However, the neuroimaging is not required. However, a cranial MRI is mandatory original principle of all the surgeries remains the same.
    [Show full text]
  • Exotropia Kenneth W
    8 Exotropia Kenneth W. Wright xodeviations are quite common, and they are not necessa- Erily pathological. A small intermittent exotropia is normal in most newborns, as 70% of normal newborns have a transient exodeviation that resolves by 2 to 4 months of age.1 Another type of exodeviation that is considered normal is a small exophoria, usually less than 10 prism diopters (PD). Most normal adults have a small exophoria when fully dissociated. Exodeviations are controlled with our innate strong fusional convergence, typi- cally measuring 30 PD or more. The most common form of divergent strabismus is intermittent exotropia, which probably accounts for more than 90% of all exodeviations. Table 8-1 lists the different categories of pathological exodeviations, with the one most frequently occurring listed first. INTERMITTENT EXOTROPIA Intermittent exotropia is a large phoria that is intermittently controlled by fusional convergence. Unlike a phoria, intermit- tent exotropia spontaneously breaks down into a manifest exotropia (Fig. 8-1). Clinical Features Intermittent exotropia is usually first observed by the parents in early childhood or late infancy as an infrequent drifting or squinting of one eye. 12 Patients with intermittent exotropia tend to manifest their deviation when they are tired, have a cold or the flu, or when they are daydreaming. Adult patients will often become exotropic after imbibing alcoholic beverages or taking sedatives. 266 chapter 8: exotropia 267 TABLE 14.1. Classifications of Exodeviations. Intermittent exotropia (common) Convergence insufficiency (common) Sensory exotropia (common) Congenital exotropia (rare) Signs of intermittent exotropia include blurred vision, asthenopia, visual fatigue, and, rarely, diplopia in older children and adults.
    [Show full text]