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Case 1
Citation preview
Motor evaluation
Sheela Evangeline K
Co ordinators:Ms. RizwanaMr. Kabilan
Case 1
Presentation Age: 8 months Complaint of inward deviation of eye
History? Onset: birth Alternating Family history – mother Not ass with shaking of eye ball Activities normal Birth history: normal
Evaluation Gross motor evaluation : normal Preference of fixating eye : alternating Visual acuity : fixates light and toys
monocularly No nystagmus Limitation of abduction Cyclopleigic refraction: OU: +2.00DS Modified Krimsky: 45 PD Fundus: normal
What do you see?
Diagnosis ?
Essential Infantile Esotropia
Management?
Case 2
Presentation
Age : 5 years C/O inward deviation of eye
History
Right eye – constant esotropia No CNS abnormalities Birth history : normal
Evaluation Vision ( with Leas)
OD: 6/12 OS: 6/9
PBCT: Distance: 30 PD Near: 40 PD
Comitant No latent nystagmus, dissociated vertical deviation
or smooth pursuit asymmetry. Worth four dot test : OD: suppression Cycloplegic retinoscopy OU: +4.00/-0.50 × 180. Slit lamp examination and fundus was normal
What will you do next ? Raab’s plus 3 test
CT over glasses Distance: ortho Near: 5 PD esophoria
Vision with glasses OD: 6/7.5 OS: 6/7.5
Diagnosis ?
Fully accommodative esotropia
Management
Partial accommodative esotropia
Left esotropia on accommodation.
Residual esotropia with hypermetropic correction.
Case 3
Presentation Age: 11 yr C/o outward deviation of left eye
History Onset : 1 yr of age Constant
Evaluation Vision OD: 6/6 ; OS: 6/15 LXT for distance and near PBCT:
Distance: 60 PD Near: 40 PD
What will you do next ?
What pattern you see ?
Patch test
Distance deviation remains higher than near deviation
Diagnosis
True divergence type Exotropia
Management
Case 4
Presentation
Age: 9 years C/o outward deviation of right eye Left face turn Limited eye movements
Evaluation
Limited abduction Retraction and narrowing of palpebral fissure
on adduction Widening on abduction Leash phenomenon present
Diagnosis ?
Duane’s syndromeType 2
Case 5
Presentation
Age: 27 years S/p RD surgery at age of 14 yrs c/o inward deviation of left eye since 2 years
More in alternate days Ass with decreased vision
Evaluation
Vision: OD: 6/6 OS: 6/36
PBCT: 60 PD on first day 12 PD on second day
Diagnosis ?
Cyclic Esotropia
Management ?
A large recession of the left medial rectus and resection of the left lateral rectus
Safety glasses
Case 6
Presentation
Age: 30 years S/p RTA
Loss of consciousness C/o double vision on awakening – says images
are tilted With chin down position diplopia disappears
Evaluation
What do you see ?
Evaluation
Slit lamp examination : normal
Fundus
Characteristic!
Diagnosis ?
Bilateral superior oblique palsy
Which way would the images be tilted?
Management
Surgery
Bilateral inferior rectus recession Medial rectus down shift Bilateral S.O. Harada-Ito Bilateral inferior oblique weakening
Few more cases
C/o squinting
Diagnosis ?
Negative angle kappa
C/o squinting
Vision OU: 6/6 Hirschberg: 15deg ET Cover test : ortho
Diagnosis ?
Pseudo strabismus due to epicanthus
Thank you