for mbbs student

1. MANAGEMENT OFMANAGEMENT OF
STRABISMUSSTRABISMUS
avav
sharmasharma

2. Why We TreatWhy We Treat
1- Restore Stereopsis1- Restore Stereopsis
2- Prevent Amblyopia2- Prevent Amblyopia
3- Prevent Confusion and Diplopia3- Prevent Confusion and Diplopia
4- Appearance4- Appearance

3. Why We TreatWhy We Treat
1- Restore Stereopsis1- Restore Stereopsis
Three dimensional vision..Three dimensional vision..

4. Why We TreatWhy We Treat
2- Amblyopia2- Amblyopia
Amblyopia is the unilateral or bilateral decrease ofAmblyopia is the unilateral or bilateral decrease of
Vision caused by form vision deprivation and/orVision caused by form vision deprivation and/or
abnormal binocular interaction for which there isabnormal binocular interaction for which there is
no obvious cause found by physical examinationno obvious cause found by physical examination
of the eye.of the eye.

5. Why We TreatWhy We Treat
3- Confusion and Diplopia3- Confusion and Diplopia
.Confusion is the simultaneous appreciation of two.Confusion is the simultaneous appreciation of two
superimposed but dissimilar images caused bysuperimposed but dissimilar images caused by
stimulation of corresponding points (usuallystimulation of corresponding points (usually
foveae) by images of different objects.foveae) by images of different objects.
. Diplopia is the simultaneous appreciation of two. Diplopia is the simultaneous appreciation of two
images of one object. Jt results from a failure toimages of one object. Jt results from a failure to
maintain binocular vision.maintain binocular vision.

7. Why We TreatWhy We Treat
4- Appearance4- Appearance

9. Treatment ofTreatment of
heterophoriaheterophoria indicated inindicated in
decompensated heterophoriadecompensated heterophoria
(i.e., symptomatic cases).(i.e., symptomatic cases).
1. Correction of refractive error1. Correction of refractive error
when detected is most important.when detected is most important.

10. 2. Orthoptic treatment.2. Orthoptic treatment.
heterophoria without refractiveheterophoria without refractive
errorerror
not corrected by glassessnot corrected by glassess
to improve convergenceto improve convergence
insufficiency and the fusionalinsufficiency and the fusional
reserve. Orthoptic exercises canreserve. Orthoptic exercises can
be done with synoptophore.be done with synoptophore.
Simple exercises to be carried outSimple exercises to be carried out
at homeat home

11. synoptophoresynoptophore

12. 3. Prescription of prism in glasses3. Prescription of prism in glasses
selected cases Prism is prescribedselected cases Prism is prescribed
with apex towards the direction ofwith apex towards the direction of
phoria , two-thirds ofphoria , two-thirds of
heterophoriaheterophoria

13. 4. Surgical treatment.4. Surgical treatment.
marked symptoms which are notmarked symptoms which are not
relieved by other measures.relieved by other measures.
strengthen the weak muscle orstrengthen the weak muscle or
weaken the strong muscleweaken the strong muscle

14. TREATMENT OFTREATMENT OF
CONCOMITANTCONCOMITANT
STRABISMUSSTRABISMUS
GoalsGoals
achieve good cosmeticachieve good cosmetic
correction, to improve visualcorrection, to improve visual
acuity and to maintain binocularacuity and to maintain binocular
vision.vision.

15. 1.Spectacles1.Spectacles
full correction of refractive error,full correction of refractive error,
every case.every case.
improve visual acuity, mayimprove visual acuity, may
correct the squint partially orcorrect the squint partially or
completely (as in accommodativecompletely (as in accommodative
squint).squint).

17. 2.Occlution therapy2.Occlution therapy
Sensitive period during which theSensitive period during which the
amblyopia can be cured is below 10amblyopia can be cured is below 10
years of ageyears of age
#. occlusion of the normal eye to#. occlusion of the normal eye to
encourage the use of the abnormal eyeencourage the use of the abnormal eye
is the most effective treatmentis the most effective treatment

19. it should be ensuredit should be ensured
that:that:
Opacity in the media (e.g.,Opacity in the media (e.g.,
cataract), if any, should becataract), if any, should be
removed first,removed first,
Refractive error, if any, should beRefractive error, if any, should be
fully correctedfully corrected

20. schedule for occlusion therapyschedule for occlusion therapy
depending up on the age is asdepending up on the age is as
below:below:
Upto 2 years, the occlusionUpto 2 years, the occlusion
should be done in 2:1, i.e., 2 daysshould be done in 2:1, i.e., 2 days
in sound eye and one day inin sound eye and one day in
amblyopic eye. At the age 3years,amblyopic eye. At the age 3years,
3:1At the age of 4 years, 4:1,3:1At the age of 4 years, 4:1,
At the age of 5 years, 5:1, andAt the age of 5 years, 5:1, and
After the age of 6 years, 6:1After the age of 6 years, 6:1

21. Duration of occlusion should beDuration of occlusion should be
until the visual acuity developsuntil the visual acuity develops
fully, or there is no furtherfully, or there is no further
improvement of vision for 3improvement of vision for 3
months.months.

22. 3 preoperative orthoptic exercise3 preoperative orthoptic exercise
4 squint surgery4 squint surgery
5 postoperative orthoptic exercise5 postoperative orthoptic exercise

23. ManagementManagement
ofof
paralyticparalytic
strabismusstrabismus
1.Treatment of the cause1.Treatment of the cause
investigative work-up.investigative work-up.

24. 2.Conservative measures.2.Conservative measures.
wait and watch for self-wait and watch for self-
improvement to occur for aimprovement to occur for a
period of 6 months, vitamin B-period of 6 months, vitamin B-
complex as neurotonic; andcomplex as neurotonic; and
systemic steroids for non-specificsystemic steroids for non-specific
inflammationsinflammations

25. 3.Treatment of annoying3.Treatment of annoying
diplopia.diplopia.
occluder on the affected eye, withoccluder on the affected eye, with
intermittent use of both eyes ,tointermittent use of both eyes ,to
prevent suppressionprevent suppression
amblyopiai.e. partial loss of visionamblyopiai.e. partial loss of vision
,in one eye,cortical supretion of,in one eye,cortical supretion of
central vision to prevent diplopiacentral vision to prevent diplopia

26. ..
. 4.Surgical treatment.. 4.Surgical treatment.
in case the recovery does notin case the recovery does not
occur in 6 months.occur in 6 months.
provide a comfortable field ofprovide a comfortable field of
binocular fixation,binocular fixation,
strengthening of the paralysedstrengthening of the paralysed
muscle by resection; andmuscle by resection; and
weakening of the overactingweakening of the overacting
muscle by recession.muscle by recession.

27. STRABISMUS SURGERY

28. Surgical techniquesSurgical techniques
1.Muscle weakening procedures1.Muscle weakening procedures
include recession, marginalinclude recession, marginal
myotomy and myectomy.myotomy and myectomy.
2.Muscle strengthening2.Muscle strengthening
procedures are resection, tuckingprocedures are resection, tucking
and advancement.and advancement.

29. 3.Procedures that change3.Procedures that change
direction of muscle action. Thesedirection of muscle action. These
include (a) vertical transpositioninclude (a) vertical transposition
of horizontal recti to correct ‘A’of horizontal recti to correct ‘A’
and ‘V’ patterns (b) posteriorand ‘V’ patterns (b) posterior
fixation suture (Faden operation)fixation suture (Faden operation)
to correct dissociated verticalto correct dissociated vertical
deviation; and (c) transplantationdeviation; and (c) transplantation
of muscles in paralytic squints.of muscles in paralytic squints.

31. Steps of resectionSteps of resection
1.Muscle is exposed as for recession and the1.Muscle is exposed as for recession and the
amount to be resected is measured withamount to be resected is measured with
callipers and marked. 2.Two absorbablecallipers and marked. 2.Two absorbable
sutures are passed through the outer quarterssutures are passed through the outer quarters
of the muscles at the marked site. 3.Theof the muscles at the marked site. 3.The
muscle tendon is disinserted from the scleramuscle tendon is disinserted from the sclera
and the portion of the muscle anterior toand the portion of the muscle anterior to
sutures is excised. 4.The muscle stump issutures is excised. 4.The muscle stump is
sutured with the sclera at the original insertionsutured with the sclera at the original insertion
site. 5.Conjunctival flap is sutured backsite. 5.Conjunctival flap is sutured back

33. Steps of recessionSteps of recession
1.Muscle is exposed by reflecting a flap of1.Muscle is exposed by reflecting a flap of
overlying conjunctiva and Tenon’s capsule.overlying conjunctiva and Tenon’s capsule.
2.Two vicryl sutures are passed through the2.Two vicryl sutures are passed through the
outer quarters of the muscle tendon near theouter quarters of the muscle tendon near the
insertion. 3.The muscle tendon is disinsertedinsertion. 3.The muscle tendon is disinserted
from the sclera with the help of tenotomyfrom the sclera with the help of tenotomy
scissors. 4.The amount of recession isscissors. 4.The amount of recession is
measured with the callipers and marked onmeasured with the callipers and marked on
the sclera. 5.The muscle tendon is suturedthe sclera. 5.The muscle tendon is sutured
with the sclera at the marked site posterior towith the sclera at the marked site posterior to
original insertion. 6.Conjunctival flap isoriginal insertion. 6.Conjunctival flap is
sutured back.sutured back.

34. thankuthanku