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Paralytic strabismus ,[object Object]
 
this does not aid in the diagnosis of the affected muscle in paretic situation.   ,[object Object],[object Object]
 
 
Terms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hering’s Law of Equal Innervation   ,[object Object],[object Object],[object Object]
Sheringtons Law of Reciprocal Innervation  ,[object Object],[object Object],[object Object]
Sequelae of Ocular Muscle Palsy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Overaction of the contralateral synergist   ,[object Object],[object Object],[object Object],[object Object]
Overaction of the ipsilateral (direct) antagonist   ,[object Object],[object Object],[object Object]
Underaction of the antagonist of the contralateral synergist (contalateral antagonist)   ,[object Object],[object Object]
Overaction of the ipsilateral synergist   ,[object Object]
For example in paralysis of the right superior rectus ,[object Object],[object Object],[object Object],[object Object],[object Object]
ANATOMICAL CONSIDERATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medial Rectus
Lateral Rectus : abduction
Superior Rectus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
In primary position muscle plane  of the SR forms angle  23°with optical axis. In this position SR Elevates the globe. Secondary  Actions intorsion and adduction
 
In 23° abduction, SR complete  Elevator, muscle plane  coincides with optical axis
Superior Oblique ,[object Object],[object Object],[object Object],[object Object],[object Object]
Eye in primary position Muscle plane SO forms  angle 54° with optical  axis. Action is intorsion Secondary actions  abduction and depression RE
When globe adducted 54°, Optical axis and muscle  plane coincide, SO is pure  depressor RE
RE In abduction SO  is primarily an intortor
Inferior Rectus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Inferior Oblique ,[object Object],[object Object],[object Object],[object Object],[object Object]
For right eye read from the top For left eye read from the bottom
Rule for the secondary actions of the vertical muscles ,[object Object]
INCOMITANT STRABISMUS :  CLASSIFICATION AND INVESTIGATION ,[object Object]
Classification ,[object Object],[object Object],[object Object],[object Object],[object Object]
Congenital ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acquired ,[object Object],[object Object],[object Object],[object Object],[object Object]
INVESTIGATION OF INCOMITANCY ,[object Object],[object Object],[object Object],[object Object],[object Object]
History and Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
History and Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General observation of the patient ,[object Object]
Abnormal head posture   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Components ,[object Object],[object Object],[object Object]
Face turn – to the left or right.  ,[object Object],[object Object]
Chin elevation or depression ,[object Object],[object Object],[object Object]
Head tilt : occurs for 2 reasons ,[object Object],[object Object],[object Object]
Head tilt : occurs for 2 reasons ,[object Object],[object Object],[object Object],[object Object],[object Object]
Cover Test with and without AHP
Cover Test: comparison of deviation with each eye fixing ,[object Object],[object Object],[object Object],[object Object],[object Object]
Cover Test: comparison of deviation with each eye fixing ,[object Object]
Motility  – check ,[object Object],[object Object],[object Object],[object Object],[object Object]
Motility  – check ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
3 step technique  (more reliable in fairly recent paresis) ,[object Object],[object Object]
3 step technique  (more reliable in fairly recent paresis) ,[object Object],[object Object]
3 step technique  (more reliable in fairly recent paresis) ,[object Object],[object Object]
3 step technique  (more reliable in fairly recent paresis) ,[object Object],[object Object]
3 step technique  (more reliable in fairly recent paresis) ,[object Object],[object Object]
3 step technique  (more reliable in fairly recent paresis) ,[object Object],[object Object],[object Object],[object Object]
Hess Screen Plots ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lateral Rectus ,[object Object],[object Object],[object Object]
Medial rectus ,[object Object],[object Object],[object Object],[object Object]
Superior Rectus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Inferior Rectus ,[object Object],[object Object],[object Object],[object Object],[object Object]
Inferior Oblique ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Superior Oblique ,[object Object],[object Object],[object Object],[object Object]

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Paralytic strabismus

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  • 17. Lateral Rectus : abduction
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  • 19. In primary position muscle plane of the SR forms angle 23°with optical axis. In this position SR Elevates the globe. Secondary Actions intorsion and adduction
  • 20.  
  • 21. In 23° abduction, SR complete Elevator, muscle plane coincides with optical axis
  • 22.
  • 23. Eye in primary position Muscle plane SO forms angle 54° with optical axis. Action is intorsion Secondary actions abduction and depression RE
  • 24. When globe adducted 54°, Optical axis and muscle plane coincide, SO is pure depressor RE
  • 25. RE In abduction SO is primarily an intortor
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  • 28. For right eye read from the top For left eye read from the bottom
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  • 44. Cover Test with and without AHP
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Editor's Notes

  1. The condition in which the patient sees not much and the practitioner nothing at all… ! It is always (or almost always) associated with strab, aniso or form deprivation in early life. Diagnosed when there reduced letter acuity, absence of pathology and when any ametropia is corrected. The results of pyschophysical studies & electrophysiological investigations suggest little primary retinal or LGN abnormality. Instead, the most profound effects of the amblyopic process are found in the striate cortex.