Sheela Evangeline K Co ordinators: Ms. Rizwana Mr. Kabilan Motor evaluation Sheela Evangeline K Co ordinators: Ms. Rizwana Mr. 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?

Essential Infantile Esotropia 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) PBCT: Comitant 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

Fully accommodative esotropia Diagnosis ? Fully accommodative esotropia

Management

Partial accommodative esotropia                                                                                                                                                                                                                                                            Left esotropia on accommodation.   Residual esotropia with hypermetropic correction. Partial accommodative esotropia Next Case of Paediatric Ophthalmology  

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 ?

Distance deviation remains higher than near deviation Patch test Distance deviation remains higher than near deviation

True divergence type Exotropia 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 syndrome Type 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: PBCT: OD: 6/6 OS: 6/36 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!

Bilateral superior oblique palsy 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