2. Squint Clinic Hyderabad L. V. Prasad Eye Institute

4. Formal Orthoptic Diagnostic Aid: 123123 123123 management is traditional rather than rational

5. Orthoptic Report Getting an orthoptic report is like kissing your own sister It doesn’t lead anywhere Getting an orthoptic report is like kissing your own sister It doesn’t lead anywhere

6. Practical Approach To Strabismus

8. Definition of Strabismus When the two visual axes do not intersect at the object of attention

9. Aim of Examination To determine the normality or abnormality of : The sensory apparatus The motor apparatus In a valid & repeatable manner To determine the normality or abnormality of : The sensory apparatus The motor apparatus In a valid & repeatable manner

10. Information Required From Exam Bifoveal Fusion Nature and degree of Deviation Fusional Vergences Measurements If Tropia – characteristics of Suppression scotoma Bifoveal Fusion Nature and degree of Deviation Fusional Vergences Measurements If Tropia – characteristics of Suppression scotoma

11. Factors to Be Controlled Accommodation Fixation Fusional vergences Accommodation Fixation Fusional vergences

12. All Tests Cycloplegic retinoscopy Refractive errors corrected Accommodative target for distance and near Cycloplegic retinoscopy Refractive errors corrected Accommodative target for distance and near

16. Sequence of Clinical Tests Bi foveal fusion Fusional vergences Deviations & Measurements Rotations, A/V, Head tilt Limitation of movements Restriction VS weakness Characteristics of suppression Bi foveal fusion Fusional vergences Deviations & Measurements Rotations, A/V, Head tilt Limitation of movements Restriction VS weakness Characteristics of suppression

17. Doctor Must Do the Examination Personally

18. Cover Test

19. Exotropia

20. Esotropia

22. Alternate Divergent Squint

23. Un - Cover Test

25. Exophoria – Fusional Reflex

26. Exophoria – Fusion Movement

27. Intermittent Divergent Squint

29. Prism Bar Cover Test

33. Ocular Movements

37. every limitation of movement must be checked uniocularly

41. Patterns : Rising Eye

42. Patterns : Falling Eye

43. Testing For A-V Pattern

44. No A or V

46. V Pattern

48. A Pattern

49. 10 ET 10 RXT 40 XT +4+4 +4+4 L/R +30 - 3 R/L +30 Recording Results

50. 10 ET 10 RXT 40 XT +4+4 +4+4 L/R +30 {-3}{-3} - 3 R/L =30 Recording Results

53. Globe Retraction

54. Exotropia with Hypertropia R.E. Fixing

56. Suspect Strabismus If abnormal head posture If closing one eye If abnormal head posture If closing one eye

57. Head Tilt Test

58. Head Tilt Test : Others

64. Sixth Nerve Paralysis & Saccades

66. Floating Saccades

67. Primary Versus Secondary Deviation

68. Forced Duction Test

70. Force Generation Test

72. Sensory System / Tests The sensory system is of inestimable importance in the management Valid inferences : Age of patient Type of squint Refraction correction H/O Motor examination The sensory system is of inestimable importance in the management Valid inferences : Age of patient Type of squint Refraction correction H/O Motor examination

73. Sensory / Suppression - Inference Early onset tropia Binocular suppression scotoma Early onset exotropia Temporal hemiretinal suppression scotoma Early onset esotropia Regional nasal hemiretinal suppression Early onset tropia Binocular suppression scotoma Early onset exotropia Temporal hemiretinal suppression scotoma Early onset esotropia Regional nasal hemiretinal suppression

74. Visual Acuity

75. Even in a Baby It Is Possible To Test the quality of vision Refract and examination fundi (with help of atropine) Test the quality of vision Refract and examination fundi (with help of atropine)

76. Qualitative Vision

77. Don’t Forget The Fundus

78. Prism RE: LE moves out And comes back to refixate Prism RE: LE moves out And comes back to refixate 4 Prism Test : Normal

79. Prism RE: LE moves out And stays out Prism RE: LE moves out And stays out 4 Prism Test : Abnormal After removal of prism

80. Prism LE : No movements 4 Prism Test: Abnormal

81. 4 Prism Test : Positive

82. Sophisticated Tests

88. Audience Interaction

89. Aim of Strabismus Management Good vision in each eye Binocular vision Preferably stereopsis Normalise : Deviations Rotations Head position Good vision in each eye Binocular vision Preferably stereopsis Normalise : Deviations Rotations Head position

90. Rx of Strabismus Glasses Occlusion Prisms (Exercises) Surgery : minimum number of interventions Glasses Occlusion Prisms (Exercises) Surgery : minimum number of interventions

91. Pseudo Strabismus

94. Glasses

98. Occlusion

100. Cosmetic Surgery

101. Adjustable Sutures

102. Superior Oblique Paralysis

108. Key to Strabismus If you master the physical examination and disregard the mystique of orthoptics then strabismus is no longer such a difficult subject Even I can handle it ? If you master the physical examination and disregard the mystique of orthoptics then strabismus is no longer such a difficult subject Even I can handle it ?

110. If you are interested in doing things mechanically Fix holes in the retina / do cataracts If you want to exercise those grey cells Do squints