1. SQUINT / STRABISMUS Dr.chandrakanth

2. Squint – condition where the visual axis of two eyes do not meet at the point or object of regard

3. Tropia – manifest squint Phoria – latent squint Orthophoric

4. Clinical parameters of squint Direction - eso/exo; hyper/hypo; incyclo/excyclo Frequency – Latent/Manifest; Intermittent/Constant Magnitude – for near / distance Comitancy – Comitant/Incomitant Laterality – Unilateral / Alternating

5. Cover test – direction of squint Uncover test – Constant/Alternating; Cover-Uncover test – Comitant/Incomitant Alternate cover test – Latent squint (phoria)

7. 2045700 Amount of deviation -Hirschberg Test

8. Clinical featuresIncomitant squint (paralytic or restrictive) Comitant squint Magnitude of squintVaries with eye positionSame in all position DiplopiaUsually presentUsually absent Ocular movementsRestrictedFull False projectionPresentAbsent Abnormal head postureUsually presentAbsent Secondary deviationMore than primaryEqual to primary Differentiating Incomitant & Comitant squint

9. Amblyopia Def: Condition with Uni/Bi subnormal vision (2lines < normal / 2 lines <fellow eye) without any ophthalmoscopic abnormality Types(etiology): a)Sensory A – stimulus deprivation b)Anisometropic.A c)Ametropic d)Strabismic A Pathophysiology:occurs critical/sensitive period 0-8 yrs

10. Management: Rx of cause- RE correction/squint correction/ Rx medial opacities a)Occlusion of fixing eye b)Penalisation c)Stimulating of lazy eye with spatial frequency gratings covering all orientations

11. Orbit Orbital cellulitis Proptosis

12. PROPTOSIS - Forward protrusion of eyeball Measurement – Hertels/Ludie’s Exophthalmometer Unilateral Pesudo tumor Obital varices Orbital cellulitis Tumors Mucocele of PNS Orbital H’age Bilateral Thyroid orbitopathy Cavernous sinus thrombosis Bilateral metastatic tumors

13. D/D of acute inflamatory proptosis S.No.Clinical FeaturesCavernous Sinus Thrombosis Orbital CellulitisPanophthalmitis 1LateralityInitial U/L, soon becomes B/L U/L 2Degree of Proptosis ModerateMarkedModerate 3VisionNot affected in early stage Complete loss of vision from begning 4Cornea & Ant. Chamber Clear in early stages Hazy due to corneal edema. Pus in AC 5Ocular MovementsComplete limitation of palsy Marked limitationPainful & limited 6Edema in mastoid region PresentAbsent 7General symptoms With fever & prostration MarkedMildmild

14. Retinoblastoma Definition: Congenital malignant tumour arising from neurosensory retina Incedence: 1 in 20,000 / between 1-2yrs / 25-30% B/L Heredity: Sporadic 94% / Famlial 6% Pathology: immature retinal neural cells- retinoblasts Histopathology: Flexner-wintersteiner/ Homer-Wright rosettes, pseudo rosettes, areas of necrosis & calcifications

15. Clinical staging Quiescent stage Glaucomatous stage Stage of extra ocular extention Stage of distant metastasis Prognostic staging – Reese- Ellworth’s

16. D/D of leukocoria(white reflex): Investigations: 1.GA examination 2.X-Ray orbit 3.USG/CT scan

17. Treatment modalities 1.LASER- Photocoagulation 2.Surgery- Enucleation/ Exentration 3.Radiation 4.Chemotherapy: VEC