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Manual of Squint
Leela Ahuja
1:
Introduction
2:
Anatomy of Extraocular Muscles
NERVE SUPPLY
3:
Neurological Control of Ocular Movements
THE PHYSIOLOGY OF OCULAR MOVEMENTS
Ocular Movements
Versions (Conjugate movements)
Vergences
Voluntary
Involuntary
ACTIONS OF EXTRAOCULAR MUSCLES
4:
Binocular Vision
MECHANISMS
Sensory Mechanisms
Retinal Sensitivity
Retinal Correspondence
Visual Pathways
Motor Mechanisms
Anatomical Factors
Physiological (or dynamic) Factors
Central Mechanisms
GRADES OF BINOCULAR VISION
Simultaneous Perception
Fusion
Stereopsis
5:
Visual Acuity
ANGULAR AND CORTICAL VISUAL ACUITY
RECORDING OF VISUAL ACUITY
VISION IN VARIOUS REFRACTIVE ERRORS
Hypermetropia
Myopia
Astigmatism
Anisometropia
OBSTACLES TO VISION AT VARIOUS AGES FROM BIRTH TO INFANCY
6:
Abnormalities of Binocular Vision
MECHANISM
Binocular Vision and Anisometropia
Vision in Anisometropia
Relationship between Anisometropia and Amblyopia
Relationship with Squint
Anisometropia and Eccentric Fixation
7:
Accommodative Convergence/Accommodation Ratio
METHODS FOR DETERMINATION OF RATIO
Details of the Methods for Determination of AC/A Ratio
THE MAJOR ABLYOSCOPIC METHOD
8:
Heterophoria
CLASSIFICATION OF HETEROPHORIA
ETIOLOGY OF HETEROPHORIA
Exophoria
Esophoria
Hyperphoria
Static Hyperphoria
Paretic Hyperphoria
Spastic Hyperphoria
ROLE OF REFRACTIVE ERRORS
SYMPTOMS OF HETEROPHORIA
Exophoria
Esophoria
Sensory Adaptation in Heterophorias
Role of Hereditary
INVESTIGATIONS
History
Ophthalmic Examination
Interpupillary Distance
Simultaneous Macular Perception
Fusion
Stereopsis
Accommodative Convergence/Accommodation Ratio (AC/A Ratio)
Refraction
TREATMENT OF HETEROPHORIA
Orthoptic Treatment
Operation
Hyperphoria
Basic Orthoptic Treatment
Cyclophoria
Convergence Insufficiency
General Physical Causes
Treatment
Treatment
Optical Treatment
Orthoptic Treatment
Prism Treatment or Prismotherapy
Surgical Treatment
Convergence Paralysis
Normal Adduction
Convergence Spasm
Treatment
9:
Pseudostrabismus
PSEUDOESOTROPIA
PSEUDODIVERGENT STRABISMUS
PSEUDOHYPERTROPIA
10:
Manifest and Concomitant Squints
CLASSIFICATION OF SQUINT
Classification
Etiological Causes (Duke Elder)
General Features
Symptoms
Cyclotropia
Sequalae of Events in a Case
METHOD OF EXAMINATION
History
Family History
Systemic Examination (Fig. 10.1)
Ophthalmological Examination
Preferential Looking Test
Contrast Sensitivity Charts
Cambridge Low Contrast Gradings
E-cut Out Test (Fig. 10.5)
Orthoptic Examination
Cardiff Acuity Test
Ductions
Cover Test (Figs 10.6A and B)
Angle of Deviation (Fig. 10.9)
Hirschberg's Method
Prism Bar Cover Test (Fig. 10.10)
Prism Bar Reflection Test (Krimsky's Test)
Synoptophore
Flashing Method
Corneal
Subjective Angle of Deviation
Assessment of Binocular Functions (On Synoptophore)
Maddox Wing Test
Near Point of Convergence
Near Point of Accommodation
Worth's Four Dot Test
Bagolini's Striated Glass Test
Sighting/Pointing Test
After Image Test on Synoptophore (Fig. 10.12)
Refraction and Fundus Examination
Eccentric Viewing vs Eccentric Fixation
CONCOMITANT SQUINT METHOD OF EXAMINATION
Qualitative Diagnosis of Strabismus
Quantitative Diagnosis of Strabismus
TREATMENT
Glasses
Treatment of Amblyopia
Orthoptic Treatment
Antisuppression Exercises
Fusion Exercises
Operation
AMOUNT OF OPERATION
Anterior Segment Ischemia
Symptoms and Sign of Anterior Segment Ischemia
Faden Operation or Postfixation Suture
Adjustable Sutures
ACCOMMODATIONAL SQUINT
Physiology
Accommodative Convergence
Proximal Convergence
Tonic Convergence
Fusional Convergence
Accommodative Convergence/Accommodation (AC/A) Ratio
Accommodating Squint
Classification
Fully Accommodative Type
Convergence—Excess Type
Divergence–Insufficiency Type
Cases in Which Binocular Single Vision is Absent
Partially Accommodative Type
Clinical Investigations
History
Refraction and Visual Acuity
Orthoptics Investigations
Cover Test
Examination with Major Amblyoscope
Measurement of Near Point of Accommodation
Estimation of the AC/A Ratio
Estimation of Negative and Positive Fusional Convergence
Treatment
Correction of Refraction Error
Occlusion
Orthoptic Treatment
Overcoming Suppression
Teaching Relaxation of Accommodation
Teaching Negative Relative Fusional, Convergence and Improving Binocular Visual Acuity
Teaching Good Binocular Convergence
Miotic Therapy
Prerequisite
Disadvantage
Surgical Treatment
Criteria for Cure
Just to Summary the Accommodation Squint
Esotropia (Convergent squint)
Accommodative Squint
Treatment of Accommodative Eso
Action of Mioties
Indication of Miotic Theory
EXODEVIATION
Introduction
Classification
Investigation
History
Visual Acuity
Refraction
External, Examination
Head Posture
Cover Test (Fig. 10.14)
Ocular Movements (Fig. 10.15)
Convergence Test
Prism Bar and Cover Test
Maddox Wing Test
Maddox Rod Test
Synoptophore Examination
Diplopia Test
Special Tests for Exodeviation
Occlusion Test
+3.0D Spherical Lens Test
Management of Exodeviation
Optical Treatment
Surgical Treatment
Choice of Surgical Procedure
Orthoptic Treatment
Preoperative Treatment
Postoperative Treatment
MICROFIXATION SYNDROME (MICROTROPIA)
Microbiology
Diagnostic Method
Monofixation Syndrome
Treatment of Microtropia
11:
Paralytic Squints
ETIOLOGY
SYMPTOMS
SEQUELAE OF EXTRAOCULAR MUSCLE PALSY (FIG. 11.2)
CLINICAL EVALUATION OF THE PATIENT
History
Record of Visual Acuity
Ocular Motility
Inspect from Distance
Compensatory Head Postures
Cover Test
Diplopia Charting (Fig. 11.3)
Hess Charting
Advantages
Interpretation
Fields of Fixation (Uniocular and Binocular) (Figs 11.4 and 11.5)
Bielschowky's Head Tilt Test
Routine Ophthalmoscopic Examination
Forced Duction Test
Estimation of Generated Muscle Force
Exaggerated Force Duction Test
Differential Intraocular Pressure
Eye Movement Velocity
Electromyography
Electro-oculography
Doll's Head Phenomenon
Bell's Phenomenon
Neurological Examination
Special Tests
Investigations for Thyroid Functions
Testing of Corneal Sensation
Other Investigations
TYPES OF PARALYSIS
IIIrd Nerve Palsy
IVth Nerve Palsy
VIth Nerve Palsy
Pseudograefe Sign
MANAGEMENT
The Indications for Therapy
Treatment of Diplopia
Surgical Correction
Surgical Procedures
Surgery for VIth Nerve Palsy
IVth Nerve Palsy
IIIrd Nerve Palsy
COMPLETE PARALYSIS OR PARESIS
Weakening Operation
BLOWOUT FRACTURE
Ocular Myopathy
Myasthenia Gravis
Painful Ophthalmoplegia
DOUBLE ELEVATOR PALSY
Treatment
Differential Diagnosis of Ocular vs Congenital Torticollis (Tables 11.2 and 11.3)
TOTAL OPHTHALMOPLEGIA
DOUBLE DEPRESSOR PARALYSIS
Botulinum Toxin
APPLIED ANATOMY
Oculomotor Nerve (IIIrd N) (Fig. 12.6)
THE TROCHLEAR NERVE (IVTH N)
THE ABDUCENS NERVE (VITH N)
Contralateral Hemiplegia
12:
Vertical Strabismus
COMITANT VERTICAL DEVIATIONS
Treatment
DISSOCIATED VERTICAL DEVIATIONS (DVD)
Diagnosis
Cover-Uncover Test
Bielschowsky Phenomenon
Treatment
Recession of Inferior Oblique
INCOMITANT VERTICAL DEVIATIONS
Inferior Oblique Overaction
Treatment
Superior Oblique Overaction
Treatment
CYCLODEVIATIONS
Excyclophoria or Excyclotropia
Incyclophoria or Incyclotropia
13:
A-V and X Syndromes
DEFINITION
CLASSIFICATION
Group I
Group II
Group III
Group IV
Pure Type
Impure Type
INCIDENCE
CLINICAL PICTURE
ETIOLOGY
Anatomical Factors
Innervational Factors
Horizontal Muscle School
Vertical Muscle School
Combined School
DIAGNOSIS
Electromyographic Studies
Method of Testing
Difference in the Pattern
Importance of Version
Tests for Fusion
Role of Orthoptic Examination
TREATMENT
Horizontal Recti
Vertical Muscle School
Vertical Recti
Combined School
14:
Musculofascial Anomalies
CLINICAL FEATURES
FORCED DUCTION TEST
Indications
Forced Duction Test of Goldstein
Forced Duction Test of Scott
DIVISION
Congenital Anomalies in the Insertions or Tendons of Muscles
Fibrosis of the Muscles
Commonest Cause of Congenital Defects in Ocular Motility
FIBROTIC RETRACTION OF MUSCLE
Duane's Retraction Syndrome
Etiology
Acquired Duane's Retraction Syndrome
Inverse Duane's Retraction Syndrome
Associated Congenital Anomaly
Wildervanck's Syndrome
Surgery
Disadvantage of Surgery
Vertical Retraction Syndrome
Superior Oblique Sheath Syndrome of Brown
Etiology
Acquired Brown's Syndrome
Clinical Features
Differential Diagnosis
Treatment
Indication for Surgery
Procedure
Superior Oblique Tenotomy
Strabismus Fixus
Treatment
Fibrosis of the Extraocular Muscles
Clinical Features
Differential Diagnosis
Treatment
Adherence Syndrome
Treatment
15:
Abnormal Retinal Correspondence
DEVELOPMENT OF ABNORMAL RETINAL CORRESPONDENCE
Relationship of ARC with the Age of Onset of the Squint
Relationship of ARC with the Type of Squint
Relationship of ARC with Angle of Squint
Relationship of ARC with Suppression and Amblyopia
DIAGNOSIS OF ABNORMAL RETINAL CORRESPONDENCE
Synoptophore Test
Bagolini's Striated Glasses Test
After-Image Test
Worth's Four Dot Test
Projected after Image Test
Bifoveal Correspondence Test
Maddox Wing Test
Maddox Rod Test
Diplopia Test
MANAGEMENT
Treatment Modalities Available and their Scope
Occlusion Therapy
Orthoptic Treatment
Home Exercises
Prismotherapy
Surgical Treatment of ARC
16:
Amblyopia
CLASSIFICATION
Congenital Amblyopia
Ametropic Amblyopia
Anisometropia Amblyopia
Strabismus Amblyopia
Meridional Amblyopia
HERIDITY IN AMBLYOPIA
Ocular Dominance
VISUAL ACUITY IN AMBLYOPIA
ACCOMMODATION IN AMBLYOPIA
Phenomenon of Contest
Pupillometer Anomaly
Dark Adaptation
Color Sense
Light Sense
Fixation Movement—Patterns
Amblyopic Scotoma
SCREENING OF AMBLYOPIC-STERCO-ACUITY
PATHOGENESIS OF AMBLYOPIA
INCIDENCE OF AMBLYOPIA
TREATMENT OF FUNCTIONAL AMBLYOPIA
Correction of Refractive Error
Occlusion
Advantages of Occlusion of Amblyopia Eye
Disadvantages
Practical Application of Recent Concept
Red Filter Treatment
Principle
Advantages
Disadvantages
Penalization
Advantages
Minimal Occlusion
CAM Vision—Stimulator Treatment
Autoflashing
Prism
Pleoptics (Gr. Pleos, full, Gr. Optikos, pertaining to sight)
Pharmacologic Therapy
Levodopa/Carbidopa for Childhood Amblyopia
Orthoptic Treatment
Home Exercises
17:
Aniseikonia
CAUSES OF ANISEIKONIA
Optical Causes
Anatomical Causes
Central Causes
CLASSIFICATION OF ANISEIKONIA
Physiological Aniseikonia
Abnormal or Anomalous Aniseikonia
Optical
Anatomical
OPTICS
Spectacle Magnification
Magnification with Contact Lenses
MEASUREMENT OF ANISEIKONIA
Clinical Instrument
Horopter Apparatus
Standard Eikonometer
Space Eikonometer
Maddox Rod Test
Aniseikonia
MANAGEMENT
18:
Nystagmus
SPECIFIC TYPES
INDEX
TOC
Index
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