Series Editors
Ashok Garg MS PhD FIAO (Bel) FRSM FAIMS ADM FICA
International and National Gold Medalist Chairman and Medical Director Garg Eye Institute and Research Centre
235-Model Town, Dabra Chowk Hisar-125 005 (India)
Emanuel Rosen MD
Medical Director Rosen Eye Associates
Harbour City, Salford Quays M50 3 BH United Kingdom
Editors
Eric R Crouch MD
Assistant Professor Pediatric Ophthalmology Eastern Virginia Medical School
880 Kemphsville Road Suite 2500, Norflock Virginia 23502, USA
Ewa Oleszczynska Prost MD PhD Director
Center for Pediatric Ophthalmology
Hertza 9, 04-603 Warsaw, Polland
Foreword
Roberto Pinelli
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Instant Clinical Diagnosis in Ophthalmology—Strabismus
© 2009, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2009
9788184485974
Typeset at JPBMP typesetting unit
Printed at Ajanta Press
- My Respected Param Pujya Guru Sant Gurmeet Ram Rahim Singh Ji for his blessings and motivation…
- My Respected Parents, teachers, my wife Dr Aruna Garg, son Abhishek and daughter Anshul for their constant support and patience during all these days of hard work…
- My dear friend Dr Amar Agarwal, a renowned International Ophthalmologist for his constant support, guidance and expertise…
Ashok Garg
- The memory of my step daughter Nicola Ross who enjoyed benefits from refractive surgery, were cut short by a tragic fatal illness…
Emanuel Rosen
My patients…
Eric R Crouch
My parents, husband and son for patience and understanding…
Ewa Oleszczynska Prost
5Contributors
- Amar Agarwal ms frcs frc ophth
- Consultant
- Dr Agarwal's Eye Hospital
- 19, Cathedral Road
- Chennai-600 086
- India
- Ankur Sinha md
- Senior Registrar
- Strabismology, Glaucoma and Neuropthalmology Services
- Dr RP Centre for Ophthalmic Sciences
- AIIMS, New Delhi-110029
- India
- Ashok Garg ms phd frsm
- Chairman and Medical Director
- Garg Eye Institute and Research Centre
- 235-Model Town, Dabra Chowk
- Hisar-125 005
- India
- Athiya Agarwal md do frsh
- Consultant
- Dr Agarwal's Eye Hospital
- 19, Cathedral Road
- Chennai-600 086, India
- Brigitte Pajic-Eggspuehler md
- Augen Zentrum Pajic (AZP)
- Titlisstrasse 44
- 5734 Reinach/AG
- Switzerland
- Carlos Laria md
- VISSUM, Instituto Oftalmologico
- De Alicante
- Avda de Denia, S/n, 03016
- Alicante, Spain
- Cintia F Gomi md
- Assistant Project Scientist
- Ratner Children's Eye Center
- University of California
- San Diego
- USA
- Cyres K Mehta, ms fsvh fage
- Director and Consultant
- Mehta International Eye Institute
- Seaside, 147, Colaba Road
- Mumbai-400 005, India
- David B Granet md
- Director
- Ratner Children's Eye Center
- University of California
- San Diego
- USA
- Emanuel Rosen md frcs
- Rosen Eye Associates
- Harbour City
- Salford Quays
- M50 3 BH
- UK
- Eric R Crouch md
- Assistant Professor of Pediatric Ophthalmology
- Eastern Virginia Medical School
- 880 Kemphsville Road
- Suite 2500, Norflock, Virginia 23502
- USA
- Eva Moreno md
- Clinica Moreno Alguacil
- San Pascual 47
- Ewa Oleszczynska Prost md phd
- Director
- Center for Pediatric Ophthalmology
- Hertza 9, 04-603
- Warsaw, Poland
- Fabrijio Gabas md
- Instituto Laser Microchirurgia Oculare
- Crystal Palace
- Via Cefalonia, 70, 25124 Brescia
- Italy
- Federico Moreno md
- Clinica Moreno Alguacil
- San Pascual 47
- Aranjuez 283 00
- Spain
- Harinder S Sethi ms
- Dr RP Centre for Ophthalmic Sciences
- AIIMS Ansari Nagar
- New Delhi-110029
- India
- Jairo E Hoyos md phd
- Instituto Oftalmologico Hoyos
- Rambla de Sabadell 62 1°
- 08201 Sabadell, Barcelona
- Spain
- Jairo Hoyos Chacon md
- Instituto Oftalmologico Hoyos
- Rambla de Sabadell 62 1°
- 08201 Sabadell, Barcelona
- Spain
- Jawahar Lal Goyal md dnb
- Professor of Ophthalmology
- Guru Nanak Eye Center
- Maulana Azad Medical College
- New Delhi-110 002
- India
- Jorge L Alio md phd
- Medical Director
- VISSUM, Instituto Oftalmologico
- De Alicante, Avda de Denia
- S/n, 03016, Alicante
- Spain
- Keiki R Mehta, ms do fios
- Chairman and Medical Director
- Mehta International Eye Institute
- 147, Shahid Bhagat Singh Road
- Colaba Road
- Mumbai-400 005
- India
- Llaria Sireno od
- Instituto Laser Microchirurgia Oculare
- Crystal Palace
- Via Cefalonia, 70
- 25124 Brescia, Italy
- Marek E Prost md
- Professor of Ophthalmology and Director Center for Pediatric Ophthalmology
- Hertza 9, 04-603, Warsaw
- Military Institute of Aviation Medicine
- Kransinskiego 54, 01-755 Warsaw
- Polland
- Maria T Depena md
- Clinica Moreno Alguacil
- San Pascual 47
- Aranjuez 283 00, Spain
- Maria T Iradier md
- Clinica Moreno Alguacil
- San Pascual 47
- Aranjuez 283 00, Spain
- Melania Cigales md
- Instituto Oftalmologico Hoyos
- Rambla de Sabadell 62 1º
- 08201 Sabadell, Barcelona
- Spain
- Navjot Kaur ms
- Guru Nanak Eye Center
- Maulana Azad Medical College
- New Delhi-1100002
- India
- Pradeep Sharma md
- Professor of Ophthalmology
- Dr RP Centre for Ophthalmic Sciences
- AIIMS, New Delhi-110029
- Priya Narang ms
- Consultant
- Narang Eye Clinic
- Ahmedabad, India
- Roberto Pinelli md
- Instituto Laser Microchirurgia Oculare
- Crystal Palace
- Via Cefalonia, 70
- 25124 Brescia, Italy
- Rohit Saxena md
- Additional Professor of Ophthalmology
- Dr RP Centre for Ophthalmic Sciences
- AIIMS, New Delhi-110 029, India
- Sameer Narang md
- Consultant
- Narang Eye Clinic
- Ahmedabad, India
- Swati Phuljhele ms
- Registrar
- Dr RP Centre for Ophthalmic Sciences
- AIIMS, New Delhi-110 029
- India
- S K Narang md
- Professor of Ophthalmology
- Narang Eye Clinic
- Ahmedabad
- India
- Sunita Agarwal ms do psvh
- Dr Agarwal's Eye Hospital
- 19, Cathedral Road
- Chennai-600 086, India
- 15, Eagle Street, Langford Town
- Bengaluru
- India
It is my honor to write the Foreword for instant series of handbooks entitled “Instant Clinical Diagnosis in Ophthalmology—Strabismus.”
Dr Ashok Garg and Dr Emanuel Rosen, both well renowned surgeons in our field, have taken upon themselves to create a book series covering the different subspecialties of Ophthalmology and I feel that this particular handbook on strabismus will prove to be a valuable resource for doctors who have just begun their career in Ophthalmology as well as for the more experienced Ophthalmic specialists.
The book is outlined in two parts: Section 1 covers the clinical aspects of strabismus including basic examination and diagnosis of various ocular deviations, as well as specific strabismus syndromes and special forms of strabismus. Section 2 covers the latest strategies and techniques in surgical management of strabismus and amblyopia, including corneal wavefront guided refractive surgery in children, Lasik for refractive accommodative esotropia correction and adjustable sutures in pediatric strabismus.
This book has many prominent names included from all parts of the world who share their experience in their observations and techniques used for the treatment of Strabismus. In this day and age there are so many new technologically advanced procedures that are created every day in all of the world and I think it is fundamental that we as medical professionals from the least experienced to the most experienced, work together in every way possible to share ideas, theories and practices.
Roberto Pinelli
President, Italian Refractive Surgery Society
Scientific Director
Istituto Laser Microchirurgia Oculare (ILMO)
Crystal Palace, 3o Piano
Via Cefalonia, 70
25124, Brescia
Italy
e-mail: pinelli@ilmo.it
Tel. No. +39 0302428343
Web: www.ilmo.it
9Preface
In modern day busy and fast life, ophthalmologists are glued to their clinical and surgical practice and have little time to read large volume books. The need of the hour is to have pocket size Ready Reckoner enriched with complete and up-to-date information of the diseases in a most comprehensive manner. At present very few Quality Ready Reference Books are available at an International level.
After detailed research and need of ophthalmologists, we have developed a series of 10 Volume Ready Reference Books termed as Instant Clinical Diagnosis in Ophthalmology. This series covers Oculoplastic and Reconstructive Surgery, Retina, Lens, Glaucoma, Refractive Surgery, Pediatric Ophthalmology, Strabismus, Anterior Segment Diseases, Cornea and Neurophthalmology.
The present series has been designed to provide up-to-date information of concerned disease in a comprehensive and lucid manner along with High Quality clinical photographs in an easy to read format. International Masters of concerned subject have contributed chapters in this series covering Pathophysiology, Clinical Signs and Symptoms, Investigations, Differential Diagnosis, Treatment and Prognosis in a simplified manner.
Strabismus as modified from a Greek word, is a clinical condition in which eyes are not properly aligned with each other. It can be either a disorder of the brain coordinating the eyes or a disorder of one or more ocular muscles that leads to disfunction of the usual direction and power of the muscles resulting in prevention of gaze of each eye to the same point in space and preventing proper binocular vision.
The present volume of this series deals with all clinical conditions of Strabismus in an easy to read format. This volume discusses all abnormalities of strabismus especially various exodeviations, esodeviations, amblyopia, cranial nerve palsies, various strabismus syndromes, special forms of strabismus and various corrective measures in a comprehensive manner for the benefit of readers.
We are highly thankful to our publisher M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi especially Shri Jitendar P Vij (Chairman and Managing Director), Mr Tarun Duneja (Director-Publishing) and all staff members for their dedication and hard efforts put in the preparation of High Quality Series of Instant Clinical Books.
We hope this 10 volume set of Ready Reference Pocket Size Books shall provide complete and useful clinical information to ophthalmologists all around the world and shall help them to accurately and precisely diagnose, treat and manage their clinical cases confidently to the satisfaction and expectations of their valued patients. We also hope this Ready Reckoner shall serve as useful companion on every clinician's desk.
Editors