130335154-Non-Surgical-Management-of-squint.ppt

non surgical management of squint

1. Non-Surgical Management
Of Squint

2. It comprises of:
Optical correction
Orthoptic treatment
Medical treatment

3. Optical correction
1 Refraction and proper
prescription of glasses
2 Use of prisms
•Provides well
focused images
•Corrects and
maintains
accomodationand
convergence
mechanisms

4. A) Proper cycloplegia : to assess correct
refractive status.
By Fully relaxing accomodation using atropine 1%
ointment
B) Proper prescription: by retinoscopy giving full
correction. Regular 6 months checkups for vision
and annual retinoscopy

5. C) Use of bifocals:
high AC/A ratios
bifocals are
required with
additional near
adds
Min add required is
tested in steps of
0.5D till the
convergence
excess for near is
controlled.

6. D) Use of over minus
glasses: in cases if
intermittent exotropia
in under 5yrs old
children.
Uses accomodative
convergence for
controlling
exodeviation.
For convergence
insufficiency type of
exotropia inverse
bifocal with minus for
near is required.

7. Use of prisms
Advantage:
•In small angle deviations,residual or
conservative deviation after surgery
•Small vertical deviations can also be
managed.Usually upto 7-8pd prisms over each
eye can be tolerated with glass prism and with
FRESNEL prisms upto 25-30pd
•Can be used in combined horizontal and vertical
deviations by using prisms rotated obliquely
•Used in fusional convergence insufficiency

9. Disadvantages:
•Undesirable optical aberrations
•Deterioration of quality of vision
•Glasses become heavy
•Plastic and Fresnel prisms not available easily
and are expensive.

10. Orthoptic treatment:
Indications:
•Combating suppression
•Improvong fusional vergences and
establishing stereopsis
•T/t of amblyopia
•Managing ARC

11. Combating suppression by anti-suppression
exercises
Basic principle is to bring the fovea out of
suppression by diff stimulations types
Some methods are:
A)Red filter: over dominant eye.

12. A)Cheiroscope
B)Pigeon-cantinnetstereoscope
C)synaptophores

13. Treatment of amblyopia:
Different modalities are:
•Occlusion
•Penalization
•Pleoptics
•Red filter T/t
•Cam vision stimulation
•Active vision therapy
•Medical T/t

14. Types of occlusions:
•Total
•Partial
•Part/ full time
•Maintenance
Total occlusion: by
•Direct skinpatch
•Spectacle patch
•Doyne’s occluder
•Pirate patch
•Contact lenses

18. Partial occlusion:
This degrades vision of the normal eye so that amblyopic
eye has the advantage.here layers of transparent tapes
are used on back surface of glasses over the dominant
eye.
Period of occlusion:
•Full time-for 2days/week upto 2 yrs old
3 days/week upto 3 yrs old
4 days/week upto 4 yrs old
5 days/week upto 5 yrs old
6 days/week for 6 yrs old n above
This is alternated with one day of occluding amblyopic eye
when dominant eye is opened

19. Part time : based on waking hours of the day
and age of child.
Follow up :
Occlusion course is indicative till vision keeps
improving or the vision doesn’t improve on two
consecutive monthly visits which is termed
occlusion failure.

20. Penalization
•Optical: over correct with plus glasses
•Pharmacological: using cycloplegics
•Partial
also termed as distance and near penalization
Pleoptics therapy
Red filter treatment
Fusional exercises

21. Medical treatment
oMiotics in accommodative esotropia: reduction of the
accommodative effort and as increase in depth of focus.best
temporary modality in children who r too small to wear glasses
oLevodopa-carbidopa: facilitate neurotransmission at
synapsespresent in retina and visual cortex
oBotulinum toxin A chemodenervation:
As inj in EOM made under EMG control.injected at the junction of ant
2/3 and post 1/3,a crackling sound is heard which quietens the
moment the whole dose is injected.
Effect starts immediately and peak action is in 5-7 days and duration
varies from 2-4 months

22. Uses:
•in abducens palsy when early inj in MR prevents its
contracture
•Transposition surgery:when vertical mus r transposed
the horizontal mus are weakened by botox
•In nystagmus as retrobulbar injection
•Blepharospasms and hemifacial spasms
•Infentile esotropia, if alligned before 6 month have good
binacularity
Complications:
•Ptosis
•Paralysis of adjacent muscles causing vertical diplopia
•Dry eyes,reduced lacrimation ,foreign body sensation
•Pupillary dilatation ,accommodational paresis