managment of strabismus

for mbbs student

1. MANAGEMENT OF MANAGEMENT OF
STRABISMUSSTRABISMUS
av av
sharmasharma

2. Why We TreatWhy We Treat
1- Restore Stereopsis1- Restore Stereopsis
2- Prevent Amblyopia2- Prevent Amblyopia
3- Prevent Confusion and Diplopia3- Prevent Confusion and Diplopia
4- Appearance4- Appearance

3. Why We TreatWhy We Treat
1- Restore Stereopsis1- Restore Stereopsis
Three dimensional vision..Three dimensional vision..

4. Why We TreatWhy We Treat
2- Amblyopia2- Amblyopia
Amblyopia is the unilateral or bilateral decrease of Amblyopia is the unilateral or bilateral decrease of
Vision caused by form vision deprivation and/or Vision caused by form vision deprivation and/or
abnormal binocular interaction for which there is abnormal binocular interaction for which there is
no obvious cause found by physical examination no obvious cause found by physical examination
of the eye.of the eye.

5. Why We TreatWhy We Treat
3- Confusion and Diplopia3- Confusion and Diplopia
.Confusion is the simultaneous appreciation of two .Confusion is the simultaneous appreciation of two
superimposed but dissimilar images caused by superimposed but dissimilar images caused by
stimulation of corresponding points (usually stimulation of corresponding points (usually
foveae) by images of different objects.foveae) by images of different objects.
. Diplopia is the simultaneous appreciation of two . Diplopia is the simultaneous appreciation of two
images of one object. Jt results from a failure to images of one object. Jt results from a failure to
maintain binocular vision.maintain binocular vision.

7. Why We TreatWhy We Treat
4- Appearance4- Appearance

9. Treatment of Treatment of
heterophoria heterophoria indicated in indicated in
decompensated heterophoria decompensated heterophoria
(i.e., symptomatic cases). (i.e., symptomatic cases).
1. Correction of refractive error 1. Correction of refractive error
when detected is most important. when detected is most important.

10. 2. Orthoptic treatment. 2. Orthoptic treatment.
heterophoria without refractive heterophoria without refractive
error error
not corrected by glassess not corrected by glassess
to improve convergence to improve convergence
insufficiency and the fusional insufficiency and the fusional
reserve. Orthoptic exercises can reserve. Orthoptic exercises can
be done with synoptophore. be done with synoptophore.
Simple exercises to be carried out Simple exercises to be carried out
at homeat home

11. synoptophoresynoptophore

12. 3. Prescription of prism in glasses3. Prescription of prism in glasses
selected cases Prism is prescribed selected cases Prism is prescribed
with apex towards the direction of with apex towards the direction of
phoria , two-thirds of phoria , two-thirds of
heterophoriaheterophoria

13. 4. Surgical treatment. 4. Surgical treatment.
marked symptoms which are not marked symptoms which are not
relieved by other measures. relieved by other measures.
strengthen the weak muscle or strengthen the weak muscle or
weaken the strong muscleweaken the strong muscle

14. TREATMENT OF TREATMENT OF
CONCOMITANT CONCOMITANT
STRABISMUSSTRABISMUS
Goals Goals
achieve good cosmetic achieve good cosmetic
correction, to improve visual correction, to improve visual
acuity and to maintain binocular acuity and to maintain binocular
vision.vision.

15. 1.Spectacles 1.Spectacles
full correction of refractive error, full correction of refractive error,
every case.every case.
improve visual acuity, may improve visual acuity, may
correct the squint partially or correct the squint partially or
completely (as in accommodative completely (as in accommodative
squint). squint).

17. 2.Occlution therapy2.Occlution therapy
Sensitive period during which the Sensitive period during which the
amblyopia can be cured is below 10 amblyopia can be cured is below 10
years of ageyears of age
#. occlusion of the normal eye to #. occlusion of the normal eye to
encourage the use of the abnormal eye encourage the use of the abnormal eye
is the most effective treatment is the most effective treatment

19. it should be ensured it should be ensured
that: that:
Opacity in the media (e.g., Opacity in the media (e.g.,
cataract), if any, should be cataract), if any, should be
removed first,removed first,
Refractive error, if any, should be Refractive error, if any, should be
fully correctedfully corrected

20. schedule for occlusion therapy schedule for occlusion therapy
depending up on the age is as depending up on the age is as
below:below:
Upto 2 years, the occlusion Upto 2 years, the occlusion
should be done in 2:1, i.e., 2 days should be done in 2:1, i.e., 2 days
in sound eye and one day in in sound eye and one day in
amblyopic eye. At the age 3years, amblyopic eye. At the age 3years,
3:1At the age of 4 years, 4:1,3:1At the age of 4 years, 4:1,
At the age of 5 years, 5:1, and At the age of 5 years, 5:1, and
After the age of 6 years, 6:1 After the age of 6 years, 6:1

21. Duration of occlusion should be Duration of occlusion should be
until the visual acuity develops until the visual acuity develops
fully, or there is no further fully, or there is no further
improvement of vision for 3 improvement of vision for 3
months.months.

22. 3 preoperative orthoptic exercise3 preoperative orthoptic exercise
4 squint surgery4 squint surgery
5 postoperative orthoptic exercise5 postoperative orthoptic exercise

23. Management Management
of of
paralytic paralytic
strabismusstrabismus
1.Treatment of the cause 1.Treatment of the cause
investigative work-up. investigative work-up.

24. 2.Conservative measures.2.Conservative measures.
wait and watch for self- wait and watch for self-
improvement to occur for a improvement to occur for a
period of 6 months, vitamin B-period of 6 months, vitamin B-
complex as neurotonic; and complex as neurotonic; and
systemic steroids for non-specific systemic steroids for non-specific
inflammationsinflammations

25. 3.Treatment of annoying 3.Treatment of annoying
diplopia.diplopia.
occluder on the affected eye, with occluder on the affected eye, with
intermittent use of both eyes ,to intermittent use of both eyes ,to
prevent suppression prevent suppression
amblyopiai.e. partial loss of vision amblyopiai.e. partial loss of vision
,in one eye,cortical supretion of ,in one eye,cortical supretion of
central vision to prevent diplopiacentral vision to prevent diplopia

26. ..
. 4.Surgical treatment.. 4.Surgical treatment.
in case the recovery does not in case the recovery does not
occur in 6 months. occur in 6 months.
provide a comfortable field of provide a comfortable field of
binocular fixation,binocular fixation,
strengthening of the paralysed strengthening of the paralysed
muscle by resection; and muscle by resection; and
weakening of the overacting weakening of the overacting
muscle by recession.muscle by recession.

27. STRABISMUS SURGERY

28. Surgical techniques Surgical techniques
1.Muscle weakening procedures 1.Muscle weakening procedures
include recession, marginal include recession, marginal
myotomy and myectomy. myotomy and myectomy.
2.Muscle strengthening 2.Muscle strengthening
procedures are resection, tucking procedures are resection, tucking
and advancement.and advancement.

29. 3.Procedures that change 3.Procedures that change
direction of muscle action. These direction of muscle action. These
include (a) vertical transposition include (a) vertical transposition
of horizontal recti to correct ‘A’ of horizontal recti to correct ‘A’
and ‘V’ patterns (b) posterior and ‘V’ patterns (b) posterior
fixation suture (Faden operation) fixation suture (Faden operation)
to correct dissociated vertical to correct dissociated vertical
deviation; and (c) transplantation deviation; and (c) transplantation
of muscles in paralytic squints.of muscles in paralytic squints.

31. Steps of resectionSteps of resection
1.Muscle is exposed as for recession and the 1.Muscle is exposed as for recession and the
amount to be resected is measured with amount to be resected is measured with
callipers and marked. 2.Two absorbable callipers and marked. 2.Two absorbable
sutures are passed through the outer quarters sutures are passed through the outer quarters
of the muscles at the marked site. 3.The of the muscles at the marked site. 3.The
muscle tendon is disinserted from the sclera muscle tendon is disinserted from the sclera
and the portion of the muscle anterior to and the portion of the muscle anterior to
sutures is excised. 4.The muscle stump is sutures is excised. 4.The muscle stump is
sutured with the sclera at the original insertion sutured with the sclera at the original insertion
site. 5.Conjunctival flap is sutured backsite. 5.Conjunctival flap is sutured back

33. Steps of recessionSteps of recession
1.Muscle is exposed by reflecting a flap of 1.Muscle is exposed by reflecting a flap of
overlying conjunctiva and Tenon’s capsule. overlying conjunctiva and Tenon’s capsule.
2.Two vicryl sutures are passed through the 2.Two vicryl sutures are passed through the
outer quarters of the muscle tendon near the outer quarters of the muscle tendon near the
insertion. 3.The muscle tendon is disinserted insertion. 3.The muscle tendon is disinserted
from the sclera with the help of tenotomy from the sclera with the help of tenotomy
scissors. 4.The amount of recession is scissors. 4.The amount of recession is
measured with the callipers and marked on measured with the callipers and marked on
the sclera. 5.The muscle tendon is sutured the sclera. 5.The muscle tendon is sutured
with the sclera at the marked site posterior to with the sclera at the marked site posterior to
original insertion. 6.Conjunctival flap is original insertion. 6.Conjunctival flap is
sutured back.sutured back.

34. thankuthanku