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Ростовский Государственный Медицинский Университет

Предмет:

Медицина общая

Файл:

Illustrated Tutorials in Ophthalmology Kanski, Bolton 2001

.pdf

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28.03.2026

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Subsequent problems

Inferior oblique overaction Dissociated vertical deviation

Microtropia

• Most common onset 2 years		• Very small angle - may not be
		detectable on cover testing
• Usually eventually bilateral		• Central suppression scotoma
		• Central suppression scotoma

	• Up-drift with excyclodeviation of
	eye under cover
	• When cover removed affected
	eye moves down

Refractive accommodative esotropia

•Presents between 18 months - 3years

•Initially intermittent

•Normal AC/A ratio

•Excessive hypermetropia

Fully accommodative	Partially accommodative


Esotropia greater for near		Straight for distance



Straight for distance and near		Esotropia for near

Non-refractive accommodative esotropia

•Presents between 18 months to 3years

•High AC/A ratio

-due to increased AC (convergence excess)

-due to decreased A (hypoaccommodative)

•No significant refractive error

Signs


Straight for distance	Esotropia for near

Management of accommodative esotropia

Refraction - prescribe full cycloplegic refraction under age 6 years Treatment of amblyopia

Surgery - if spectacles do not fully correct deviation


Recession	Resection

Constant exotropia

	Congenital	Sensory


•	Presents at birth	• Disruption of binocular reflexes by
	Large angle	acquired lesions, such as cataract
•	Large angle
•	Alternating fixation
•	Normal refraction for age

Consecutive - follows previous surgery for esotropia

Intermittent exotropia

Signs

•Presents - usually prior to 5 years

•Usually alternating (amblyopia uncommon)

•Treatment - surgery

Basic

• Angle greater for near

Convergence weakness

•Angle greater for near

•May be associated with myopia

Divergence excess

•Angle greater for distance

•May be true or simulated

Duane syndrome

•Bilateral in about 20%

•On attempted adduction - retraction of globe and narrowing of palpebral fissure

•On attempted abduction - opening of palpebral fissure and normal globe position

Left type I (left)


Adductionnormal or mildly limited	Primary position - straight	Abduction - limited or absent
Adductionnormal or mildly limited	or mild esotropia	Abduction - limited or absent

Type II

•Abduction - normal or mildly limited

•Adduction - limited

•Primary position - straight or mild exotropia

Type III (left)


Abduction - limited	Primary position - straight or mild esotropia	Adduction - limited

Brown syndrome (right)


Normal elevation in	Straight in primary position	Limited elevation in
abduction		adduction

Double elevator palsy (right)

Unilateral elevation failure in all positions

Mobius syndrome

Signs


• Bilateral sixth nerve palsies -	•	Primary position - 50%	•	Bilateral, usually
patient looking left	•	Primary position - 50%	•	Bilateral, usually
patient looking left		straight, 50% esotropic		asymmetrical facial
		straight, 50% esotropic		asymmetrical facial
	•	Horizontal gaze palsy in		palsies sparing lower face
	•	Horizontal gaze palsy in
		50%	•	Paresis of 9th and 12th
				cranial nerves

<<< < Предыдущая 60 61 62 63 64 65 66 67 68 69 70 7172 / 8772 73 74 75 76 77 78 79 80 81 82 83 84 > Следующая >>>

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