Ординатура / Офтальмология / Английские материалы / Manual of Practical Cataract Surgery_Sundararajan_2009
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Understanding the Basics of Strabismus 119
b.Clinical demonstration of restriction of movement of the particular muscle. Each affected muscle has different diplopia charting, compensatory headposture and chin position to avoid the discomforts of the diplopia.
Treatment
1.Treatment of the cause, if possible and curable.
2.Occlusion of the affected eye by some means to eliminate the discomfort for diplopia.
3.Temporary prismatic spectacles if available.
4.Appropriate surgical procedures to tackle the problem towards the improvement of the situation as it is difficult in most of the conditions.
120 Manual of Practical Cataract Surgery
Diagnostic features of palsy of extrinsic muscles
Muscle |
Ocular |
Defective |
Diplopia |
Greatest |
Usual comp |
and |
posture |
movement |
Type |
separation |
-ensatory |
nerve |
|
|
|
of images |
head |
supply |
|
|
|
|
postures |
|
|
|
|
|
|
Lateral |
Eye |
Outwards |
horizontal |
on abdu- |
Face turned |
Rectus |
turned in |
(abduction) |
homonymous |
ction |
towards |
|
|
|
|
|
affected side |
Sixth |
|
|
|
|
side(also chin |
Cerebral |
|
|
|
|
may be |
|
|
|
|
|
lowered) |
|
|
|
|
|
|
Medial |
Eyeturned |
Inwards |
Horizontal |
Onaddu- |
Face turne |
Rectus |
out |
(adduction) |
crossed |
ction |
towards nor- |
|
|
|
|
|
mal side (also |
Third |
|
|
|
|
chin may be |
Cerebral |
|
|
|
|
raised |
|
|
|
|
|
|
Superior |
Eye |
Upwards |
Vertical, upper |
On elevation Chin raised |
|
rectus |
turned |
when the |
(false) image |
outwards |
and head |
|
downwards eye is |
belonging to |
|
usually turned |
|
Third |
(and |
abducted |
affected eye; |
|
and tilted |
cerebral |
slightly |
|
also intorsional |
|
towards |
|
outwards) |
|
and corssed |
|
affected side |
|
|
|
|
|
|
Inferior |
Eyeturned |
Downwards |
Vertocal, upper Onde- |
Chin lowered |
|
Rectus |
upwards |
when the |
(False) image |
pression |
and face |
|
(and slightly eye is abduc- |
belonging to |
outwards |
usually turned |
|
|
outwards) |
ted |
affected eye; |
|
towards |
Third |
|
|
|
|
affected side |
cerebral |
|
|
|
|
and head tilted |
|
|
|
|
|
towards the |
|
|
|
|
|
normal side |
|
|
|
|
|
|
Superior |
Eye |
Downwards |
vertical, lower |
On depress- |
Chin lowered |
oblique |
turnedup- |
when the eye |
(false) image |
ion outw- |
and head tilted |
|
wards (and |
is adducted |
belonging to |
ards |
ad turned to- |
|
slightly |
|
affected eye; |
|
wards normal |
Fourth |
inwards) |
|
also intors- |
|
side |
cerebral |
|
|
ional crossed |
|
|
|
|
|
|
|
|
Inferior |
Eyeturned |
Upwards |
Vertical, upper |
On |
Chin raised |
Oblique |
downwards when the |
(false) image |
elevation |
andfaceturned |
|
|
(and slightly eye is |
belonging to |
inwards |
towards nor- |
|
|
inwards) |
adducted |
affected eye; |
|
mal side and |
|
|
|
also extorsional |
|
head tilted to- |
|
|
|
and crossed |
|
wards affected |
|
|
|
|
|
side |
|
|
|
|
|
|
Index
A
Accommodation 94 cycloplegia 96 nerve pathways 96 paralysis 96
Accommodation and convergence factors 97
Amblyopia 117 treatment 117
B
Bagolinis striated lens test interpretation 112
Basics of strabismus 91 anatomical factors 92 physiological factors 92
Bridle suture 3
C
Capsulorhexis |
12, 79 |
|
complications 90 |
||
purpose 79 |
||
Capsulotomy |
79 |
|
procedures |
81 |
|
types |
79 |
|
anterior |
80 |
|
posterior |
80 |
|
uses |
80 |
|
in |
anterior |
|
|
capsulotomy 80 |
|
in |
posterior |
|
|
capsulorhexis 80 |
|
Complications in planned ECCE 46
Concomitant squint 115 Conjunctival incision 4 Conjunctival closure 32 Convergence 113
accommodative 114 treatment 114
fusional 114 proximal 114 tonic 114
treatment 114 Cover test 99
D
Delivery of nucleus 74 Descemet’s detachment in
SICS 37
E
Eccentric fixation 117 treatment 117 Epinucleus delivery 30
Esophoria 97
Excellent visual control 72 Exophoria 97
Extention of incision 16
F
Frown incision 5
H
Half nucleus delivery 35 Heterophoria 96
122 Manual of Practical Cataract Surgery
Heterotropias 108 qualitative types 108
convergent squint 108 divergent squint 109
High magnification 51 Hydrodissection 16, 72 Hypermetropia 99
I
Implantation 76
Insertion of IOL 31 Iridodialysis 33
Irrigating vectis method 25 Irrigation and aspiration 73
L
Linear incision 5
Low magnification 48
M
Maddox rod test 112 Maddox wing 112 Manual phaco 1
complications 1 prevention 1
Manual rotation of nucleus 17
McPherson forceps 58 Morgagnian cataract 70
N
Nucleus 18, 22, 34, 43 delivery 18, 22 rotation 43
sinking 34
P
Palsy of extrinsic muscles 120 diagnostic features 120
Paralytic squint 117 causes 117 investigations 118 treatment 119
Posterior capsular rupture 65 dialation 67
illumination 67 incision 66 magnification 67 small needle tip 67
R
Repeat capsulorhexis 84
S
Scleral incision 5 Scleral side of anterior
capsulotomy 70 Shallow anterior chamber 71 Side port incision 9
Small pupil 21 Small rhexis 21 Small scleral side
capsulotomy 48 Smiling face technique 60 Superior rectus fixation 3
T
Treatment of phorias 107 Tunnel making 6
U
Undialated pupil 21
Utratas forceps 90
Uveitis 21
V
Vectis method 25
W
Worth’s four dot test 100