Partial accommodative Esotropia

Views:
 
Category: Education
     
 

Presentation Description

No description available.

Comments

Presentation Transcript

PowerPoint Presentation:

Presenter:Mr.Krushna Gopal Panda Moderator:Mr . Soumya Ranjan Parida Case Presentation Miriam hyman children’s eye care center

PowerPoint Presentation:

P049118 01/08/2009 2 years/M Berhampur,Orissa Case Detail

PowerPoint Presentation:

Complaints and History C/o inward turning of both the eyes since birth as noticed by the parents No H/o using glasses No H/o Ocular/Head injury No H/o Patching Therapy for amblyopia No H/o ophthalmic consultation Birth History GA-36 weeks, BW-2000 gm., Normal delivery, Cried immediately after Birth, Mother was taking steroid during pregnancy, Mother having autoimmune disease

PowerPoint Presentation:

On TLE OD OS Lids Flat Flat Conjunctiva Quiet Quiet Cornea Clear Clear Anterior Chamber Deep Deep Pupil R/R/R R/R/R Lens Clear Clear IOP Dig N Dig N Ocular Motility Full and ~35 ∆ alternate ET

PowerPoint Presentation:

20 35

PowerPoint Presentation:

01/08/2009 Visual acuity OD OS Unaided Distance 20/30 20/25 with Cardiff acuity card at 1 meter distance Dry Retinoscopy Good Glow Cycloplegic Retinoscopy +3.50 sph +3.50 sph Indirect Ophthalmoscopy WNL 0.3:1 WNL ??

PowerPoint Presentation:

Pseudoesotropia Duane’s retraction syndrome Mobius syndrome Nystagmus blockage syndrome Infantile esotropia Early accommodative esotropia Sensory esotropia Differential diagnosis

PowerPoint Presentation:

Pseudoesotropia Duane’s retraction syndrome Mobius syndrome Nystagmus blockage syndrome Infantile Esotropia Early accommodative esotropia Sensory esotropia Visual axes are aligned accurately Flat,broad nasal bridge, Prominent epicanthal folds, narrow interpupilary distance In cover –uncover test no deviation is seen Type A corresponded to limited abduction and less limited adduction. Type B corresponded to limited abduction but normal adduction. Type C corresponded to limitation of adduction that is greater than limitation of abduction Facial paralysis , Delayed speech, inability to move the eyes from side to side, Corneal erosion resulting from difficulty in blinking, Limb abnormalities-missing fingers or toes, Chest-wall abnormalities Nystagmus noted in early infancy with esotropia One eye is patched he will turn his head in the direction of the uncovered eye Base-out prism is placed in the fixating eye the follow eye remains adducted and the esotropia increases Visual acuity is good With in 6 months of birth Large angle of deviation is noted for distance and near Alternative fixation is noted in primary gaze and crossed fixation in lateral gaze Hypermetropia with esotropia Blurring of vision for near work Large angle of deviation Visual acuity will better Monocular vision loss Amblyopia in the affected eye

PowerPoint Presentation:

19/10/2009 Visual acuity OD OS Glasses Distance 20/30 P 20/25 P with Cardiff acuity card at 1 meter distance BCVA Distance 20/30 P(+3.50 sph) 20/30 P(+3.50) sph) On TLE Anterior Segment-WNL IOP-Dig N(OU) PGP- (OU) +3.50 sph Cont. Same Glasses Review after 2 months

PowerPoint Presentation:

Visual acuity OD OS Glasses Distance 20/20 20/20 with Cardiff acuity card at 1 meter distance Cycloplegic Retinoscopy / +3.50/-0.50 X10 +3.50/-0.50 X170 Acceptance (20/20) (20/20) with Cardiff acuity card at 1 meter distance On TLE Anterior Segment-WNL IOP-Dig N(OU) Advice PGP- (OU) +3.50 sph (OU)MR Recession GA ET ~35 ∆ alternate ET 14/12/2009

PowerPoint Presentation:

01/12/2010 Came for general eye check up and for the new glasses Visual acuity OD OS Unaided Distance 20/30 20/30 with Kay Picture chart Cycloplegic Retinoscopy/ +4.25/-0.75 X5 +4.00/-0.50 X175 Acceptance (20/20) (20/20) with Kay Picture chart On SLE Anterior Segment-WNL IOP-Dig N(OU) Advice PGP- Broken (OU) Glasses Review after 3 months

PowerPoint Presentation:

Visual acuity OD OS Glasses Distance 20/20 20/30 with Snellen Chart Cycloplegic Retinoscopy/ +4.25/-0.75 X5 +4.50/-0.75 X175 Acceptance (20/20) (20/30) with Snellen chart On SLE Anterior Segment-WNL IOP-Dig N(OU) Advice PGP- (OD)+3.50/-0.50 X180 Change (OD) Glasses (OS)+4.50/-0.50 X175 ET 30 ∆ for near and variable ET for distance Plan and management : Change glasses Squint surgery 23/01/2012

PowerPoint Presentation:

Visual acuity OD OS Glasses Distance 20/20 20/30 with Snellen Chart Visual Acuity Glasses Near N6 N6 at 30 cm with reduced Snellen chart On SLE Anterior Segment-WNL IOP-Dig N(OU) Advice PGP- (OD +4.25/-0.75 X5 (OU)MR Recession on 14/3/2012 (OS)+4.50/-0.50 X175 ET 30 ∆ for near and 20 ∆ for distance DVD(OS) large positive angle kappa 05/03/2012

PowerPoint Presentation:

Partial accommodative Esotropia

PowerPoint Presentation:

AC/A Ratio It is the amount of accommodative convergence measured in prism – D iopter to the number of D iopter of accommodation which causes the convergence. Methods - Heterophoria Method Gradient Method Amblyoscope Method

PowerPoint Presentation:

Heterophoria method

PowerPoint Presentation:

Gradient method

PowerPoint Presentation:

Amblyoscope -Method

PowerPoint Presentation:

Clinical distance and near Method AC/A ratio N DEV - D DEV =

PowerPoint Presentation:

Convergent deviation varies in degree according to amount of accommodation exerted Due to excessive Hypermetropia The difference between distance & near deviation is usually less than 10 degree Accommodative Esotropia

PowerPoint Presentation:

Refractive Accommodative Esotropia Varies in degree depending on the amount of accommodation exerted, and wearing of spectacles eliminates the esotropia in all fixation distances in all gaze positions Uncorrected hypermetropia, AC/A ratio, child’s personality

PowerPoint Presentation:

Time of onset : Manifest between the age of 2-3 years Ocular deviation : Development of accommodative esotropia usually passes through stages of esophoria and intermittent esotropia Hypermetropia : ranging from 2-6 ± 4.75 Diopters AC/A ratio is usually normal Associations : Vertical deviations, A-V pattern Clinical characteristics

PowerPoint Presentation:

Clinical evaluation and diagnosis Measurement of deviation Cycloplegic refraction Examination of fundus and media

PowerPoint Presentation:

Treatment Optical correction Role of miotics Amblyopia therapy Role of surgery

PowerPoint Presentation:

Non-refractive Accommodative Esotropia Caused by a High AC/A ratio and significantly greater at near than distance fixation Unrelated to refractive error and the near point of accommodation

PowerPoint Presentation:

Time of onset : between the age of 2-3 years Ocular deviation : Small and intermittent, near deviation is typically much greater than the distance deviation AC/A ratio is High Associations : Vertical deviations, A-V pattern Clinical characteristics

PowerPoint Presentation:

Clinical evaluation and diagnosis Measurement of deviation Cycloplegic refraction Examination of fundus and media

PowerPoint Presentation:

Diagnosis Near esotropia is typically much greater than the distance esotropia AC/A ratio is high by lens gradient method Special care needed for confusion of V-esotropia and Non refractive accommodative esotropia

PowerPoint Presentation:

Treatment Amblyopia therapy Bifocal glasses Miotics Role of surgery

PowerPoint Presentation:

Hypo Accommodative Esotropia Associated with weakness of accommodation Large for near fixation and small for distance fixation Not related to uncorrected hypermetropia AC/A ratio is not High

PowerPoint Presentation:

Partially Accommodative Esotropia Due to partly some accommodative factor and partly some due to some non accommodative factor

PowerPoint Presentation:

Infantile esotropia with superadded accommodative esotropia Child develops infantile esotropia before 6 months of age and nonaccommodative Superadded at the age of 2-3 years Accompanied by a larger hypermetropia

PowerPoint Presentation:

Decompensated accommodative esotropia with superadded non-accommodative esotropia After giving glasses the esotropia again develops due to some superadded non accommodative factor Postulated that in decompensated accommodative esotropia either increased convergence tone or mechanical factors such as hypertrophy or contracture of the medial rectus muscles Tenon’s capsule may play a role

PowerPoint Presentation:

Treatment Correction of accommodative part of esotropia Amblyopia Surgery

PowerPoint Presentation:

Day-1 Visual acuity OD OS Glasses Distance 20/20 20/30 with Snellen Chart On SLE OD OS Lids Flat Flat Conjunctiva Conj Conj Cornea Clear Clear Anterior Chamber Deep/Quiet Deep/Quiet Pupil R/R/R R/R/R Lens Clear Clear IOP Dig N Dig N Ocular Motility Full and small LH T Surgery was done on 14/03/2012 0

PowerPoint Presentation:

Advice Predinisolone Acetate eye drop 4 times/day 1 week 3 times/day 1 week Tobramycin eye drop 4 times/day 1 wee 2 times/day 1 week Review after 2 weeks

PowerPoint Presentation:

Day- 2 weeks Visual acuity OD OS Glasses Distance 20/20 20/30 with Snellen Chart On TLE OD OS Lids Flat Flat Conjunctiva Quiet Quiet Cornea Clear Clear Anterior Chamber Deep/Quiet Deep/Quiet Pupil R/R/R R/R/R Lens Clear Clear IOP Dig N Dig N Ocular Mortality Full and Flick ET for distance and ET ~ 20 ∆ for near Advice Bifocal glasses RTC-3/12

PowerPoint Presentation:

Take home massage Cycloplegic refraction is mandatory for all esotropic child. Prescribe full amount of optical correction Cycloplegic refraction is necessary in all visits and change the glass prescription if there is a difference of 0.75 D

authorStream Live Help