logging in or signing up Partial accommodative Esotropia boptomgopal Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: Embed: Flash iPad Dynamic Copy Does not support media & animations Automatically changes to Flash or non-Flash embed WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 332 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: April 18, 2012 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript PowerPoint Presentation: Presenter:Mr.Krushna Gopal Panda Moderator:Mr . Soumya Ranjan Parida Case Presentation Miriam hyman children’s eye care centerPowerPoint Presentation: P049118 01/08/2009 2 years/M Berhampur,Orissa Case DetailPowerPoint 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 diseasePowerPoint 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 ETPowerPoint Presentation: 20 35PowerPoint 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 diagnosisPowerPoint 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 eyePowerPoint 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 monthsPowerPoint 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 14/12/2009PowerPoint 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 monthsPowerPoint 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 23/01/2012PowerPoint 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 05/03/2012PowerPoint Presentation: Partial accommodative EsotropiaPowerPoint 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 MethodPowerPoint Presentation: Heterophoria methodPowerPoint Presentation: Gradient methodPowerPoint Presentation: Amblyoscope -MethodPowerPoint 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 EsotropiaPowerPoint 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 personalityPowerPoint 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 characteristicsPowerPoint Presentation: Clinical evaluation and diagnosis Measurement of deviation Cycloplegic refraction Examination of fundus and mediaPowerPoint Presentation: Treatment Optical correction Role of miotics Amblyopia therapy Role of surgeryPowerPoint 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 accommodationPowerPoint 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 characteristicsPowerPoint Presentation: Clinical evaluation and diagnosis Measurement of deviation Cycloplegic refraction Examination of fundus and mediaPowerPoint 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 esotropiaPowerPoint Presentation: Treatment Amblyopia therapy Bifocal glasses Miotics Role of surgeryPowerPoint 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 HighPowerPoint Presentation: Partially Accommodative Esotropia Due to partly some accommodative factor and partly some due to some non accommodative factorPowerPoint 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 hypermetropiaPowerPoint 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 rolePowerPoint Presentation: Treatment Correction of accommodative part of esotropia Amblyopia SurgeryPowerPoint 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 0PowerPoint 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 weeksPowerPoint 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-3/12PowerPoint 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 You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.