Strabismus & AmblyopiaStrabismus & AmblyopiaDr. Linda Trisna, SpM(K)Dr. Linda Trisna, SpM(K)StrabismusStrabismusDefnition :Defnition :Ocular misalignment, whether due to Ocular misalignment, whether due to anormalities in inocular !ision or anormalities in inocular !ision or anomalies o" neuromuscular control o" anomalies o" neuromuscular control o" ocular motilit#ocular motilit#$hen the e#es ecome dissociated $hen the e#es ecome dissociated (not aligned) (not aligned) StraismusStraismus The %d!antages o" &inocular 'ision :The %d!antages o" &inocular 'ision :&etter !isual acuit# &etter !isual acuit# ()p. : * One e#e()p. : * One e#e +,, ** &oth e#es+,, ** &oth e#es -,+ -,+* One e#e* One e#e -,+ ** &oth e#es-,+ ** &oth e#es -,. -,.$ider feld o" !iew$ider feld o" !iewStereoscopic !isionStereoscopic !ision/ormal condition o" muscle alance /ormal condition o" muscle alance OrthophoriaOrthophoria producing producing single single inocular !isioninocular !isionExtra Ocular MusclesExtra Ocular Muscles% T(%M O0% T(%M O0 S12 M3S4L(S S12 M3S4L(S 4O/T5OLS T6( MO'(* 4O/T5OLS T6( MO'(*M(/T O0 (%46 (7( and &%L%/41/8 T6( (7( M(/T O0 (%46 (7( and &%L%/41/8 T6( (7(T6( 5(4T3S M3S4L( T6( 5(4T3S M3S4L(* T6( M(D1%L 5(4T3S* T6( M(D1%L 5(4T3S adduction adduction* T6( L%T(5%L 5(4T3S* T6( L%T(5%L 5(4T3S aduction aduction* T6( S39(51O5 5(4T3S* T6( S39(51O5 5(4T3S supraduction supraduction* T6( 1/0(51O5 5(4T3S* T6( 1/0(51O5 5(4T3S in"raduction in"raductionT6( O&L1:3( M3S4L( T6( O&L1:3( M3S4L(* T6( S39(51O5 O&L1:3(* T6( S39(51O5 O&L1:3( intorsion intorsion* T6( 1/0(51O5 O&L1:3(* T6( 1/0(51O5 O&L1:3( e)torsion e)torsionSingle Binocular VisionSingle Binocular Vision1s a condition when retinal images 1s a condition when retinal images "rom two e#es integrating into a "rom two e#es integrating into a single three*dimensional !isual single three*dimensional !isual perceptionperception9rere;uisites "or inocular !ision :9rere;uisites "or inocular !ision :'isual acuit# o" the two e#es a"ter 'isual acuit# o" the two e#es a"ter corrected are the same or slightl# corrected are the same or slightl# di)es :*phoria : %*phoria : % latent latent de!iation that is controlled #de!iation that is controlled # the "usional mechanism so that under normalthe "usional mechanism so that under normal inocular !ision o" the e#es remain aligned inocular !ision o" the e#es remain aligned()p : ()ophoria, (sophoria, etc ()p : ()ophoria, (sophoria, etc *tropia : %*tropia : % mani"est mani"est de!iation that e)ceeds thede!iation that e)ceeds the control o" the "usional mechanism so that thecontrol o" the "usional mechanism so that the e#es are not aligned e#es are not aligned()p. : 6#potropia, (sotropia, etc ()p. : 6#potropia, (sotropia, etcClassification of StrabismusClassification of Strabismus%ccording to f)ation :%ccording to f)ation :%lternating : Spontaneous alternation o" %lternating : Spontaneous alternation o" f)ation "rom one e#eto the otherf)ation "rom one e#eto the otherMonocular : Defnite pre"erence "or Monocular : Defnite pre"erence "or f)ation with one e#ef)ation with one e#e%ccording to age o" onset :%ccording to age o" onset :4ongenital 4ongenital prior o" ? months o" ageprior o" ? months o" age%c;uired %c;uired a"ter ? months o" age a"ter ? months o" age Classification (Cont.Classification (Cont.%ccording to the t#pe o" de!iation :%ccording to the t#pe o" de!iation :6ori@ontal : (sode!iation or 6ori@ontal : (sode!iation or ()ode!iation()ode!iation'ertical : 6#perde!iation or 'ertical : 6#perde!iation or h#pode!iationh#pode!iationTorsional : 1nc#clode!iation or Torsional : 1nc#clode!iation or e)c#clode!iatione)c#clode!iation4omined : 6ori@ontal, !ertical, andAor 4omined : 6ori@ontal, !ertical, andAor torsionaltorsionalClassification (Cont.Classification (Cont.%ccording to !ariation o" the %ccording to !ariation o" the de!iation with f)ating e#e :de!iation with f)ating e#e :4omitant (concomitant) :does not !ar# 4omitant (concomitant) :does not !ar# with e#e directionwith e#e direction1ncomitant : !aries with e#e direction1ncomitant : !aries with e#e directionEtiology of StrabismusEtiology of Strabismus6eterophoria :6eterophoria :Muscle wea=ness :Muscle wea=ness :4ongenital 4ongenital%c;uired %c;uiredMuscle spasmMuscle spasm5e"raction anomalies5e"raction anomalies%nomalies o" anatom# o" the e#e muscle %nomalies o" anatom# o" the e#e muscle Etiology of Strabismus (Cont.Etiology of Strabismus (Cont.6eterotropia :6eterotropia :4ongenital :4ongenital :(#e muscle or neural anomalies (#e muscle or neural anomaliesDisturances o" accommodationDisturances o" accommodation1n"ection1n"ectionTraumaTrauma6eadArain neoplasm6eadArain neoplasmSpecifc e#e disease that attac= macula Specifc e#e disease that attac= macula to)oplasmosisto)oplasmosisClinical SymptomClinical SymptomSuBecti!e :SuBecti!e :6eterophoria :6eterophoria :&lurred !ision, especiall# when tired &lurred !ision, especiall# when tired6eadache a"ter reading 6eadache a"ter reading6eterotopia :6eterotopia :Diplopia Diplopia(#e allCs range o" mo!ement(#e allCs range o" mo!ement limited limited4hanging the position o" the head 4hanging the position o" the headAssessment of StrabismusAssessment of Strabismus9atientCs e#e all appearance 9atientCs e#e all appearance (simplest methods)(simplest methods)4orneal light reDe) test :4orneal light reDe) test :6irscherg test6irscherg testModifed Krims=#Cs method testModifed Krims=#Cs method test%ssessment (4ont.)!4o!er tests"4o!er*unco!er test"%lternate co!er test#$erapy of Strabismus#$erapy of StrabismusMain goal o" therap# Main goal o" therap# Single Single inocular !isioninocular !isionOther goal Other goal cosmetic reasoncosmetic reasonTreatment :Treatment :4ongenital 4ongenital straismus surger# as straismus surger# as soon as possilesoon as possile5e"raction disturances 5e"raction disturances correctioncorrectionOrthoptic e)ercisesOrthoptic e)ercisesSurger#Surger#4omplication!%ml#opia!4osmetic!6ead posture disturancesAmblyopiaAmblyopiaDefnition :Defnition :3nilateral or ilateral reduction o" !isual 3nilateral or ilateral reduction o" !isual acuit# (with est re"racti!e correction) acuit# (with est re"racti!e correction) that cannot e attriuted directl# to the that cannot e attriuted directl# to the e