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Ophthalmology
Examination of a Case of Squint
Built from Strabismus Simplified, Second Edition
What’s inside
13 sections · 125 slides
The squint examination
- Scope of the squint examination
- Essential equipment for the squint clinic
- Essential equipment, continued
- Desirable equipment
- Additional equipment
- Two aspects of the squint examination
- Components of the motor examination
Head posture
- Observation of head posture
- Three components of an abnormal head posture
- Abnormal head postures in strabismus
- Purpose of an abnormal head posture
- Causes of abnormal head posture
- Non-strabismic causes of head posture
- Ocular torticollis in congenital superior oblique palsy
- Head posture in right superior oblique palsy
Interpupillary distance
- Value of measuring interpupillary distance
- Measuring interpupillary distance with a millimetre scale
- Monocular pupillary distance and facial asymmetry
- Interpupillary distance on the Pulzone-Hardy rule and synoptophore
Is the squint real?
- True squint versus apparent squint
- Causes of pseudoesotropia
- Causes of pseudoexotropia
- Lid position masking and mimicking deviation
- Angle kappa
Cover tests
- Components of the cover-uncover test
- Prerequisites of a valid cover test
- Observations made during covering
- Cover test in schematic form
- Observations made during uncovering
- Fixation preference and dominance on uncovering
- Prerequisites and limitations of the cover-uncover test
- Cover testing in the uncooperative infant
- Information obtained from the cover-uncover test
Measuring the deviation
- Objective and subjective methods of measurement
- Prism bar cover test
- Horizontal and vertical prism bars
- Prism orientation in vertical and combined deviations
- Position of the prism in front of the eye
- Static and dynamic components of the deviation
- Relaxing accommodation and fusion before measurement
- Effect of high plus and minus lenses on the measured deviation
- Aspects of measurement: distance, glasses and gaze
- Aspects of measurement: patterns, fixation and correspondence
- Examination of the eyes in nine gaze positions
- Alternative technique using head rotation
Instruments of measurement
- Construction of the synoptophore
- Optics and limitation of the synoptophore
- Uses and modifications of the synoptophore
- The synoptophore
- Optical layout of the synoptophore
- Hirschberg's corneal reflection test
- Corneal reflection positions in esodeviation and exodeviation
- Krimsky's prism reflex test
- Neutralising the corneal reflex with a prism
Subjective tests of deviation
- The diplopia principle and the haploscopic principle
- Perception of a single object as two images
- Haploscopic principle in Hess charting
- Diplopia testing with red-green glasses
- Technique of diplopia charting
- Hess and Lees screen
- Reading the Hess chart
- Subjective measurement of cyclodeviation
- Double Maddox rod test
- Objective assessment of cyclodeviation
- Fundus appearance in extorsion and intorsion
- Extorted fundus with the disc-fovea axis sloping downward
Ocular movements
- Assessment of limitation of movement
- Recording underaction and overaction of extraocular muscles
- Landmarks of normal ocular excursion
- Grading oblique overaction from the vertical deviation
- Angular grading of inferior oblique overaction
- Angular grades of inferior oblique overaction
- Grading superior oblique overaction
Fusional vergences
- Clinical importance of fusional vergences
- The three planes of vergence
- Near point of convergence
- Convergence sustenance
- Measurement of vergences with prisms
- Order of testing the vergences
- Normal fusional vergence amplitudes
Sensory status
- Importance of the sensory examination
- The six questions of the sensory examination
- Binocular and monocular diplopia
- Types of retinal correspondence
- Suppression
- Bagolini striated glasses test
- Responses on Bagolini striated glasses
- Perceptions on Bagolini striated glasses
- Worth four dot test
- Five dot responses and the limits of the Worth test
- Responses on the Worth four dot test
- The three levels of binocular vision
- Interpretation of synoptophore slide testing
- After-image testing
- Responses on after-image testing
- Binocular responses to monocular after-images
- Charting the extent of suppression
- Patterns of suppression scotoma
- Depth of the suppression scotoma
- Related assessments covered elsewhere
Fixation disparity
- Concept of fixation disparity
- Associated phoria and its measurement
- Testing for fixation disparity with polaroid dissociation
- Fixation disparity curves
- Curve types and their clinical associations
- Instruments for measuring fixation disparity
- Procedure on the disparometer
Summary
- Take-home points: the motor examination
- Take-home points: the sensory examination
- Suggested reading
- Suggested reading (continued)
- Strabismus Simplified