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Ophthalmology
Paralytic Strabismus
Built from Strabismus Simplified, Second Edition
What’s inside
9 sections · 105 slides
Overview
- Scope of this presentation
Definitions and Classification
- Incomitant strabismus defined
- Intracranial course of the third, fourth and sixth nerves
- Classification of the motor deficiency
- Myogenic causes of limited ductions
- Causes of neurogenic lesions
- Clinical hallmarks of paralytic strabismus
- Primary and secondary deviation
- Paralytic versus comitant strabismus
- Why the classical features may be absent
- Stages of a paralytic squint
- Inhibitional palsy and the occlusion test
- Stages of a paralytic squint in the nine gazes
Examining the Paralytic Case
- History in a suspected palsy
- Past pointing
- Measurement of ocular deviation
- Three rules for reading a diplopia chart
- Diplopia charting in three palsies
- Hess and Lees charting
- Foster torches and polaroid dissociation
- Hess chart of a left lateral rectus palsy
- Hess chart of a right superior oblique palsy
- Hess chart of a left third nerve palsy
- Binocular fields of fixation
- Forced duction test
- Method of forced duction testing
- Pitfalls in forced duction testing
- Active force generation test
- Intraocular pressure in different gazes
- Saccadic velocity recording
- Electromyography in ocular motility
- Paralytic versus restrictive squint
Oculomotor Nerve Palsy
- Levels of oculomotor nerve involvement
- Muscles supplied by the oculomotor nerve
- Total oculomotor nerve palsy of the right eye
- Aberrant regeneration in oculomotor nerve palsy
- Tonic pupil in aberrant regeneration
- Pupillary involvement in oculomotor nerve palsy
- Ischaemic mononeuropathy
- Nuclear oculomotor nerve palsy
- Superior rectus palsy
- Medial rectus palsy
- Synergistic divergence and dissociated horizontal deviation
- Inferior rectus palsy
- Inferior oblique palsy
- Detecting trochlear palsy within a third nerve palsy
- Combined third and fourth nerve palsy with positive head tilt test
Trochlear Nerve Palsy
- Clinical presentation of trochlear nerve palsy
- Late changes in trochlear nerve palsy
- Congenital trochlear palsy and head posture
- Testing excyclotropia
- Magnitude of excyclotropia
- When to suspect bilateral superior oblique palsy
- Bielschowsky head tilt test
- Management of fourth nerve palsy by Knapp's classification
Abducens Palsy and Related Syndromes
- Abducens nerve palsy
- Mobius syndrome
- Skew deviation
- Double elevator palsy
- Congenital and acquired double elevator palsy
- Double depressor palsy
- Supranuclear gaze palsy
- Internuclear ophthalmoplegia
Management of Paralytic Squint
- Initial evaluation and follow-up
- Non-surgical management during follow-up
- Botulinum toxin in paralytic squint
- Principles of surgery in paralytic squint
- Retroequatorial myopexy and management of contracture
- Transposition procedures for abducens palsy
- Left abducens palsy before and after partial vertical rectus transposition
- Management of third nerve palsy
- Horizontal surgery in third nerve palsy
- Periosteal anchoring of the globe
- Surgical steps of periosteal anchoring of the globe
- Medial periosteal anchoring in third nerve palsy: outcome
- Lateral periosteal anchoring and adjunctive procedures
- Ptosis management with crutch glasses
- Surgery for fourth nerve palsy
- Choosing between superior and inferior rectus recession
- Inferior oblique weakening procedures
- Superior oblique palsy corrected by inferior oblique recession and anteropositioning
- Acquired superior oblique palsy treated by superior oblique tuck
- Surgery for double elevator palsy
Myasthenia and Myopathies
- Clinical presentation of ocular myasthenia
- Aetiology and pathogenesis of myasthenia
- Icepack test and sleep test
- Tensilon test
- Neostigmine test
- Confirmatory investigations in myasthenia
- Treatment of myasthenia
- Chronic progressive external ophthalmoplegia
- Management of chronic progressive external ophthalmoplegia
Summary
- Key points on diagnosis
- Key points on management
- Suggested reading
- Suggested reading (continued)
- Strabismus Simplified