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Squint
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Examine this patient's eyes. The squint will be obvious and thus examination of the eye must quickly focus on distinguishing a paralytic from a nonparalytic squint.Full examination of the ocular movements of each eye separately is mandatory.Do not forget to ask the patient whether he/she sees double with every movement of the eye in the direction of action of the ocular muscles being tested.Once examination is complete, the answer should be precise.To identify the presence of a squinting eye use the cover test (the patient is asked to fix the eyes on an object. One eye is then covered and the movement of the other eye is observed. If the uncovered eye makes a movement to take up a fixation point then a squint is present). The test is repeated with the opposite eye. The fixing eye will not move when the squinting eye is covered.
Neurology and neurosurgery
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
Most cases of convergent squint are due to disturbances of vision, such as hypermetropia, which require treatment with glasses or topical myotics. Aligning the squinting eye by surgery will not restore vision. The majority of patients respond to treatment with glasses, although some may require surgery for a residual squint. Retinoblastoma and congenital glaucoma cause visual disturbance which leads to convergent squint. A divergent squint has better prognosis than convergent squint. When due to esotropia it is alternating and vision is likely to develop equally in both eyes.
Squint
Published in Anne Stephenson, Martin Mueller, John Grabinar, Janice Rymer, 100 Cases in General Practice, 2017
Anne Stephenson, Martin Mueller, John Grabinar, Janice Rymer
It is not easy to examine a baby's eyes. What looks like a squint can be caused by the shape of the eyes and wide medial epicanthal folds. The corneal light reflex can be seen at arms' length without unduly disturbing the child: with a true squint the corneal light reflex is asymmetrical. The cover test is a little more difficult and may not be possible in such a young baby: the GP covers the eye that looks normal and then watches the uncovered abnormal-looking eye for movement as it takes up fixation. An important part of the examination is the red reflex using the ophthalmoscope set at ‘0’ at a distance of about 25 cm. A cataract or corneal opacity will show up as black against the red reflex and fundal lesions will appear white. In addition, as always, the GP must take into account the baby's general health.
Hemifield-slide diplopia successfully managed with botulinum toxin injection in a patient with traumatic chiasmal disruption
Published in Clinical and Experimental Optometry, 2022
Kaveh Abri Aghdam, Ali Aghajani, Faeze Hashemi Rahbarian, Mostafa Soltan Sanjari
Some authors have proposed different ways for managing symptoms in these patients. Prism and stereo-typoscope (a novel fusion aid that utilises midline stereopsis) have been used successfully in one study.7 Surgical management of squint and diplopia is another proposed treatment modality. Van Waveren et al.6 suggested surgery in these patients in cases of normal retinal correspondence. They proposed that surgery could be performed after observing functional improvement under prismatic correction and weighing the reduction of the binocular visual field against its sensory outcome. However, the result of surgery is not always favourable and sensory abnormalities may persist despite apparent elimination of ocular misalignment.1 On the other hand, some patients might not consent to surgery (as in this case), and thus we explored treatment alternatives. Based on the previous reports of successful application of botulinum toxin in small-angle exotropia,8 the authors decided to inject botulinum toxin A (Dysport®; Ipsen, Paris, France) in both lateral rectus muscles; the result of which was satisfying and long-lasting.
Status of Eye Health among School Children in South India – Sankara Nethralaya School Children Eye Examination Study (SN-SEES)
Published in Ophthalmic Epidemiology, 2021
Anuradha Narayanan, Sruthi Sree Krishnamurthy, Krishna Kumar R
It is worthwhile to note that children with other ocular abnormalities were 2.14%, 1.46%, and 1.68% in Chennai, Kanchipuram, and Thiruvallur districts, respectively. Strabismus, retina, and neuro-ophthalmology-related abnormalities, ptosis, and corneal scars were found to be among the top causes for referrals. This study reports strabismus as the first major cause of referral, and although the presence of strabismus is noticeable by the parents and others, it did not receive attention for management. Squint is often considered as a sign of luck30 and awareness level about the causative factors and the need for early treatment or management is low among the community for this condition. Strabismus and ptosis is a manifest condition and could be diagnosed easily but the prevalence of a significant proportion of other ocular abnormalities also highlights the need for trained professionals to be involved in the screening. Considering that the refractive amblyopia was predominant, this stresses the importance of regular school eye screening, referral, and the need to improve compliance to spectacle wear by increasing the awareness and acceptance of eye care services. There is a significant proportion of ocular problems in all the three districts and rural region shows almost similar proportions of refractive errors and other ocular problems which emphasizes the need for services to tackle ocular problems apart from the refractive services.
Causes and Outcomes of Patients Presenting with Diplopia: A Hospital-based Study
Published in Neuro-Ophthalmology, 2021
Nitin Kumar, Savleen Kaur, Srishti Raj, Vivek Lal, Jaspreet Sukhija
A detailed history was taken from each patient including age at diagnosis, laterality, any trauma, ocular surgery, diabetes mellitus, hypertension, hypercholesteraemia, cardiovascular diseases, and history of smoking. Patients who presented with a short history of sudden and recent onset (few days to weeks) were identified as acute/subacute and those who presented after 1 month of onset as chronic. The examination included a recording of visual acuity by Snellen charts, slit lamp examination for anterior segment evaluation as well as posterior segment examination by slit-lamp biomicroscopy. Squint examination included evaluation of the ocular movements, measurement of ocular deviation by the prism bar cover test and Krimsky test when there was no central fixation. Diplopia charting was done with red-green glasses at 1 m. Patients with long-standing phorias or latent strabismus sometimes present with diplopia due to decompensation of their phorias due to fever, trauma, and advancing age. Thorough ophthalmological evaluation and management by a strabismologist was performed in such cases and systemic investigations avoided. These conditions were labelled as decompensating heterotopias. Systemic examination was performed and appropriate investigations were ordered in all other cases. A record was made of the investigations ordered. These were principally, full blood count, blood sugar testing, blood pressure monitoring, lipid profile, chest radiograph, C-reactive protein, antinuclear antibody, anti-neutrophil cytoplasmic antibody, and any imaging of the brain with computed tomography (CT) or magnetic resonance imaging (MRI).