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    T11 Special Forms of Strabismus 1

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    Arpita Paul
    The document discusses several special forms of strabismus including third nerve palsy, Brown's syndrome, Duane's syndrome, aberrant regeneration, sixth cranial nerve palsy, Grave's eye disease, chronic progressive external ophthalmoplegia, and myasthenia gravis. For each condition, the document describes signs and symptoms, causes, diagnosis, and treatment.

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    T11 Special Forms of Strabismus 1

    Uploaded by

    Arpita Paul
    4 views10 pages
    The document discusses several special forms of strabismus including third nerve palsy, Brown's syndrome, Duane's syndrome, aberrant regeneration, sixth cranial nerve palsy, Grave's eye disease, chronic progressive external ophthalmoplegia, and myasthenia gravis. For each condition, the document describes signs and symptoms, causes, diagnosis, and treatment.

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    Forms of Nystagmus

    Original Title

    T11 SPECIAL FORMS OF STRABISMUS 1

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    The document discusses several special forms of strabismus including third nerve palsy, Brown's syndrome, Duane's syndrome, aberrant regeneration, sixth cranial nerve palsy, Grave's eye disease, chronic progressive external ophthalmoplegia, and myasthenia gravis. For each condition, the document describes signs and symptoms, causes, diagnosis, and treatment.

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    © All Rights Reserved
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    Download as docx, pdf, or txt
    4 views10 pages

    T11 Special Forms of Strabismus 1

    Uploaded by

    Arpita Paul
    The document discusses several special forms of strabismus including third nerve palsy, Brown's syndrome, Duane's syndrome, aberrant regeneration, sixth cranial nerve palsy, Grave's eye disease, chronic progressive external ophthalmoplegia, and myasthenia gravis. For each condition, the document describes signs and symptoms, causes, diagnosis, and treatment.

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    of 10

    SPECIAL FORMS OF STRABISMUS

    Third Nerve Palsy


    Brown Syndrome
    Duane’s Syndrome
    Aberrant Regeneration
    Sixth Cranial Nerve Palsy
    Grave’s Eye Disease
    Chronic Progressive External Ophthalmoplegia
    Myasthenia Gravis
    Third nerve palsy

     The third cranial nerve controls the movement of four of the six eye muscles.
    This muscles move the eye inward. Up & down & they rotate the eye.
     It also controls the constriction of pupil, the position of upper eyelid, the ability
    of the eye to focus.
     A complete 3rd nerve palsy cause a completely closed eyelid & deviation of eye
    outward & downward.
     The eye can’t move upward or inward , the pupil is typically enlarged and
    doesn’t react normally to light.
     A partial 3rd nerve palsy affects , to varying degrees, any of the functions
    controlled by 3rd cranial .

    SIGNS & SYMPTOMS

     Diplopia( due to misalignment of eye )


     Droopy eyelid covers the pupil ( ptosis )
     Enlarged pupil ( first sign of 3rd nerve palsy )
    CAUSES:

    a) Congential:
     By birth
     Idiopathic
    b) Acquired:
    Associated with Trauma, Infection, Migraine , Brain Tumour , Aneurysm ,
    Diabetes Or High Blood Pressure.
    c) Children: Amblyopia - SMP & stereopsis is absent

    TREATMENT:

     Congenital - No treatment to function of weak nerve.


     Acquired - May resolved depending upon the case

    MANAGEMENT:

     Surgical management: Relief of pressure on 3rd nerve from tumour or blood


    vessels with surgery may improve the 3rd nerve palsy.
     Non surgical management : treatment of underlying cause
    Occlusion patch or prism
    Monitor children for development of amblyopia.

    CHRONIC PROGRESSIVE EXTERNAL OPHTHALMOPLEGIA

    Adisorder characterized by slow progressive paralysis of the Extra Ocular Muscles.

    It affects the function of the Levator Palpebral Superiorismuscle


    CLINICAL FEATURES:

    Chronic progressive external ophthalmoplegia usually begins in childhood with

     Ptosis
     Sporadic
     A true pigmentary retinal dystrophy usually absent
     Constricted field of view

    SYMPTOMS:

     Ptosis
     Muscle weakness

    DIAGNOSIS:

     Muscle biopsy
     Molecular test

    MANAGEMENT :
    Treatment for drooping eyelids.
    Tightens levator muscles to lift eyelids, which improves
    vision and appearance.

    6TH NERVE PALSY

    It is a disorder associated with dysfunction of cranial nerve (vi)which is responsible


    for causing contraction of Lateral Rectus Muscle to abduct the eye.

    The inability of an eye to turn outward which result in Esotropia.

    SIGNS AND SYMPTOMS:

     Esotropia(covergent squint on distance fixation )


     Face and head turn towards the deviation
     Diplopia

    DIAGNOSIS:

     Medical history
     Physical examination
     Eye examination
     Blood test
     MRI
     CT
     Spinal tap

    TREATMENT:

     Antibiotic for bacterial infection


     Prism glasses
     Corticosteroids

    ABERRANT REGENERATION

    Aberrant regenerationof Cranial Nerve (III) otherwise known as


    OculomotorSynkinesis

    Its appearance usually follows an oculomotor palsy,but it can also occur primarily
    without any preceding nerve function.
    SIGNS:

     Elevation of upper eye lid on attempted downward gaze or adduction


     Constriction of the pupil on attempted adduction
     Pseudo-graefe’s sign
     Limitation of elevation and depression
     Pseudo-Argyll roberston pupil is seen most often with adduction

    CAUSE:

     Trauma
     Tumour
     Aneurysm

    BROWN’S SYNDROME

    Brown syndrome is the inability of upwards movement of the eye.

     Restriction of elevation in adduction


     Shortening of the anterior sheath of the superior oblique tendon
     Restriction of the superior oblique tendon at the trochlear pulley

    CAUSE:

     Bilateral -10% ,monocular-90%


     Congenital
     Acquired
     Trauma in the region of trochlea
     Systemic inflammation – sinus infection

    SIGNS AND SYMPTOMS:

     Double vision
     Strabismus
     Ptosis
     Chin up and head tilt
     Decreased ability to look upward and inward with the affected eye
    DIAGNOSIS:

     Medical and physical examination


     Eye examination
     Imaging test – superior oblique muscle tendon

    MANAGEMENT:

     Observation alone in about two third of all brown syndrome cases


     Systemic treatment
     Corticosteroid injection near the trochlea

    TREATMENT:

     Based on severity of symptoms and cause


     Surgery- tendonotomy of the superior oblique, or tendonectomy

    MYASTHENIA GRAVIS

    Myasthenia gravis (MG) is a neuromuscular disorder that causes weakness in the


    skeletal muscles, which are the muscles your body uses for movement.
    When the symptoms of myasthenia gravis is isolated to Levator Palpebral
    Superioris , Orbicularis Oculi and The Oculomotor Muscles then it is referred to as
    OCULAR MYASTHENIA GRAVIS(OMG)

    CLINICAL FEATURES:

    Triad : Ptosis

    Oculomotor Paresis Orbicularis Oculi

    Signs &Symptoms :

     Fluctuating in vision
     Fatiable weakness
     Extra ocular muscles
     Dioplia
     Lagophthalmos

    DIFFERNETIAL DIAGNOSIS:

     Thyroid ophthalmopathy
     Chronic progressive external ophthalmoplegia
     Muscular dystrophy
     Brainstem and motor cranial nerve pathology

    DIAGNOSIS:

     Sleep test
     Ice pack test
     Tensilon test

    TREATMENT:Treatment of ocular myasthenia gravis is aimed at relieving the


    symptoms of ptosis and diplopia
    Non surgical treatment: Immunosupperssion steroids

    Surgical treatment: Thymectomy

    Non pharmacologic treatment:

     Occlusive devices
     Prisms
     Contact lens
     Eye lid support

    DUANE’S SYNDROME

    Duane syndrome (DS) also known as Duane Retraction syndrome (DRS), is an eye
    movement disorder present at birth (congenital) characterized by horizontal eye
    movement limitation a limited ability to move the eye inward toward the nose
    (adduction), outward toward the ear (abduction), or in both directions.

    The three types of Duane syndrome:


    Duane syndrome Type 1: The ability to move the affected eye(s) outward
    toward the ear (abduction) is limited, but the ability to move the affected
    eye(s) inward toward the nose (adduction) is normal
    Duane syndrome Type 2: The ability to move the affected eye(s) inward
    toward the nose (adduction) is limited, whereas the ability to move the eye
    outward (abduction) is normal or only slightly limited.
    Duane syndrome Type 3:The ability to move the affected eye(s) both
    inward toward the nose (adduction) and outward toward the ear (abduction)
    is limited.
    SYMPTOMS:

     Holding the head in an abnormal posture, turned to the right or left


     Crossing or misalignment of the eyes
     Closing one eye to see better
     Double vision
     Neck pain
     Headache
     Difficulty seeing things on the side of the affected eye

    TREATMENT:

     Observation, treatment of amblyopia (such as patching of the better seeing eye)


    or possibly surgery.
     Vision Therapy to treat secondary convergence insufficiency
     prism
     special rear view mirror to help during driving

    GRAVE’S EYEDISESASE

    Thyroid eye disease (TED) is an eye condition in which the eye muscles and fatty
    tissue behind the eye become inflamed. This can cause the eyes to be pushed
    forward (‘staring’ or ‘bulging’ eyes) and the eyes and eyelids to become swollen
    and red.

    SYMPTOMS:

     Change in the appearance of the eyes (usually staring or


    bulging eyes)
     A feeling of grittiness in the eyes
     Dry or watery eyes
     Dislike of bright lights
     Swelling or feeling of fullness in one or both upper eyelids
     Bags under the eyes
     Redness of the lids and eyes
     Blurred or double vision
     Pain in or behind the eye, especially when looking up, down
    or sideways
     Difficulty moving the eyes

    DIAGNOSIS:

     CT
     MRI
     Scan of the eye muscles.

    TREATMENT:'Decompression' surgery to create more space


    behind the eyes when there is pressure on the nerve or if there
    is a lot of protrusion of the eyeballs, in order to improve a
    person’s appearance

     Eye muscle surgery to treat double vision


     Eyelid surgery to improve the appearance of the eyelids

    ---------------------

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