squint in chidren

7/25/2019 Squint in Chidren

1/46

! "

$#

%"

!


2/46


3/46

Male child ,5 yrs, presents `e cough, colds& low gradefever that started few days back.

No H! vo"iting ,#$M or sy"pto"s of other syste"affection

He is not following in other speciality clinics

&'(%

'here was (ve signs of )*'+

-uint ,which was not docu"ented in the file before, wasnoticed there was inward deviation of the #t.eye


4/46

/urther history ,clinical neurological

e0a"ination was done that revealed a

(ve H! of head trau"a

'he patient is following now in a private

clinic, where the investig. done

were difficult to know


5/46

)*+,-,.,/-

-uint is a "isalign"ent of the two eyes so that botheyes are not looking in the sa"e direction.

+n other words the two eyes don1t look straight in the

pri"ary ga2e0-/. /1.2/.1/3,40

+t is a co""on condition a"ong children. +t "ay alsooccur in adults.

trabis"us can occur in one or both eyes, and in anydirection


6/46

5,-/46781 9,-:7* ;,9,/-

)nder nor"al circu"stances, when both theeyes have good vision and they are alignedproperly, they focus on the sa"e ob3ect.

4ach of the eyes sends picture of the sa"eob3ect, viewed fro" a slightly different angle.

'hese two i"ages reach the brain, where theyare fused to for" a single threedi"ensionalpicture with depth perception.


7/46


8/46

)*;*7/3


9/46


10/46


11/46


12/46


13/46

C*1


14/46

classification

),1*4.,/- /+ 9D6,-.6 7onvergent 8eso96 :ivergent 8e0o96 )pwards 8hyper9

6 :ownwards 8hypo9 E/-9.8-4= /+ 9D6,-.6 #atent 8present inter"ittently,e.g.when tired9;phoria6 Manifest 8present all the ti"es9;tropia

F6-4.,/- /+ (G&GH.

6 7o"itant 8no Ms.paralysis96


15/46


16/46


17/46


18/46

(3,@* percent of the population

J,9K +84./19 +/1 9.18A,9


19/46


20/46

E869*9 /+ 42,7@2//@ 9D6,-.

E/-:*-,.87 9D6,-.%these children are born with a s-uint, though it "ay notbe obvious for few weeks. strong fa"ily history could be present. +n allchildren the vision and need for spectacles has to be assessed.

M/-: 9,:2.*@-*99 /1 2=3*1


21/46

31,


22/46


23/46


24/46

R8187=.,4 LD6,-.

one of the "uscle attached to the eyes is paraly2ed and the eye "ove"ent is restricted

in the direction of the action of the paraly2ed "uscle.

'his can be caused by6 direct trau"a to the "uscle as for e.g. in3ury during forceps delivery or any other in3ury.6 peripheral neuritis or diseases of the 7N, e.g. "eningitis, encephalitis etc.

+f it occurs in a young age,a"blyopia "ay results

+f it occurs in an older child when the eye has already learnt to see, double visionoccurs 8diplopia9, which is "a0i"al in looking towards the direction of the paraly2ed"s.

'reat"ent of paralytic s-uint depends on the cause and "any ti"es paralytic s-uint"ay not be co"pletely cured. +n such cases spectacles with pris"s are prescribed.

LD6,-. /+ 96@@*- /-9*. ,9 /+.*- 8 9,:- /+ 9*1,/696-@*17=,-: 4/-@,.,/- *G:G 9384* /4463=,-: 7*9,/-


25/46

S/- R8187=.,4T E/


26/46

L=


27/46

),++*1*-.,87 @,8:-/9,9

+n infants, true strabis"us "ust be differentiated fro"

6 R9*6@/ 9.18A,


28/46

R9*6@/ 9.18A,9


29/46

R9*6@/ *>/.1/3,8

+t is caused by te"poral dragging of the "acula secondary to retinaltraction.

*etinopathy of pre"aturity is the "ost co""on

cause of pseudoe0otropia

other causes include6 vascular abnor"alities,6 7horoiditis6 other peripheral retinal disorders

s with pseudoesotropia, pseudoe0otropia can be differentiatedfro" true strabis"us with6 corneal light refle0 and6 the coveruncover tests.


30/46

:rawback of s-uint

Bhen the eyes are not aligned properly, each of the eyes isfocusing on a different ob3ect and sends signal to the brain. 'hesetwo different i"ages reaching the brain led to confusion and "ayhave either of the two effects%

child would ignore the i"age co"ing fro" the deviated eye, and

thus sees only one i"age. $ut in the process, he loses the depthperception. 'his suppression of the i"age fro" the deviating eyeresults in poor develop"ent of vision in this eye, which is known asU8


31/46


32/46

(V?MW?CO&S


33/46


34/46

O


35/46

C2* 32=9,487 *>8


36/46

C2* /32.2878


37/46


38/46

4/;*1 .*9.


39/46


40/46

C1*8.


41/46


42/46

X2*- L2/67@ L61:*1= 5* )/-*

+n a young child with a constant s-uint, surgeryshould be done once vision is e-ual in both eyesto enable binocular vision to develop.

+n a child with inter"ittent s-uint, surgery is notso urgent as he can e0perience binocular visionso"e of the ti".

o"eti"es this is the only choice to straightenthe eye


43/46


44/46

F1*D6*-4= /+ *=* *>8


45/46

E/-4769,/-

L.18A,9


46/46

squint in chidren

Documents