Abnormal Eye Position

8/13/2019 Abnormal Eye Position

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ABNORMAL EYE POSITION


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TOPICS

1. Ocular Motility and Inervation2. Strabismus

3. Enophtalmus and Exophtalmus


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1. Ocular Motility

The four rectus muscles:

the superior, inferior, medial, and lateral rectus

muscles.

The two oblique muscles:

the superior and inferior oblique muscles.


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2. Strabismus


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2. Strabismus

Strabismus is defined as deviation of aneyes visual axis from its normal position

There are two major types of manifest

strabismus : concomitant (nonparalytic)

incomitant (paralyticor restrictive)strabismus


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2.a. Concomitant Strabismus

Strabismus is called concomitant or nonparalytic

when the angle (or degree) of misalignmentis

approximately equal in all directions of gaze

Epidemiology: occurs almost exclusively in

children. Approximately 5.37.4 % of all children

are affected. In 6070 % of all cases, the disorderinitially manifests it self within the first two years

of life.


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Etiology :

Genetic factors Uncorrected refractive errors

Insufficient fusion

Unilateral visual impairment Others possible causes


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Forms:

Esotropia: Inward deviation of the visual axis.

Exotropia: Outward deviation of the visualaxis.

Hypertropia and hypotropia: Ocular deviationwith one eye higher orlower than the other.

Cyclotropia: This refers to the rotation of oneeye around its visual axis.


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2.b. Incomitant Strabismus

Occur when the degree of misalignment varies

with the direction of gaze

One or more of the extraocular muscles or

nerves may not be functioning properly or

normal movement may be mechanicallyrestricted


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2.b. Incomitant Strabismus

Etiology

serious neurologic disorder, such as third cranialnerve paresis

orbital disease or trauma, such as the restrictive

ophthalmopathy of thyroid disease


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2.c. Examination & Diagnosis

General Inspection

Corneal Light Reflex (Hischberg Reflex)

Cover and Uncover Test


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2.c.1. General inspection:

Having the patient look in the six cardinal

positions of gaze may reveal whether the

deviation is approximately the same in all fields-indicating concomitant strabismus-or is

significantly different in one field of gaze-

indicating a possible incomitant strabismus.


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Corneal Light Reflex


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2.c.2 Cover test

can be used on any patient over the age of 6 or 7

months.

have the patient look at a fixation point Cover the fixating eye and observe the other eye


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2.d Management Of

Strabismus

Eyeglass Prescription

Surgery

Esotropia is corrected by a combined

procedure involving a medial rectus recession

and a lateral rectus resection Exotropia is corrected by posteriorly a lateral

rectus recession in combination with a medial

rectus resection


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3. Enophtalmus

3.a. Definition

A backward displacement of the eyeball into

the orbit


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3. Enophtalmus3.b. Causes

Orbital fractures (most frequent cause) Blowout fracture not associated with an orbital

hematoma

Neurogenic causes Horners syndrome (sympathetic palsy)

Paresis of the oblique ocular muscles

Atrophy of orbital tissue (symmetrical) Senile atrophy of the orbital fat

Dehydration


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4. Exophtalmos

4.a. Definition Exophthalmos is a bulging of the eye

anteriorly out of the orbit


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4. Exophtalmos

4.b. Causes

Graves disease (most frequent cause)

Inflammatory orbital disorders

Vascular orbital disorders

Orbital tumors (slowly progressive)

Developmental anomalies


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4.c. Treatment

Surgical


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THANKS

Abnormal Eye Position

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