Motor evaluation

Sheela Evangeline K

Co ordinators:Ms. RizwanaMr. Kabilan

Case 1

Presentation

Age: 8 months Complaint of inward deviation of eye

History?

Onset: birth Alternating Family history – mother Not ass with shaking of eye ball Activities normal Birth history: normal

Evaluation

Gross motor evaluation : normal Preference of fixating eye : alternating Visual acuity : fixates light and toys

monocularly No nystagmus Limitation of abduction Cyclopleigic refraction: OU: +2.00DS Modified Krimsky: 45 PD Fundus: normal

What do you see?

Diagnosis ?

Essential Infantile Esotropia

Management?

Case 2

Presentation

Age : 5 years C/O inward deviation of eye

History

Right eye – constant esotropia No CNS abnormalities Birth history : normal

Evaluation Vision ( with Leas)

OD: 6/12 OS: 6/9

PBCT: Distance: 30 PD Near: 40 PD

Comitant No latent nystagmus, dissociated vertical deviation

or smooth pursuit asymmetry. Worth four dot test : OD: suppression Cycloplegic retinoscopy OU: +4.00/-0.50 × 180. Slit lamp examination and fundus was normal

What will you do next ?

Raab’s plus 3 test

CT over glasses Distance: ortho Near: 5 PD esophoria

Vision with glasses OD: 6/7.5 OS: 6/7.5

Diagnosis ?

Fully accommodative esotropia

Management

Partial accommodative esotropia

                                                                                                                                                                                                                                                          Left esotropia on accommodation.

 

                                                                                                                                                                                                                                                          Residual esotropia with hypermetropic correction.

Case 3

Presentation

Age: 11 yr C/o outward deviation of left eye

History

Onset : 1 yr of age Constant

Evaluation

Vision OD: 6/6 ; OS: 6/15 LXT for distance and near PBCT:

Distance: 60 PD Near: 40 PD

What will you do next ?

                 

                 

                 

                 

                 

                 

                 

                 

                 

What pattern you see ?

Patch test

Distance deviation remains higher than near deviation

Diagnosis

True divergence type Exotropia

Management

Case 4

Presentation

Age: 9 years C/o outward deviation of right eye Left face turn Limited eye movements

                 

                 

                 

                 

                 

                 

                 

                 

                 

                 

                 

                 

Evaluation

Limited abduction Retraction and narrowing of palpebral fissure

on adduction Widening on abduction Leash phenomenon present

Diagnosis ?

Duane’s syndrome

Type 2

Case 5

Presentation

Age: 27 years S/p RD surgery at age of 14 yrs c/o inward deviation of left eye since 2 years

More in alternate days Ass with decreased vision

Evaluation

Vision: OD: 6/6 OS: 6/36

PBCT: 60 PD on first day 12 PD on second day

Diagnosis ?

Cyclic Esotropia

Management ?

A large recession of the left medial rectus and resection of the left lateral rectus

Safety glasses

Case 6

Presentation

Age: 30 years S/p RTA

Loss of consciousness C/o double vision on awakening – says images

are tilted With chin down position diplopia disappears

Evaluation

What do you see ?

Evaluation

Slit lamp examination : normal

Fundus

Characteristic!

Diagnosis ?

Bilateral superior oblique palsy

Which way would the images be tilted?  

Management

Surgery

Bilateral inferior rectus recession Medial rectus down shift Bilateral S.O. Harada-Ito Bilateral inferior oblique weakening

Few more cases

C/o squinting

Diagnosis ?

Negative angle kappa

C/o squinting

Vision OU: 6/6 Hirschberg: 15deg ET Cover test : ortho

Diagnosis ?

Pseudo strabismus due to epicanthus

Thank you