Types and Management of Exodeviations
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This document discusses exodeviations (divergent strabismus), which occurs when the visual axis is deviated laterally and the fovea is rotated nasally. Exodeviations can be comitant or incomitant. Comitant exodeviations include infantile exotropia, intermittent exotropia, and sensory exotropia. Incomitant exodeviations include paralytic, restrictive, and musculofascial innervational anomalies. Treatment options depend on the type of exodeviation and include non-surgical approaches like optical treatment and orthoptic exercises or surgical approaches like lateral rectus recession and medial rectus resection.
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Types and Management of Exodeviations
- 2. Exo – visual axis is deviated laterally and fovea rotated nasally Exodeviations = divergent strabismus latent manifest (controlled by fusion) - intermittent or constant - unilateral or alternating
- 3. Appearance of exodeviations ◦ wide interpupillary distance ◦ large positive angle kappa- hyperopia, ROP
- 4. Idiopathic Proposed causes are: ◦ Excessive tonic divergence ◦ Anatomical and mechanical factors within the orbit
- 5. A. COMITANT Primary Infantile exotropia Intermittent exotropia Secondary Sensory exotropia Consecutive exotropia B. Incomitant Paralytic Restrictive Musculofascial innervational anomalies
- 7. It is a rare condition It occurs in patients with; ◦ Craniofacial anomalies ◦ Ocular albinism ◦ Cerebral palsy Features: ◦ Large angle constant exo deviation is mostly more than 35PD ◦ Fusion will be poor ◦ amblyopia> intermittent exotropia
- 9. Most common form of XT Onset: typically in first few years of life Most common symptoms; ◦ Blur ◦ Asthenopia ◦ Diplopia ◦ Monocular eye closure in bright sunlight ◦ None(suppression or ARC)
- 11. Poor vision in one eye leads to XT Sensory esotropia or exotropia may occur Secondary to some sensory deficit Causes - Marked anisometropia Eg; unilateral high myopia retinoblastoma(22% present with strabismus) Unilateral cataract
- 15. Formerly esotropic patient Either spontaneously or after surgical overcorrection Treatment: ◦ Correction of refractive error if present ◦ surgery(cosmetic)
- 17. 3rd nerve palsy Internuclear ophthalmoplegia(INO) Ocular myasthenia
- 18. 2nd Row
- 19. Dysthyroid orbitomyopathy Fibrosis secondary to orbital trauma and orbital surgery Parasitic cyst Orbital tumours
- 20. Duanes’s retraction syndrome type 2: ◦ LR innervations present on abduction as well as adduction ◦ Abduction : normal ◦ Adduction : limited - globe retraction - narrowing of palpebral aperture - upshoot or down shoot
- 21. 1) Stage of latent deviation (Phoria ) 2) Stage of intermittent exotropia (Distance deviation > near deviation) 3) Stage of constant exodeviation (inadequate fusional convergence lead to constant exo)
- 22. Latent or intermittent form increases. Prevalence less than esodeviation. Age of onset of majority is shortly after birth. Genuine “congenital” exotropia: poor prognosis. More common in females. Refractive errors-mostly seen in myopes. Precipitating factors.
- 23. Merely a descriptive classification 1. Divergence excess pattern 2. Basic exodeviation 3. Convergence insufficiency pattern 4. Simulated divergence excess pattern
- 24. The exodeviation is at least 15PD greater at distance than near even after performing the patch test.
- 25. Exodeviation is equal at distance and at near. It is associated with both divergence excess and convergence insufficiency. Also known as mixed type exodeviation.
- 26. Near deviation is 15PD larger than distance deviation.
- 27. Distance deviation is 15 PD larger than near deviation. Initially Pt has esophoria, to overcome this pt does excessive effort to diverge This results to simulation of Exo Deviation
- 28. Exophoria: -eyestrain -headache -blurring of vision -difficulties with prolonged periods of reading Children with intermittent or constant exotropia: -less frequently symptomatic Adults with intermittent exotropia -commonly symptomatic Micropsia occurs in patients who uses accomodative convergence to control exodeviations.
- 29. 1.NON-SURGICAL: -Optical treatment -Prismotherapy -Orthoptic treatment: a.Antisuppression exercises b.Relative convergence exercise c.Occlusion 2.SURGICAL: -LR Recession(15D=4mm) -MR Resection(3-6mm depending upon size of deviation)