Exodeviations , Exotropia
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Transcript of Exodeviations , Exotropia
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By: JenilSisiraGopika
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Exo –
visual axis is deviated laterally and fovea
rotated nasally
Exodeviations = divergent strabismus
latent manifest(controlled by fusion) - intermittent or constant
- unilateral or alternating
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Appearance of exodeviations◦ wide interpupillary distance
◦ large positive angle kappa- hyperopia, ROP
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Idiopathic
Proposed causes are:
◦ Excessive tonic divergence
◦ Anatomical and mechanical factors within the orbit
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A. COMITANT
Primary
Infantile exotropia
Intermittent exotropia
Secondary
Sensory exotropia
Consecutive exotropia
B. Incomitant
Paralytic
Restrictive
Musculofascial innervational anomalies
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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
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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)
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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
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Formerly esotropic patient
Either spontaneously or after surgical overcorrection
Treatment:
◦ Correction of refractive error if present
◦ surgery(cosmetic)
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3rd nerve palsy
Internuclear ophthalmoplegia(INO)
Ocular myasthenia
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2nd Row
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Dysthyroid orbitomyopathy
Fibrosis secondary to orbital trauma and orbital surgery
Parasitic cyst
Orbital tumours
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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
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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)
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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.
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Merely a descriptive classification
1. Divergence excess pattern
2. Basic exodeviation
3. Convergence insufficiency pattern
4. Simulated divergence excess pattern
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The exodeviation is at least 15PD greater at
distance than near even after performing the patch
test.
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Exodeviation is equal at distance and at near.
It is associated with both divergence excess and
convergence insufficiency.
Also known as mixed type exodeviation.
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Near deviation is 15PD larger than distance deviation.
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Distance deviation is 15 PD larger than near deviation.
Initially Pt has esophoria, to overcome this ptdoes excessive effort to diverge
This results to simulation of Exo Deviation
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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.
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1.NON-SURGICAL:
-Optical treatment-Prismotherapy-Orthoptic treatment:
a.Antisuppression exercisesb.Relative convergence exercisec.Occlusion
2.SURGICAL:
-LR Recession(15D=4mm)-MR Resection(3-6mm depending upon size of deviation)
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