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Motor evaluation
Sheela Evangeline K
Co ordinators:Ms. RizwanaMr. Kabilan
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Case 1
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Presentation Age: 8 months Complaint of inward deviation of eye
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History? Onset: birth Alternating Family history – mother Not ass with shaking of eye ball Activities normal Birth history: normal
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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
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What do you see?
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Diagnosis ?
Essential Infantile Esotropia
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Management?
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Case 2
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Presentation
Age : 5 years C/O inward deviation of eye
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History
Right eye – constant esotropia No CNS abnormalities Birth history : normal
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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
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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
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Diagnosis ?
Fully accommodative esotropia
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Management
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Partial accommodative esotropia
Left esotropia on accommodation.
Residual esotropia with hypermetropic correction.
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Case 3
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Presentation Age: 11 yr C/o outward deviation of left eye
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History Onset : 1 yr of age Constant
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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 ?
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What pattern you see ?
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Patch test
Distance deviation remains higher than near deviation
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Diagnosis
True divergence type Exotropia
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Management
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Case 4
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Presentation
Age: 9 years C/o outward deviation of right eye Left face turn Limited eye movements
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Evaluation
Limited abduction Retraction and narrowing of palpebral fissure
on adduction Widening on abduction Leash phenomenon present
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Diagnosis ?
Duane’s syndromeType 2
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Case 5
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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
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Evaluation
Vision: OD: 6/6 OS: 6/36
PBCT: 60 PD on first day 12 PD on second day
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Diagnosis ?
Cyclic Esotropia
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Management ?
A large recession of the left medial rectus and resection of the left lateral rectus
Safety glasses
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Case 6
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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
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Evaluation
What do you see ?
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Evaluation
Slit lamp examination : normal
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Fundus
Characteristic!
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Diagnosis ?
Bilateral superior oblique palsy
Which way would the images be tilted?
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Management
Surgery
Bilateral inferior rectus recession Medial rectus down shift Bilateral S.O. Harada-Ito Bilateral inferior oblique weakening
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Few more cases
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C/o squinting
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Diagnosis ?
Negative angle kappa
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C/o squinting
Vision OU: 6/6 Hirschberg: 15deg ET Cover test : ortho
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Diagnosis ?
Pseudo strabismus due to epicanthus
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Thank you