ABNORMAL EYE POSITION

TOPICS
1. Ocular Motility and Inervation 2. Strabismus 3. Enophtalmus and Exophtalmus

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.

2. Strabismus

2. Strabismus
Strabismus is defined as deviation of an eyes visual axis from its normal position There are two major types of manifest strabismus :
concomitant (nonparalytic) incomitant (paralyticor restrictive)strabismus

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 5.3 7.4 % of all children are affected. In 60 70 % of all cases, the disorder initially manifests it self within the first two years of life.

Pathophysiology
Deviation of the visual axis of the deviating eye causes objects to be projected to noncorresponding points on the retina One would expect these patients suffer from constant double vision because the left and right eyes supply different information to the brain

2.a. Concomitant Strabismus

Etiology :
Genetic factors Uncorrected refractive errors Insufficient fusion Unilateral visual impairment Others possible causes

2.a. Concomitant Strabismus

Forms: Esotropia: Inward deviation of the visual axis. Exotropia: Outward deviation of the visual axis. Hypertropia and hypotropia: Ocular deviation with one eye higher orlower than the other. Cyclotropia: This refers to the rotation of one eye around its visual axis.

2.a. Concomitant Strabismus

Symptoms: Crossed eyes Double vision (diplopia) Eyes that do not align in the same direction Uncoordinated eye movements (eyes do not move together) Vision loss in one eye

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 mechanically restricted

2.b. Incomitant Strabismus

Etiology
serious neurologic disorder, such as third cranial nerve paresis orbital disease or trauma, such as the restrictive ophthalmopathy of thyroid disease

2.c. Examination & Diagnosis

General Inspection Corneal Light Reflex (Hischberg Reflex) Cover and Uncover Test

2.c. Examination & Diagnosis

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 fieldsindicating concomitant strabismus-or is significantly different in one field of gazeindicating a possible incomitant strabismus.

Corneal Light Reflex

2.c. Examination & Diagnosis

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

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

3. Enophtalmus
3.a. Definition

A backward displacement of the eyeball into the orbit

3. Enophtalmus
3.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

4. Exophtalmos

4.a. Definition Exophthalmos is a bulging of the eye anteriorly out of the orbit

4. Exophtalmos
4.b. Causes Graves disease (most frequent cause) Inflammatory orbital disorders Vascular orbital disorders Orbital tumors (slowly progressive) Developmental anomalies

4.c. Treatment

Surgical

THANKS