Assignment

Is Strabismus

SUBMITTED BY: Tehreem Fatima

REGISTRATION #: OD 02181040
SUBMITTED TO: Sir Qazi Omair
TOPIC: HOW CAN TROPIA BE
DEFFERENTIATED FROM PHORIA

DEPARTMENT:
OPTOMETRY & VISION SCIENCES
(5th semester)

The University Of Lahore


HOW CAN TROPIA BE DEFFERENTIATED FROM PHORIA
Tropia
 A tropia is a misalignment of the two
eyes when a patient is looking with
both eyes uncovered.
 A tropia is always present
 Tropia is used to detect Manifest
Strabismus
 A tropia is a misalignment of the eyes
that is always present. Even when the
eyes are both open and trying to work
together, large angle misalignments
are apparent. A tropia is the resting
position that your eyes go to when
covered or when fusion is broken by
repetitively alternately covering each
eye.
 TROPIA Misalignment that is always
there, even when both eyes are open
and attempting to work together.
Large angle deviations are obvious. If
small angle, you can detect it with the
Cover-Uncover test.
 Types of tropia
 Exotropia
 Esotropia
 Hypertropia
 Hypotropia
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Phoria
 A phoria (or latent deviation) only
appears when binocular viewing is
broken and the two eyes are no
longer looking at the same object.
 Phorias are there some of the time
 Phoria is used to detect latent
Strabismus
 A phoria is a misalignment of the
eyes that only appears when
binocular viewing is broken and
the two eyes are no longer looking
at the same object. The
misalignment of the eyes starts to
appear when a person is tired,
therefore it is not present all of the
time.
 PHORIA Misalignment that only
occurs some of the time, such as
when the synch -ronization
between the eyes is broken by
covering one eye. You can "break
fusion" using the Cross-Cover test
 Types of phoria
 Exophoria
 Esophoria
 Hyperphoria
 Hypophoria

 Techniques
The single cover test is a test is used
to determine if there is a heterotropia
or tropia, which is a manifest
strabismus or misalignment that is
always present.
 Child fixates on a point (e.g. small
toy, penlight)
 Cover one eye
 Observe for movement of
uncovered eye
 Abnormal or positive test
suggests manifest strabsimus
(tropia)
 Cover other eye and repeat test
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 Techniques
The next test is a cover uncover
test.This is a that test is performed
to determine if there is a
heterophoria or phoria, which is a
latent strabismus or misalignment
that is only present when binocular
sion is suspended or interrupted.
 Child fixates on a point (e.g.
small toy, penlight)
 Cover one eye for 1-2 seconds
 Rapidly uncover the eye
 Observe for movement of
previously covered eye from a
deviated position back to fixation
on object
 Abnormal or positive test
suggests latent Strabismus
(phoria) 5. Cover other eye and
repeat test
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 Symptoms  Symptoms

 Diplopia (double vision)  Headaches.

 Decreased binocular vision (the
ability of the eyes to work together)
 Depth perception issues
 inward turning of the eyes
 crossing of the eyes
 lazy eye
 Sore eyes.
 Difficulty reading (especially in
children)
 Low reading comprehension.
 Dislike of reading.
 Issues with concentration.
 Double vision.
 Difficulty with tasks that are done
close in or near the eyes.

 Risk factors  Risk factors

 a family history of strabismus  General debility and lowered

 having another eye disorder, such vitality.
as cataracts or glaucoma  Mental stress.
 certain medical disorders, such as  Inadequacy of fusion reserve.
diabetes and overactive thyroid  Advancing age.
 neurological conditions, including  Precision jobs.
excessive fluid in the brain
 premature birth
 stroke

 Example
 Causes
 Exotropia occurs when there's an
imbalance in eye muscles or when
there's a signaling issue between
the brain and eye. Sometimes a
health condition, like cataracts or
stroke, can cause this to occur.
The condition may also be
inherited.
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 Example
 Causes
 Size and shape of globes.
 Abnormal strength or structure of
extraocular muscles.
 Volume of retro-bulbar tissue,
orbital fascias and ligaments.
 Anomalous central distribution of
the tonic innervations of eyes.
 Variation to the optical axis of the
eye.

 Treatment
The goal of treatment is to get the
eyes to align as much as possible
and improve vision. Treatments
include:
• Glasses:
Glasses that help correct near- or
farsightedness will help keep the eyes
aligned.
Patching:
People with exotropia tend to favor
the aligned eye, so vision in the eye
turned outward can weaken, resulting
in amblyopia (lazy eye). To improve
strength and vision in the misaligned
eye, some doctors will recommend
patching the "good" eye for up to
several hours a day to encourage you
to use the weaker eye.
Exercises:
Your doctor may suggest a variety of
eye exercises to improve focus.
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 Treatment
Medical therapy
 Optical
• Esophoria:
Full correction of the refractive error
is given to the patient when refraction
shows significant amount of
hypermetropia (+1.25 dioptres or
more).
Patients with high AC/A ratio and a
symptomatic esophoria without
hypermetropia may be treated with
miotics or bifocal glasses.
• Exophoria:
Patients without asthenopia do not
require any treatment.
 Orthoptics
This is the mainstay of treatment.
Patients with moderate degrees of
exophoria or esophoria who have fair
degree of binocular function, orthoptic
execises are the treatment of choice.
Patients with convergence
insufficiency are given convergence
exercises on synoptophore. Likewise,
patient with divergence insufficiency
are given divergence exercises.

 Surgical therapy:
• In some cases, your doctor may
also recommend surgery to
readjust eye muscles. The surgery
is done under general anesthesia
for a child and with a local
numbing agent for an adult.
Sometimes the surgery has to be
repeated.
• In adults, the surgery doesn't
usually improve eyesight. Instead,
an adult may choose to have the
surgery to make their eyes appear
straight.
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 Miotic drugs:
Miotic drugs may be useful in near
esophoria due to high AC/A ratio.
These facilitate peripheral
accommodation so that less than
normal innervation is required and
consequently less than normal
accommodative convergence occurs.
 Surgical therapy:
• This is indicated in patients with
intermittent exotropia who show
signs of worsening in the form of
Exotropia lasts for more than 50%
of the waking hours.
• There are symptoms of
asthenopia or diplopia. Patient
develops abnormal retinal
correspondence or suppression.
• There is decrease in stereo-acuity.
There is development of
secondary convergence
insufficiency. There is increase in
deviation.
Surgical procedures which may be
performed are
Bi-medial recession: Bi-medial
recession is done in cases of
convergence excess.
Bilateral resection: Bilateral resection
is done in cases of divergence
insufficiency.