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Strabismus is a condition in which the eyes do not properly align with each other when looking at an object. The eye that is focused on an object can alternate. The condition may be present occasionally or constantly. If present during a large part of childhood, it may result in amblyopia or lazy eyes and loss of depth perception. If onset is during adulthood, it is more likely to result in double vision.
An eye examination is a series of tests performed to assess vision and ability to focus on and discern objects. It also includes other tests and examinations pertaining to the eyes. Eye examinations are primarily performed by an optometrist, ophthalmologist, or an orthoptist. Health care professionals often recommend that all people should have periodic and thorough eye examinations as part of routine primary care, especially since many eye diseases are asymptomatic.
Pediatric ophthalmology is a sub-speciality of ophthalmology concerned with eye diseases, visual development, and vision care in children.
Vision therapy (VT), or behavioral optometry, is an umbrella term for alternative medicine treatments using eye exercises, based around the pseudoscientific claim that vision problems are the true underlying cause of learning disabilities, particularly in children. Vision therapy has not been shown to be effective using scientific studies, except for helping with convergence insufficiency. Most claims—for example that the therapy can address neurological, educational, and spatial difficulties—lack supporting evidence. Neither the American Academy of Pediatrics nor the American Academy of Ophthalmology support the use of vision therapy.
Sixth nerve palsy, or abducens nerve palsy, is a disorder associated with dysfunction of cranial nerve VI, which is responsible for causing contraction of the lateral rectus muscle to abduct the eye. The inability of an eye to turn outward, results in a convergent strabismus or esotropia of which the primary symptom is diplopia in which the two images appear side-by-side. Thus, the diplopia is horizontal and worse in the distance. Diplopia is also increased on looking to the affected side and is partly caused by overaction of the medial rectus on the unaffected side as it tries to provide the extra innervation to the affected lateral rectus. These two muscles are synergists or "yoke muscles" as both attempt to move the eye over to the left or right. The condition is commonly unilateral but can also occur bilaterally.
The Worth Four Light Test, also known as the Worth's Four Dot test or W4LT, is a clinical test mainly used for assessing a patient's degree of binocular vision and binocular single vision. Binocular vision involves an image being projected by each eye simultaneously into an area in space and being fused into a single image. The Worth Four Light Test is also used in detection of suppression of either the right or left eye. Suppression occurs during binocular vision when the brain does not process the information received from either of the eyes. This is a common adaptation to strabismus, amblyopia and aniseikonia.
Fixation disparity is a tendency of the eyes to drift in the direction of the heterophoria. While the heterophoria refers to a fusion-free vergence state, the fixation disparity refers to a small misalignment of the visual axes when both eyes are open in an observer with normal fusion and binocular vision. The misalignment may be vertical, horizontal or both. The misalignment is much smaller than that of strabismus. While strabismus prevents binocular vision, fixation disparity keeps binocular vision, however it may reduce a patient's level of stereopsis. A patient may or may not have fixation disparity and a patient may have a different fixation disparity at distance than near. Observers with a fixation disparity are more likely to report eye strain in demanding visual tasks; therefore, tests of fixation disparity belong to the diagnostic tools used by eye care professionals: remediation includes vision therapy, prism eye glasses, or visual ergonomics at the workplace.
In the fields of optometry and ophthalmology, the Hirschberg test, also Hirschberg corneal reflex test, is a screening test that can be used to assess whether a person has strabismus.
A cover test or cover-uncover test is an objective determination of the presence and amount of ocular deviation. It is typically performed by orthoptists, ophthalmologists and optometrists during eye examinations.
Strabismus surgery is surgery on the extraocular muscles to correct strabismus, the misalignment of the eyes. Strabismus surgery is a one-day procedure that is usually performed under general anesthesia most commonly by either a neuro- or pediatric ophthalmologist. The patient spends only a few hours in the hospital with minimal preoperative preparation. After surgery, the patient should expect soreness and redness but is generally free to return home.
Heterophoria is an eye condition in which the directions that the eyes are pointing at rest position, when not performing binocular fusion, are not the same as each other, or, "not straight". This condition can be esophoria, where the eyes tend to cross inward in the absence of fusion; exophoria, in which they diverge; or hyperphoria, in which one eye points up or down relative to the other. Phorias are known as 'latent squint' because the tendency of the eyes to deviate is kept latent by fusion. A person with two normal eyes has single vision (usually) because of the combined use of the sensory and motor systems. The motor system acts to point both eyes at the target of interest; any offset is detected visually. Heterophoria only occurs during dissociation of the left eye and right eye, when fusion of the eyes is absent. If you cover one eye you remove the sensory information about the eye's position in the orbit. Without this, there is no stimulus to binocular fusion, and the eye will move to a position of "rest". The difference between this position, and where it would be were the eye uncovered, is the heterophoria. The opposite of heterophoria, where the eyes are straight when relaxed and not fusing, is called orthophoria.
Dissociated vertical deviation (DVD) is an eye condition which occurs in association with a squint, typically infantile esotropia. The exact cause is unknown, although it is logical to assume it is from faulty innervation of eye muscles.
Cyclotropia is a form of strabismus in which, compared to the correct positioning of the eyes, there is a torsion of one eye about the eye's visual axis. Consequently, the visual fields of the two eyes appear tilted relative to each other. The corresponding latent condition – a condition in which torsion occurs only in the absence of appropriate visual stimuli – is called cyclophoria.
Botulinum toxin therapy of strabismus is a medical technique used sometimes in the management of strabismus, in which botulinum toxin is injected into selected extraocular muscles in order to reduce the misalignment of the eyes. The injection of the toxin to treat strabismus, reported upon in 1981, is considered to be the first ever use of botulinum toxin for therapeutic purposes. Today, the injection of botulinum toxin into the muscles that surround the eyes is one of the available options in the management of strabismus. Other options for strabismus management are vision therapy and occlusion therapy, corrective glasses and prism glasses, and strabismus surgery.
In ophthalmology, horror fusionis is a condition in which the eyes have an unsteady deviation, with the extraocular muscles performing spasm-like movements that continuously shift the eyes away from the position in which they would be directed to the same point in space, giving rise to diplopia. Even when the double vision images are made to nearly overlap using optical means such as prisms, the irregular movements prevent binocular fusion. The name horror fusionis arises from the notion that the brain is, or at least appears to be, actively preventing binocular fusion.
The prism cover test (PCT) is an objective measurement and the gold standard in measuring strabismus, i.e. ocular misalignment, or a deviation of the eye. It is used by ophthalmologists and orthoptists in order to measure the vertical and horizontal deviation and includes both manifest and latent components. Manifest is defined by the eye deviating constantly or intermittently, whereas latent is where the deviation is normally controlled but becomes present when the eyes are dissociated. A PCT reveals the total deviation and cannot distinguish between latent and manifest strabismus as you are using an alternate cover test.
Bagolini striated glasses test, or BSGT, is a subjective clinical test to detect the presence or extent of binocular functions and is generally performed by an optometrist or orthoptist or ophthalmologist. It is mainly used in strabismus clinics. Through this test, suppression, microtropia, diplopia and manifest deviations can be noted. However this test should always be used in conjunction with other clinical tests, such as Worth 4 dot test, Cover test, Prism cover test and Maddox rod to come to a diagnosis.
The prism fusion range (PFR) or fusional vergence amplitude is a clinical eye test performed by orthoptists, optometrists, and ophthalmologists to assess motor fusion, specifically the extent to which a patient can maintain binocular single vision (BSV) in the presence of increasing vergence demands. Motor fusion is largely accounted to amplitudes of fusional vergences and relative fusional vergences. Fusional vergence is the maximum vergence movement enabling BSV and the limit is at the point of diplopia. Relative fusional vergence is the maximum vergence movement enabling a patient to see a comfortable clear image and the limit is represented by the first point of blur. These motor fusion functions should fall within average values so that BSV can be comfortably achieved. Excessive stress on the vergence system or inability to converge or diverge adequately can lead to asthenopic symptoms, which generally result from decompensation of latent deviations (heterophoria) or loss of control of ocular misalignments. Motor anomalies can be managed in various ways, however, in order to commence treatment, motor fusion testing such as the PFR is required.
The management of strabismus may include the use of drugs or surgery to correct the strabismus. Agents used include paralytic agents such as botox used on extraocular muscles, topical autonomic nervous system agents to alter the refractive index in the eyes, and agents that act in the central nervous system to correct amblyopia.
Alan Brown Scott was an American ophthalmologist specializing in eye muscles and their disorders, such as strabismus. He is best known for his work in developing and manufacturing the drug that became known as Botox, research described as "groundbreaking" by the ASCRS.
References
- ↑ Christoff A, Guyton DL (2006). "The lancaster red-green test". Am Orthopt J. 56: 157–65. doi:10.3368/aoj.56.1.157. PMID 21149144.
- ↑ Kenneth Weston Wright; Peter H. Spiegel (January 2003). Pediatric Ophthalmology and Strabismus. Springer. p. 201. ISBN 978-0-387-95478-3 . Retrieved 23 July 2013.
- ↑ J.N. Hwang; D.L. Guyton (June 1999). "The Lancaster red-green test before and after occlusion in the evaluation of incomitant strabismus". Journal of AAPOS. 3 (3): 151–156. doi:10.1016/S1091-8531(99)70060-1. PMID 10428588.
- ↑ An Orderly Approach to Assessing Strabismus, eyetubeOD (downloaded 23 July 2013)
- ↑ Ahmed Awadein (April 2013). "A computerized version of the Lancaster red-green test". Journal of AAPOS. Vol. 17, no. 2. pp. 197–202.
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