Esodeviations



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Clinical findings:


  • age of onset between 6 months and 4 years(usually at 18 months)

  • occasionally then one eye divergens patient close this eye in bright light

  • sometimes diplopia occurs

  • once suppression has been triggered by the eye drifting out

  • patients have a larger binocular peripheral visual field than normal people

  • typical cases have stereoacuity at near, this is where most patients control their deviation

Investigation:


  • assessment of vision, fusion and stereopsis

  • Hirschberg test at near and distance (Fig7,8)

  • cover-uncover test at near and distance

  • Maddox test

  • high AC/A can be diagnosed by the patch test

Differential diagnosis:


  • exophoria

  • congenital exotropia

  • convergens insufficiency

  • convergens paralysis

  • deprivation (sensory) exotropia

  • consecutive exotropia

Treatment:

Prognosis:


  • cosmetic success is often defined as a deviation less than 15PD

  • functional success is than a deviation less than 10PD with peripheral fusion

  • some patients may miss the panoramic visual field inherent in intermittent exotropia
Convergence insufficiency

Convergence weakness is a type of exotropia in which the deviation is only or greater at near than at distance.Fig.9.10.

Fig.9 Convergens insufficiency. Small exotropia in the distance.



Fig.10 Convergens insufficiency when child looking at near point the exotropia appears.



Clinical findings:
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