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Motor evaluation

Motor evaluation

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Motor evaluation

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  1. Motor evaluation Sheela Evangeline K Co ordinators: Ms. Rizwana Mr. Kabilan

  2. Case 1

  3. Presentation Age: 8 months Complaint of inward deviation of eye

  4. History? Onset: birth Alternating Family history – mother Not ass with shaking of eye ball Activities normal Birth history: normal

  5. 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

  6. What do you see?

  7. Diagnosis ? Essential Infantile Esotropia

  8. Management?

  9. Case 2

  10. Presentation • Age : 5 years • C/O inward deviation of eye

  11. History • Right eye – constant esotropia • No CNS abnormalities • Birth history : normal

  12. 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

  13. 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

  14. Diagnosis ? Fully accommodative esotropia

  15. Management

  16. Partial accommodative esotropia

  17. Case 3

  18. Presentation Age: 11 yr C/o outward deviation of left eye

  19. History Onset : 1 yr of age Constant

  20. 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 ?

  21. What pattern you see ?

  22. Patch test Distance deviation remains higher than near deviation

  23. Diagnosis True divergence type Exotropia

  24. Management

  25. Case 4

  26. Presentation • Age: 9 years • C/o outward deviation of right eye • Left face turn • Limited eye movements

  27. Evaluation • Limited abduction • Retraction and narrowing of palpebral fissure on adduction • Widening on abduction • Leash phenomenon present

  28. Diagnosis ? Duane’s syndrome Type 2

  29. Case 5

  30. 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

  31. Evaluation • Vision: • OD: 6/6 • OS: 6/36 • PBCT: • 60 PD on first day • 12 PD on second day

  32. Diagnosis ? Cyclic Esotropia

  33. Management ? • A large recession of the left medial rectus and resection of the left lateral rectus • Safety glasses

  34. Case 6

  35. 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

  36. Evaluation What do you see ?

  37. Evaluation • Slit lamp examination : normal