Ophthalmology Book

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Strabismus

Aka: Strabismus
  1. See Also
    1. Amblyopia
    2. Anisometropia
    3. Congenital Cataract
    4. Cover Test
    5. Visual Fixation
    6. Pediatric Eye Exam
    7. Pinhole Test
  2. Epidemiology
    1. Accounts for 50% of Amblyopia (most common cause)
  3. Types
    1. Esodeviation (Cross-Eyed)
      1. Both eyes turn inward
      2. Accounts for >50% of ocular deviations in children
    2. Exodeviation (walleye)
      1. One eye turns outward while other eye faces forward
      2. Deviation most evident with distant vision
      3. Parents often note changes on a bright day
        1. Eye deviates outward
        2. Child closes one eye
    3. Fourth Cranial Nerve palsy (superior oblique palsy)
      1. Eye rises when Head Tilted to side of palsy
      2. Findings
        1. Hypertropia (deviating eye turns up)
        2. Hypotropia (deviating eye turns down)
  4. Signs: Screen at every well child check
    1. Test Specifically for Strabismus
      1. Only 50% children with Strabismus have obvious defect
  5. Signs: Organized by Strabismus type
    1. Manifest (Tropia): Strabismus that is always present
      1. Corneal Light Reflex
      2. Cover-Uncover exam
      3. Bruckner Test (Red Reflex)
      4. Fixation and following
    2. Intermittent Strabismus
      1. Healthy newborns develop alignment after age 4 weeks
      2. Intermittent exodeviation under 6 months
      3. Esodeviation much more likely to be pathologic
    3. Latent (Phoria): Present if binocular vision blocked
      1. Only found when specifically tested
      2. Cover-Uncover exam
  6. Signs: Small-Angle Strabismus (Accommodative esotropia)
    1. Identified with Cover Testing
    2. Seen in Farsighted toddlers
    3. Corrected with glasses or bifocals
    4. Abnormal use of accommodative convergence
      1. Normal reflex for near vision
      2. Farsighted children use convergence all the time
  7. Screening
    1. General
      1. See testing above
      2. Photoscreening (picture of eyes and Red Reflex)
        1. May be used in future for mass screening
    2. Timing
      1. Screen frequently in first 3 years of life
      2. Example protocol: 8, 12, 18, 25, 31, 37 months of age
      3. Early diagnosis results in best outcome
    3. References
      1. Williams (2002) BMJ 324: 1549-51 [PubMed]
  8. Diagnosis: Immediate Ophthalmology Consult Indications
    1. Manifest (constant) deviation in any age
    2. Intermittent Exodeviation >6 months
    3. Intermittent Esodeviation >2 months
  9. Diagnosis: Pitfalls - Pseudostrabismus
    1. Esotropia may be apparent despite normal alignment
    2. Iris appears to be surrounded by different white
    3. Illusion of different amount white on each side of iris
      1. Flat nasal bridge
      2. Large epicanthal folds
    4. Differentiate from Strabismus with proper testing
      1. See Strabismus signs above
    5. Refer to Ophthalmology for any question of misalignment
  10. Management: Early Consultation is critical
    1. Surgical Realignment of eyes
    2. Amblyopia treated prior to realignment surgery
  11. Prognosis for congenital esotropia
    1. Repair under age 1 year
      1. Offers best chance of near-normal binocular vision
    2. Repair over age 1 year
      1. Significantly worse prognosis for binocular vision
  12. References
    1. Berson (1987) Ophthalmology Study Guide, AAO, p. 95-110
    2. Essman (1992) Am Fam Physician 46(4):1243-52 [PubMed]
    3. Mills (1999) Am Fam Physician 60(3):907-16 [PubMed]
    4. Simon (2001) Am Fam Physician 64(4):623-8 [PubMed]

Strabismus (C0038379)

Definition (MSHCZE) Obecný pojem pro všechny formy šilhavosti (abnormální souhyb očních bulbů). Skryté, latentní šilhání se obecně nazývá heteroforie, manifestní šilhání heterotropie. Ezoforie (ezotropie) označuje konvergentní, sbíhavé šilhání, exoforie (exotropie) šilhání divergentní. Patognomicky se s. rozděluje na tři základní skupiny. Neparalytický (konkomitující) s. se vyskytuje nejčastěji, je typický u dětí. Paralytický s. je vždy způsoben kompletní nebo částečnou parézou příslušného okohybného nervu, která může být kongenitální nebo získaná (traumata, neuroinfekce, postvirové syndromy, cévní příčiny, systémové onemocnění aj.). Strabické syndromy zahrnují speciální, zvláštní typy s. nejč. způsobené strukturálními anomáliemi okohybných svalů. Šilhá jen jedno oko, popř. se oči střídají. Dvojitému vidění zabrání „vypnutí“ obrazu přicházejícího z odchylujícího se oka, které však může trvale slábnout (vzniká tupozrakost, amblyopie). Léčí se speciálními brýlemi (současně bývá obv. i refrakční vada), speciálními očními „cviky“ (tzv. ortoptika), někdy operativně. Léčit je nutné včas a důsledně. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) Strabismus is the intermittent or constant misalignment of an eye so that its line of vision is not pointed at the same object as the other eye. Strabismus is caused by an imbalance in the extraocular muscles which control the positioning of the eyes. Strabismus is normal in newborns but should resolve by the time the baby is 6 months old. In older children with strabismus, the brain may learn to ignore the input from one eye, and this may lead to amblyopia, a potentially permanent decrease in vision in that eye if not corrected.
Definition (MSH) Misalignment of the visual axes of the eyes. In comitant strabismus the degree of ocular misalignment does not vary with the direction of gaze. In noncomitant strabismus the degree of misalignment varies depending on direction of gaze or which eye is fixating on the target. (Miller, Walsh & Hoyt's Clinical Neuro-Ophthalmology, 4th ed, p641)
Concepts Disease or Syndrome (T047)
MSH D013285
ICD9 378.40, 378.30, 378.4
ICD10 H50.5, H50.9, H50.40, H50.50
SnomedCT 14619009, 155196009, 194107007, 194114009, 194116006, 246726008, 194137003, 267745004, 155192006, 22066006, 128602000
LNC MTHU013559
English Phorias, Squint, Strabismus, Phoria, Heterophoria, HETEROTROPIA, SQUINT, STRABISMUS, Disord binoc eye movem, Heterophoria, unspecified, Heterotropia, unspecified, Strabismus NOS, Strabismus, unspecified, strabismus, heterotropia (diagnosis), strabismus (diagnosis), heterotropia, squinting (symptom), squinting, heterophoria (diagnosis), heterophoria, Binocular eye movement disorder NOS, Unspecified disorder of binocular eye movements, Heterophoria NOS, Heterotropia NOS, Unspecified heterotropia, Unspecified heterophoria, Unspecified strabismus, Strabismus [Disease/Finding], eye deviation, crossed eye, Squinting, phoria, phorias, deviations eye, Unspecified heterotropia (disorder), Heterophoria NOS (disorder), Ocular dissociation (finding), Disorder of binocular eye movements (disorder), Strabismus NOS (disorder), Unspecified heterophoria (disorder), Eye deviation, Binocular eye movement disorder, Heterotropia, Disorder of binocular eye movements, Ocular dissociation, Heterotropia (disorder), Strabismus (disorder), eye; deviation, eye; movement disorder (binocular), Heterophoria, NOS, Heterotropia, NOS, Squint, NOS, Strabismus, NOS, squint
French STRABISME, Strabisme SAI, Hétérotropie, Anomalie non précisée des mouvements binoculaires, Anomalie des mouvements conjugués des yeux SAI, Hétérophorie, non précisée, Hétérotropie, non précisée, DEFAUT CONVERGENCE AXES VISUELS, Anomalie des mouvements conjugués des yeux, Hétérophorie, Strabisme, Phories
Portuguese ESTRABISMO, Estrabismo NE, Heterotropia NE, Alteração binocular dos movimentos do olho NE, Heteroforia NE, Heterotropia, Alteração dos movimentos binoculares do olho NE, HETEROTROPIA, PISCAR DE OLHOS, Estrabismo não Manifesto, Estrabismo Paralítico, Estrabismo Manifesto, Heteroforia, Alteração binocular dos movimentos do olho, Estrabismo, Forias, Vergo Estrabismo
Spanish ESTRABISMO, estrabismo latente, Estrabismo NEOM, Heteroforia no especificada, Heterotropía, Heterotropía no especificada, Trastorno de los movimientos binoculares de los ojos NEOM, Bizco, Trastorno no especificado de los movimientos binoculares de los ojos, HETEROTROPIA, heteroforia, SAI (trastorno), heteroforia, SAI, heterotropía no especificada, heteroforia no especificada (trastorno), heterotropía no especificada (trastorno), heteroforia no especificada, estrabismo, SAI, estrabismo, SAI (trastorno), Estrabismo no Manifesto, Estrabismo Paralítico, Estrabismo Manifesto, estrabismo (trastorno), estrabismo, heterotropía (trastorno), heterotropía, Heteroforia, Trastorno de los movimientos binoculares de los ojos, Estrabismo, Estrabismo Curvo, Foria
German STRABISMUS, unspezifische Stoerung der binokulaeren Augenbewegungen, Heterotropie, Heterophorie, unspezifisch, Heterotropie, unspezifisch, binokulaere Augenbewegungsstoerung NNB, Strabismus NNB, BEGLEITSCHIELEN, SCHIELEN, Strabismus, nicht naeher bezeichnet, Heterophorie, binokulaere Augenbewegungsstoerung, Phorie, Schielen, Strabismus
Italian Disturbo del movimento binoculare dell'occhio, Eteroforia, Disturbo del movimento binoculare dell'occhio NAS, Eteroforia, non specificata, Eterotropia, Disturbi non specificati dei movimenti binoculari dell'occhio, Eterotropia, non specificata, Strabismo NAS, Forie, Strabismo
Dutch scheelzien, heteroforie, niet-gespecificeerd, heterotropie, niet-gespecificeerde stoornis van binoculaire oogbeweging, niet-gespecificeerde heterotropie, binoculaire oogbewegingsafwijking NAO, strabismus NAO, Strabisme, oog; bewegingsstoornis (binoculair), oogstand; deviatie, Heteroforie, Strabismus, niet gespecificeerd, binoculaire oogbewegingsafwijking, heteroforie, strabismus, Strabismus, Scheelzien
Japanese 眼球斜位、詳細不明, 斜視、詳細不明, 両眼球運動障害NOS, 眼球斜位, 両眼球運動障害, 斜視NOS, 詳細不明の両眼の眼球運動の障害, ガンキュウシャイショウサイフメイ, リョウガンキュウウンドウショウガイ, シャシショウサイフメイ, ガンキュウシャイ, シャシ, シャシNOS, リョウガンキュウウンドウショウガイNOS, ショウサイフメイノリョウガンノガンキュウウンドウノショウガイ, やぶにらみ, 上斜位, 上斜視, 斜位(眼球), 斜視
Swedish Skelning
Czech šilhání, strabismus, Strabismus, Heterotropie, blíže neurčená, Heteroforie, blíže neurčená, Heteroforie, Šilhání, Binokulární okohybná porucha, Blíže neurčené binokulární okohybné poruchy, Binokulární okohybná porucha NOS, Heterotropie, Strabismus NOS, šilhavost
Finnish Karsastus
Russian KOSOGLAZIE, STRABIZM, КОСОГЛАЗИЕ, СТРАБИЗМ
Korean 상세불명의 사시, 사위
Croatian STRABIZAM
Polish Zez
Hungarian Heterophoria, Kancsalság, Heterotropia, nem meghatározott, Binocularis szemmozgás-betegség, Binocularis szemmozgás zavar k.m.n., Heterophoria, nem meghatározott, Heterotropia, Strabismus k.m.n., Nem meghatározott binocularis szemmozgás zavar
Norwegian Skjeling, Strabisme, Fori
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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