1. Sheela Evangeline K Co ordinators: Ms. Rizwana Mr. Kabilan
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. Essential Infantile Esotropia
Diagnosis ?
Essential Infantile Esotropia

9. Management?

11. Case 2

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

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

14. Evaluation Vision ( with Leas) PBCT: Comitant
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: /-0.50 × 180.
Slit lamp examination and fundus was normal

15. 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

17. Fully accommodative esotropia
Diagnosis ?
Fully accommodative esotropia

18. Management

20. Partial accommodative esotropia
                                                                                                                                                                                                                                                          
Left esotropia on accommodation.
Residual esotropia with hypermetropic correction.
Partial accommodative esotropia
Next Case of Paediatric Ophthalmology

21. Case 3

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

23. History
Onset : 1 yr of age
Constant

24. 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 ?

25.                  
What pattern you see ?

26. Distance deviation remains higher than near deviation
Patch test
Distance deviation remains higher than near deviation

27. True divergence type Exotropia
Diagnosis
True divergence type Exotropia

29. Management

31. Case 4

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

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

36. Diagnosis ?
Duane’s syndrome
Type 2

40. Case 5

41. 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

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

45. Diagnosis ?
Cyclic Esotropia

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

47. Case 6

48. 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

49. Evaluation
What do you see ?

50. Evaluation
Slit lamp examination : normal

51. Fundus
Characteristic!

53. Bilateral superior oblique palsy
Diagnosis ?
Bilateral superior oblique palsy
Which way would the images be tilted?  

55. Management Surgery Bilateral inferior rectus recession
Medial rectus down shift
Bilateral S.O. Harada-Ito
Bilateral inferior oblique weakening

57. Few more cases

58. C/o squinting

59. Diagnosis ?
Negative angle kappa

60. C/o squinting
Vision OU: 6/6
Hirschberg: 15deg ET
Cover test : ortho

61. Diagnosis ?
Pseudo strabismus due to epicanthus

62. Thank you