DiplopiaandBinocularVisionDisordersGraphics课程.pptVIP

Diplopia and Binocular Vision Disorders: Is it Neurologic or is it Strabismic? T. Otis Paul, M.D. California Pacific Medical Center San Francisco, California When the eyes are not aligned Definition: Neurologic Vs. Strabismic What if the patient does not have diplopia? Visual confusion Vs. diplopia Organization of the diplopia work-up Pearls about the physical exam not mentioned in the textbook Conditions which appear neurologic but are secondary to a strabismic disorder A. Sensory Disorders Afferent pupillary defect and amblyopia Nystagmus types associated with strabismus Fixation switch diplopia Conditions continued... B. Motility Disorders 1. Esodeviations a. Congenital Esotropia b. Duane syndrome c. Moebius syndrome d. Cyclic Esotropia e. Accommodative Esotropia f. Decompensated Phorias g. Acquired restrictive causes post pterygium, post medial wall fracture, thyroid h. Convergence spasm Infantile Esotropia Duane Syndrome Moebius Syndrome Moebius Syndrome Accommodative Esotropia Pterygium Surgery Conditions continued... 2. Exodeviations: a. Intermittent Exotropia becoming constant b. Consecutive Exotropia c. Congenital fibrosis syndrome d. Post cataract e. Duane syndrome, Type 2 f. Convergence insufficiency Intermittent Exotropia Consecutive Exotropia Duane Syndrome II Conditions continued... 3. Vertical Deviations a. DVD b. Overactive obliques c. Brown’s syndrome d. Elevator palsy e. Congenital IVth nerve palsy f. Post cataract g. Blow-out fracture h. Thyroid DVD Oblique Overaction Brown Syndrome Blow-Out Fracture Thyroid Eye Disease Conditions which appear strabismic but are secondary to a neurologic disorder A. Sensory Disorders 1. Visual loss incorrectly attributed to amblyopia 2. Nystagmus incorrectly attributed to strabismus 3. Acquired loss of fusion Conditions continued... B. Motility Disorders 1. Esodeviations a. Acquired Esotropia in children due to a posterior fossa lesion b. Bilateral mil