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Dr Anumeha
It comprises of:
Optical correction Orthoptic treatment Medical treatment
Optical correction:
By
Provides sharp, well focused and fused images Corrects and maintains accomodation and convergence mechanisms
Use of prisms
Advantage: In small angle deviations,residual or conservative deviation after surgery Small vertical deviations can also be managed.Usually upto 7-8pd prisms over each eye can be toleratedwith glass prism and with FRESNEL prisms upto 25-30pd Can be used in combined hori and vert deviations by using prisms rotated obliquely Used in fusional convergence insufficiency
Disadvantages:
Undesirable optical aberrations Deterioration of quality of vision Glasses become heavy Plastic and Fresnel prisms not available easily and are expensive.
Orthoptic treatment: Indications: Combating suppression Improvong fusional vergences and establishing stereopsis T/t of amblyopia Managing ARC
Types of occlusions: Total Partial Part/ full time Maintenance Total occlusion: by
Direct skinpatch Spectacle patch Doynes occluder Pirate patch Contact lenses
Partial occlusion:
This degrades vision of the normal eye so that amblyopic eye has the advantage.here layers of transparent tapes are used on back surface og glasses over the dominant eye.
Period of occlusion:
Full time- for 2days/week upto 2 yrs old 3 days/week upto 3 yrs old 4 days/week upto 4 yrs old 5 days/week upto 5 yrs old 6 days/week for 6 yrs old n above This is alternatedwith one day of occluding amblyopic eye when dominant eye is opened
Penalization
Optical: over correct with plus glasses Pharmacological: using cycloplegics Partial also termed as distance and near penalization
Medical treatment
o Miotics in accommodative esotropia: reduction of the
accommodative effort and as increase in depth of focus.best temporary modality in children who r too small to wear glasses synapsespresent in retina and visual cortex
Uses: in abducens palsy when early inj in MR prevents its contracture Transposition surgery:when vertical mus r transposed the horizontal mus are weakened by botox In nystagmus as retrobulbar injection Blepharospasms and hemifacial spasms Infentile esotropia, if alligned before 6 month have good binacularity Complications: Ptosis Paralysis of adjacent muscles causing vertical diplopia Dry eyes,reduced lacrimation ,foreign body sensation Pupillary dilatation ,accommodational paresis