Heroin and diplopia

Aims: To describe the eye misalignments that occur during heroin use and heroin detoxification and to give an overview of the management of persisting diplopia (double vision) which results from eye misalignment. Methods: A literature review using Medline and the search terms strabismus, heroin and substance withdrawal syndrome is presented. General management of cases presenting to the ophthalmologist and orthoptist with acute acquired concomitant esotropia is described. Findings: A tendency towards a divergence of the visual axes appears to be present in heroin users, although when present it may not always lead to diplopia. Following detoxification intermittent esotropia or constant esotropia (convergence of the visual axes) can occur; if intermittent the angle tends to be small and diplopia present when viewing distance objects. Occlusion of one eye to eliminate the second image could encourage the development of a constant deviation. The deviation is not caused by a cranial nerve palsy. Constant deviations of this type are classified as 'acute acquired concomitant esotropia'. Relief from the diplopia may be gained by prismatic correction, and the deviation may then resolve spontaneously. Botulinum toxin or surgical intervention may be necessary in cases that do not resolve. Conclusions: Heroin use may lead to intermittent or constant exotropia and withdrawal may result in intermittent or constant esotropia. Awareness of the mechanism causing this may avoid referral to other specialties (e.g. neurology) and awareness of treatment modalities could encourage patients to seek appropriate help for relief of symptoms

Ocular screening tests of elementary school children

This report presents an analysis of 507 abnormal retinal reflex images taken of Huntsville kindergarten and first grade students. The retinal reflex images were obtained by using an MSFC-developed Generated Retinal Reflex Image System (GRRIS) photorefractor. The system uses a 35 mm camera with a telephoto lens with an electronic flash attachment. Slide images of the eyes were examined for abnormalities. Of a total of 1835 students screened for ocular abnormalities, 507 were found to have abnormal retinal reflexes. The types of ocular abnormalities detected were hyperopia, myopia, astigmatism, esotropia, exotropia, strabismus, and lens obstuctions. The report shows that the use of the photorefractor screening system is an effective low-cost means of screening school children for abnormalities

Prevalence and pattern of strabismus in primary school pupils in Benin City, Nigeria

Background: Strabismus is the most common amblyogenic factor and approximately 40% of children with manifest strabismus have amblyopia. In Nigeria, it is generally believed that strabismus is not common. However, few studies have been done to determine the prevalence of strabismus in Benin City, Edo State. Objective: This study aims to determine the prevalence and pattern of tropias and phorias in primary school children in Benin City.Methods: This was a cross-sectional study carried out on primary school pupils in government schools located within Egor Local Government Council Area, Edo State.Results: Two thousand one hundred and thirty-nine students (2139) were examined. There were 1024 males (47.87%) and 1115 females (52.13%). The overall prevalence of tropias in this study was 0.89%. Esotropia was seen in 0.56% (12 pupils, SE 0.03%) and exotropia in 0.33% (7 pupils, SE 0.02%) of the pupils. Infantile esotropia was the most common form of esotropia while alternating exotropia was the most common pattern of exotropia. 57.04% of the pupils had heterophoria.Conclusion: The prevalence of manifest strabismus in Benin City was low however there should be training of non-ophthalmic staff such as teachers to detect and refer cases of strabismus.Keywords: Children, Nigeria, pattern, prevalence, pupils, strabismu

Principles of Strabismus Surgery for Common Horizontal and Vertical Strabismus Types

Strabismus can be distressing to our patients, yet often challenging to treat even in experienced hands. The goal of this chapter is to clearly and concisely share with the reader strategies and strabismus surgical techniques in common horizontal and vertical strabismus, that will improve the care of our patients. We describe indications for strabismus surgery, how to plan for successful surgery results and do’s and don’ts regarding effective surgical procedures. This includes incision techniques, muscle tightening and weakening procedures and transposition surgery, for rectus as well as oblique muscles. Advice on how to avoid complications of strabismus surgery is also provided. The chapter is based on evidence-based medicine where available and consensus and/or common sense advice is provided where evidence-based medicine is not available. It is the intent of this chapter to be a practical, usable guide helpful for surgeons of diverse experience, from resident ophthalmologists to the expert strabismologist

Determination of the Correlation Between Types of Strabismus and Certain Medical Conditions

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.There are numerous subtypes of strabismus: esotropia where one eye deviates inward compared to the other, exotropia where one eye deviates outward compared to the other, hypertropia where one eyes is higher than the other, concomitant strabismus where the degree of deviation is the same in each gaze, incomitant strabismus where the degree of deviation varies in different gazes. Adult strabismus can be caused by various conditions including vasculopathic diseases (diabetes, hypertension, and stroke), compressive CNS lesions, myasthenia gravis, sensory strabismus, thyroid ophthalmopathy, multiple sclerosis, trauma, post-surgical strabismus, recurrent childhood strabismus, longstanding adult strabismus without proven cause, syndrome related strabismus, restrictive orbital masses, and congenital fibrosis of the extraocular muscles. It is currently unknown whether any of these underlying conditions correlate with a specific type of strabismus. The purpose of this study is to determine if underlying conditions correlate with a certain misalignment (i.e. esotropia, exotropia, hypertropia, concomitant, or incomitant). If there is a statistically significant correlation between a certain misalignment and systemic disease, this could add to the algorithm that physicians use to diagnose these systemic conditions. This was a retrospective review of 692 patients >=21 years of age who presented to a pediatric ophthalmologist with adult strabismus from September 2008 to September 2015. The inclusion criteria were: (1) an age of 21 years or older, (2) a confirmed diagnosis of new-onset or recurrent childhood strabismus, (3) any severity and type of deviation, and (4) documentation of diplopia in any field of gaze. The variables that were extracted from the files were: the type of misalignment (esotropia, exotropia, hypertropia, concomitant, incomitant) and the underlying disorder (vasculopathic diseases (diabetes, hypertension, and stroke), compressive central nervous system (CNS) lesions, myasthenia gravis, sensory strabismus, thyroid ophthalmopathy, multiple sclerosis, trauma, post-surgical strabismus, recurrent childhood strabismus, longstanding adult strabismus without proven cause, syndrome related strabismus, restrictive orbital mass caused strabismus, and congenital fibrosis). Interpretation of the data consisted of determining if a correlation between type of misalignment and underlying condition exists. The average age of the population is 60.5 years with a standard deviation of 16.9, of which 49.6% were male. Results of this study indicate that multiple conditions that cause strabismus have a proclivity to negatively or positively predict a certain type of strabismus. Specifically, post-surgical patients are more likely to have hypertropia than esotropia or exotropia, sensory strabismus patients are more likely to have exotropia. Adult patients with recurrent childhood strabismus are more likely to have exotropia and concomitancy. Compressive CNS lesions, thyroid ophthalmopathy, and traumatic causes of strabismus are more likely to cause incomitant strabismus. Vasculopathic causes of strabismus do not have a tendency to cause any certain type of strabismus. These findings will assist ophthalmologists in delineating a cause of their patient’s strabismus based on which types of strabismus correlate with certain conditions.This item is part of the College of Medicine - Phoenix Scholarly Projects 2019 collection. For more information, contact the Phoenix Biomedical Campus Library at [email protected]

Prevalence of strabismus and associated risk factors: the Sydney childhood eye studies

Knowledge of the natural history of strabismus and accurate estimates of prevalence are fundamental to the operation of effective vision screening and preventing vision loss in children. A comprehensive literature review of previous studies revealed there are systematic variations in the reported prevalence of strabismus dependent on population sampled and methodology used. It is recommended when establishing the prevalence of strabismus in a population that the gold standard should be cover test by an appropriately trained professional conducted on a population-based sample. Inclusion of previously diagnosed strabismus cases should also be reported when establishing the true prevalence of strabismus. From our own study of Sydney children we report the prevalence, risk factors and parental awareness of strabismus and its subtypes. We found that the risk factors for esotropia are different from exotropia. Esotropia was primarily associated with antenatal events. We confirm the strong association of strabismus with active maternal smoking during pregnancy. In contrast, exotropia was associated with indicators of low SES, such as no parental home ownership, low parental education and/or no parental employment. We conclude from our questioning of parents that parental awareness of strabismus and other significant ocular disorders is poor and cannot reliably replace vision screening. Almost two-thirds of children in our studies would go untreated without vision screening programmes at an early age. These children could suffer the permanent yet avoidable consequences of failure to achieve timely treatment into adulthood with increased risk of visual impairment, adding a powerful argument for the continuation of vision screening

Reoperation in Horizontal Strabismus and its Related Risk Factors

This study was performed to determine the surgical outcomes and the related risk factors of second operation in patients with residual horizontal deviations. In this interventional case series study, a total of 119 patients with a history of reoperation were included (39 exotropia and 80 esotropia). Cases with consecutive strabismus, muscular palsy, systemic disease, lack of ocular fixation, and those, who had vertical deviation and Dissociated Vertical Deviation (DVD)>5 Prism Diopters (pd) were excluded. Medial Rectus (MR) resection in residual Exotropia (XT) and Lateral Rectus (LR) resection in residual Esotropia (ET) were performed. Unilateral or bilateral operations were considered if the preoperative residual deviation was < 20 pd or > 20 pd, respectively. Success of the reoperation was considered if the postoperative angle of deviation was ≤ 10 pd. Unilateral and bilateral MR resection was performed in 26% and 74% of patients with XT, respectively, with greater dose response in unilateral cases (2.8 versus 2.6 mm/pd). Successful surgical outcomes were observed in 94.9% of patients with XT. Unilateral and bilateral LR resection was also performed in patients with residual ET, each in 50% of patients. Unilateral cases showed greater dose-response compared to bilateral ones (2.6 versus 2 mm/pd) and successful surgical outcomes were observed in 83.8% of patients with ET. No variable was found as a risk factor of reoperation in both groups. In conclusion, both LR and MR resection are easy and predictable surgical approaches with high success rate in patients with residual ET and XT. Generally, MR resection is more effective than LR resection. Unilateral operation is less recommended in the residual exotropic group, due to its lower success compared to the bilateral operation. Unfortunately, none of the mentioned variables were found to be the risk factor of reoperation in the sampled patients.Â

Strabismus in paediatric age (3-16 year): a clinical study

Background: Strabismus is a clinical condition in which the eyes are not aligned with each other properly. The main objective of the study was to study the prevalence, aetiology and the most common type of strabismus in children between 3- 16 years of age.Methods: This was a prospective study conducted from November 2012 to October 2014 at Government regional eye hospital Visakhapatnam. A total of 50 patients included in this study. Children between 3-16 years of age presenting with squint included in this study. All children below 3years and above 16 years excluded from this study. Detailed history regarding the complaint, birth history, developmental history was taken. Patients were thoroughly evaluated for Visual acuity, both distance and near vision with naked eye as well as best corrected visual acuity. Thorough anterior segment evaluation using slit lamp, cycloplegic refraction using atropine (7 years), fundus examination was don.Results: A total of 9678 children attended GREH during the period of the study. Among them total number of children with strabismus was 59.Thus the prevalence of strabismus is 0.6%. Children in the age group of 3-10 years of age are more involved 37 (62.7%).   Exotropia was seen in 34 cases and esotropia in 24 cases. Commitant esotropia was more common, seen in 16 (27.1%) of cases. In exotropia commitant exotropia was more common, seen in 32 cases and incommitant in 2 cases and divergence excess seen in 9 cases.  History of consanguinity present in 22% of cases.Conclusions: Prevalence of squint in children in 3 - 16 years age group was 0.6%. Commitant squint was more common than incommitant squint. Among commitant squint, exotropia was more common than esotropia. More research is needed to validate the role of consanguinity in strabismus.

Computer assisted strabismus/amblyopia diagnosis

Computer assisted strabismus/amblyopia diagnosi

Last Guidelines Overview of Consecutive Esotropia Management: Review Article

Background: Consecutive esotropia (ET) is persistent esodeviation for 24 weeks afterward bilateral lateral rectus recession (BLRR) for correcting exotropia (XT) with or without diplopia. Some patients may have limited eye movement; amblyopia and loss of binocularity can result. Early postoperative overcorrection has been recommended in surgical treatment of intermittent XT due to tendency towards postoperative exotropic drift. ET with small angles (within 15 PD) vanishes naturally over time, whereas bigger angles are more likely to be present at the start. Patients who have ET that has persisted for at least 24 weeks after BLRR and has been present for more than 15 postoperative days should have surgery. Objective: Hallmark the updated lines of management of consecutive esotropia. Conclusion: For the purpose of maintaining one MR muscle for a future intervention, several research have shown that ET can be performed consecutively after BLR recession by advancement of LR muscle previously recessed and MR muscle recession in the more deviating eye. Studies in recent years have sought to determine the effectiveness of the use of lateral rectus advancement in the treatment of consecutive ET