By Edward L. Raab, MD, JD
Examines the scientific gains, prognosis and remedy of esodeviations and exodeviations, horizontal and vertical deviations, amblyopia and designated sorts of strabismus. Discusses the complete variety of pediatric ocular issues, extraocular muscle anatomy, motor and sensory body structure and the way to set up rapport with young ones in the course of an ocular exam. comprises a variety of pictures, together with colour photographs. lately revised 2010 2011.
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Extra resources for 2011-2012 Basic and Clinical Science Course, Section 6: Pediatric Ophthalomology and Strabismus (Basic & Clinical Science Course)
F. Fixation point; FL and FR, left and right foveas, respectively. Point 2, fa lling within Panum's area, is seen singly and stereoscopically. Point 3 falls outside Panum's area and is therefore seen double, Figure 4-1 all points lying on the horopter curve stimulate corresponding retinal elements and thus are seen singly. All points not lying on the horopter fall on disparate retinal elements and would therefore be expected to create double vis ion. However, double vision does not occur physiologically within a limited area surrounding the horopter curve because the visual system fuses the 2 disparate retinal images, resulting in single binocular vision with stereopsis.
A, With right paretic eye fixating, little or no vertical difference appears between the 2 eyes in the right (uninvolvedl field of gaze (1 and 41. In primary position (31. a left hypotropia may be present because the right eleva tors require less innervation and thus the left elevators will receive less than normal innervation. When gaze is up and left (21. the RIO needs less than normal innervation to elevate the right eye because Its antagonist. the RSO, IS paretic. Consequently. its yoke. the LSR.
Patients answer: Horizontal [eliminating all but the medial and lateral recti]. 2. Is the diplopia worse at distance or at near? Patients answer: Distance [implicating the lateral recti, which act more at distance viewing than in convergence]. 3. Is the diplopia worse on looki ng to the left or to the right? Patient's answer: Looking to the left [the field of action of the left lateral rectus]. Table 3· ' Action of the Extraocular Muscles from Primary Position Muscle* Primary Secondary Tertiary Medial rectus Lateral rectus Inferior rectus Superior rectus Inferior oblique Superior oblique Adduction Abduction Depression Elevation Extorsion Intorsion Extorsion Intorsion Elevation Depression Adduction Adduction Abduction Abduction * The superior muscles are intortors; the inferior muscles, extortors.