Non-Surgical Management Of Squint

Dr Anumeha

It comprises of:
Optical correction Orthoptic treatment Medical treatment

Optical correction:
By

Refraction and proper prescription of glasses Use of prisms

It

Provides sharp, well focused and fused images Corrects and maintains accomodation and convergence mechanisms

A) Proper cycloplegia : to assess correct

refractive status. By Fully relaxing accomodation using atropine 1% ointment B) Proper prescription: by retinoscopy giving full correction. Regular 6 months checkups for vision and annual retinoscopy

C) Use of bifocals: in high AC/A ratios bifocals

are required with additional near adds Min add required is tested in steps of 0.5D till the convergence excess for near is controlled.

D) Use of over minus glasses: in cases if

intermittent exotropia in under 5yrs old children. Uses accomodative convergence for controlling exodeviation. For convergence insufficiency type of exotropia inverse bifocal with minus for near is required.

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

Combating suppression by anti-suppression exercises

Basic principle is to bring the fovea out of suppression by diff stimulations types Some methods are: A) Red filter: over dominant eye. B) Cheiroscope C) Pigeon-cantinnet stereoscope D) synaptophores

Treatment of amblyopia: Diff modalities are:

Occlusion Penalization Pleoptics Red filter T/t Cam vision stimulation Active vision therapy Medical T/t

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

Part time : diff waking hours of the day on basis

of age of child Follow up : Occlusion course is indicative till vision keeps improving or the vision doesnt improve on two consecutive monthly visits which is termed occlusion failure.

Penalization
Optical: over correct with plus glasses Pharmacological: using cycloplegics Partial also termed as distance and near penalization

Pleoptics therapy Red filter treatment Fusional exercises

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

o Levodopa-carbidopa: facilitate neurotransmission at o Botulinum toxin A chemodenervation:

As inj in EOM made under EMG control.injected at the junction of ant 2/3 and post 1/3,a crackling sound is heard which quietens the moment the whole dose is injected. Effect starts immediately and peak action is in 5-7 days and duration varies from 2-4 months

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