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Ophthalmology
Exotropia
Built from Strabismus Simplified, Second Edition
What’s inside
9 sections · 78 slides
Overview
- Scope of this presentation
Exodeviation defined
- Definition and causation of exodeviation
- Early-onset exotropia and neurological disease
- Large angle exotropia
Classification of exodeviations
- Classification of exodeviations
- Concomitant exodeviations
- Incomitant exodeviations
- Intermittent exotropia, manifest and controlled
- Duane's classification of exodeviations
- Simulated divergence excess
- Divergence excess exotropia
- Convergence insufficiency exotropia
- Classification by fusional reserve
- Burian and Kushner classifications compared
- Kushner's mechanism-based groups
Clinical presentation
- Essential infantile exotropia: the term essential
- Features of essential infantile exotropia
- Intermittent exotropia: definition and binocular status
- Symptoms of intermittent exotropia
- Photophobia and micropsia in exotropia
- Distance stereoacuity as an early marker
- Sensory exotropia
- Consecutive exotropia
Natural history and progression
- Natural history of intermittent divergent squint
- Determinants of fusional control
- Factors to be recorded for progression
- Calhounz phases of exodeviation
- Clinical significance of the Calhounz phases
Sensory adaptations in exotropia
- Amblyopia in exotropia
- Suppression and anomalous retinal correspondence
- Suppression scotoma and test dissociation
- Twin-point scotoma on the Polaroid scotometer
Magician's forceps phenomenon
- Reverse phase reflex
- Magician's forceps phenomenon
- Evidence that the reflex is proprioceptive
- Reverse phase reflex and magician's forceps phenomenon
Nonsurgical management
- Principles of nonsurgical treatment
- Nonsurgical options in intermittent exotropia
- Antisuppression exercises
- Relative convergence exercises
- Why convergence exercises fail
- Home convergence exercises
- Simple home orthoptic trainer
- Optical treatment with overcorrected concave lenses
- Prism therapy in exotropia
- Determinants of the need for surgery
Surgical management
- Indications for surgery: control and progression
- Indications for surgery: sensory status
- Surgery in Calhounz phase IV
- Timing of surgery: early versus delayed
- Newcastle score and individualised timing
- The Newcastle control score
- Factors determining the choice of surgery
- Two surgical options in exotropia
- Indications for symmetrical bilateral lateral rectus recession
- Exotropia with V-pattern
- Exotropia with A-pattern
- How much surgery: over- or under-correction
- Dosing in purely cosmetic adult cases
- Preoperative management: refractive correction
- Preoperative management: sensory preparation and measurement
- Postoperative counselling
- Management of consecutive esotropia after surgery
- Management of residual exotropia after surgery
- Criteria for excellent success
- Summary of key points in exotropia
- Summary of surgical principles
- Suggested reading
- Suggested reading (continued)
- Strabismus Simplified