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Chapter-37 Management of Paralytic Squint

BOOK TITLE: Surgical Techniques in Ophthalmology (Pediatric Ophthalmic Surgery)

Author
1. Saxena Rohit
2. Sinha Ankur
3. Phuljhele Swati
ISBN
9789350251485
DOI
10.5005/jp/books/11282_37
Edition
1/e
Publishing Year
2011
Pages
12
Author Affiliations
1. RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
2. Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India, Dr RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, India, Strabismology, Glaucoma and Neurophthalmology Services Dr RP Centre for Ophthalmic Sciences AIIMS, New Delhi, Strabismology, Glaucoma and Neuropthalmology Services, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi-110 029, India, Dr RP Center for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, India, Centre for Sight, B-5/24, Safdarjung Enclave (Opp. Deer Park), New Delhi-110029, India
3. RP Centre for Ophthalmic Sciences, All India Institute for Medical Sciences, New Delhi, India, Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Dr RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, India, Dr RP Centre for Ophthalmic Sciences AIIMS, Ansari Nagar New Delh, Dr RP Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, India, RP Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, India, Dr RP Centre for Ophthalmic, Sciences, AIIMS, Ansari Nagar, New Delhi, India, Dr RP Centre for Ophthalmic, Sciences (AIIMS), Ansari Nagar, New Delhi, India, Dr RP Centre for Ophthalmic, Sciences (AIIMS), Ansari Nagar, New Delhi (India), Dr RP Centre for Ophthalmic, Sciences, AIIMS, Ansari Nagar, New Delhi, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
Chapter keywords

Abstract

Paralytic strabismus is the only subset of strabismus with possible ominous implications particularly in acquired case. The paralytic squint can be classified into neurogenic, myogenic and neuromuscular junction disease. The clinical features are diplopia, head posture, limitation of movement, incomitance in amount of deviation, associated neurological features. Congenital cranial nerve palsy does not require any specific investigation apart from routine work-up for paralytic cases. In cases of acquired paralytic strabismus, the management can be divided into two parts. During the acute phase of the disease the aim is to overcome the problem of diplopia till the deviation stabilizes and surgery can be performed. The primary aim of all surgeries for paralytic strabismus is to increase the area of binocular single vision and reduce diplopia, particularly so in primary and down gazes. The aim of surgery in cases of complete external third nerve palsy is to align affected eye in primary position, though ocular movements cannot be restored. The management of each patient varies according to differences in the extent of paresis and recovery. Knapp’s classification and management protocol is one of the important landmarks in management of cases of fourth nerve palsy. In the sixth nerve palsy the surgical decision is based upon the amount of abduction possible, amount of deviation in the primary gaze, muscle power of lateral rectus on active force generation test and contracture of medial rectus as on forced duction test.

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