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2011-2012 Basic and Clinical Science Course, Section 6: by Edward L. Raab, MD, JD

By Edward L. Raab, MD, JD

Examines the medical good points, prognosis and remedy of esodeviations and exodeviations, horizontal and vertical deviations, amblyopia and detailed different types of strabismus. Discusses the total variety of pediatric ocular problems, extraocular muscle anatomy, motor and sensory body structure and the way to set up rapport with teenagers in the course of an ocular exam. includes a number of pictures, together with colour photographs. lately revised 2010 2011.

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Additional info for 2011-2012 Basic and Clinical Science Course, Section 6: Pediatric Ophthalomology and Strabismus (Basic & Clinical Science Course)

Example text

The alignment of the eyes under complete muscle paralysis is divergent. Therefore. convergence tone is necessary in th e awake state to mainta in straight eyes even in the absence of strabismus. CHA PTER 3, Motor Physiology. 37 Accommodative convergence of the visual axes Part of the syn kinetic near reflex. A fairl y consistent inc rem ent of accommodati ve co nve rgence (AC) occurs for each diopter of accommodation (A), giving th e accommodative cO l1vergence/accommodation (AG/A) ra tio. Abno rm alities o f this ratio are commo n, an d they are an important cause of strabismus.

The term yoke muscles is used to describe 2 muscles (I in each eye) that are th e prime movers of the ir respective eyes in a given position of gaze. For example. when the eyes move or attempt to move into right gaze, the right lateral rectus muscle and the left medial rectus mllscle are Simultaneously inn ervated and contracted. These muscles are said to be "yoked" together. Each ex traocular muscle in I eye has a yoke muscle in the other eye. le to eye movement. See Figure 3-2, which shows the 6 ca rdinal positions of gaze and the yoke muscles whose primary actions are in that field of gaze.

Inferior shifts of the lateral rectus pulley in adduction can produce a restrictive hypotropia closely resembling Brown syndrome. or they can produce an X-pattern exotropia. 24 • Pediatric Ophthalmology and Strabi sm us Another recogni zed pathologic state of the pulley system is pulley hil1dral1ce, in which normal posterior shift with extraocular muscle contract io n is mechanically impeded. Intentionall y created hindrance can be therapeutic, however. The fadenoperat ion, or posterior fixa ti on of an extraocular muscle through the und erlying sclera, was designed to red uce an extraocular muscle's effect in its fi eld of actio n by redu cing the extraocular muscle's arc of con tact and its rotational lever arm.

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