Strabismus and Brückner Test

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What is the Krimsky method used for in cases where one eye is blind?

To center the corneal reflex in the blind eye

How does a synoptophore help measure squint?

By determining the position of the visual axes and optic axes

What does it mean if the deviation is different when both eyes fixate objects simultaneously compared to when each eye is used separately?

Abnormal correspondence

Explain how the Krimsky method is implemented in practice.

By placing increasing strengths of prisms in front of the seeing eye until the corneal reflex is centered in the blind eye Signup and view all the answers

What is the main principle behind the synoptophore?

Binocular viewing to determine fusion ability Signup and view all the answers

How are the visual axes and optic axes determined using a synoptophore?

By centering the corneal reflexes on the pupil Signup and view all the answers

What surgical approach is recommended for patients with 'A' esotropia in the absence of vertical muscle anomaly?

Resection of the lateral recti with displacement of the insertions downwards. Signup and view all the answers

How should 'A' esotropia associated with convergence excess be managed surgically?

Recession of the medial recti with shifting of the insertions upwards. Signup and view all the answers

What surgical intervention may be effective for large degrees of esotropia in small children with gross overaction of the superior obliques?

Bilateral weakening of the superior obliques. Signup and view all the answers

What is the recommended management for intermittent exotropia with convergence insufficiency?

Bilateral anteroposition of the lateral rectus muscles with recession of the medial rectus muscles. Signup and view all the answers

How can divergence excess type exotropia be managed surgically?

Anteroposition of the lateral rectus muscles. Signup and view all the answers

What is the basic type of exotropia according to Duane's classification?

Exotropic at near and distance fixation. Signup and view all the answers

What surgical approach is recommended for smaller degrees of 'A' exotropia?

Resection of the medial recti with elevation of the insertions Signup and view all the answers

How can large degrees of 'A' exotropia in small children with overaction of the superior obliques be treated?

Bilateral weakening of the superior obliques Signup and view all the answers

What surgical technique is effective for 'V' esotropia in the absence of vertical muscle anomaly?

Recession of the medial recti with displacement of the insertions downwards Signup and view all the answers

If overaction of the inferior obliques is present in 'V' esotropia, what surgical approach is recommended?

Bilateral anteroposition of the muscle Signup and view all the answers

What are the features of microtropia?

Small esotropia of less than 10 prism dioptres, minor/moderate amblyopia, eccentric fixation, harmonious anomalous retinal correspondence Signup and view all the answers

How can microtropia be detected when the cover test is not reliable?

Using a prism of 4 dioptres to demonstrate a small scotoma Signup and view all the answers

What is the purpose of the Brückner test in detecting small-angle strabismus?

To illuminate both eyes simultaneously and observe the fundus reflexes. Signup and view all the answers

How can you differentiate between an orthotropic patient and a patient with strabismus using fundus reflexes?

In an orthotropic patient, the fundus reflex is equal in both eyes, whereas in a patient with strabismus, the fundus reflex of the fixing eye is darker. Signup and view all the answers

What is the significance of the difference in brightness in determining the presence of strabismus?

The difference in brightness is more important than the difference in color. Signup and view all the answers

How can the cover test help determine the characteristics of a squint?

The cover test can help determine if the squint is latent or manifest, intermittent or constant, alternating or unilateral, convergent or divergent, comitant or incomitant. Signup and view all the answers

What is the key observation in an apparent squint during the cover test?

There is no restitutional movement when either eye is covered and then uncovered. Signup and view all the answers

Describe how the Brückner test is conducted to detect small-angle strabismus.

The examiner shines a wide beam of light from a direct ophthalmoscope onto the patient's eyes to compare fundus reflexes. Signup and view all the answers

What sutures are used for passing through the upper and lower edges of the muscle in the 'whip-stitch' fashion?

Absorbable 5-0 or 6-0 vicryl sutures Signup and view all the answers

In strabismus surgery, where are the vicryl sutures passed after tying them following muscle manipulation?

The conjunctival incision Signup and view all the answers

How is the muscle resection clamp used in the resection of a rectus muscle?

To hold the distal part of the muscle during cutting Signup and view all the answers

Where is the incision made for resection of a rectus muscle, relative to the corneoscleral junction?

2 mm behind and concentric with the corneoscleral junction Signup and view all the answers

What is the purpose of passing whip-stitch sutures through the upper and lower edges of the muscle during resection?

To ensnare a breadth of about 2 mm of the muscle fibers Signup and view all the answers

What is the technique used to determine and mark the length of muscle and tendon for resection?

Using a strabismus hook passed between the muscle and sclera Signup and view all the answers