Management of Tropia Lecture Notes PDF

Management of tropia Lecture no (1) Syllabus:  Vision therapy  Lens therapy  Occlusion therapy  Prism therapy  Pharmacological therapy  Surgical treatment of strabismus  Non-surgical treatment of strabismus Vision therapy:  A plan used to correct specific dysfunctions of vision , including...

Management of tropia Lecture no (1) Syllabus:  Vision therapy  Lens therapy  Occlusion therapy  Prism therapy  Pharmacological therapy  Surgical treatment of strabismus  Non-surgical treatment of strabismus Vision therapy:  A plan used to correct specific dysfunctions of vision , including strabismus, accommodation anomalies, amblyopia, oculomotor functions and visual perceptions motor abilities  Training method aimed at improving visual functions , performance synonyms, orthoptics,eye training, and eye exercises Indications: Skipping of lines or words Confusion between certain words, or certain letters Inability to read Headaches Discomfort Poor attention Sitting very close to TV Diplopia Head tilt Examples of VT training:  Vergence training  Accommodation training  Eccentric fixation training  Ant suppression training  Amblyopia  ARC Vergence training: 1) Aperture rule training 2) Breads and strings 3) Chiastopic/free space fusion cards 4) Gross convergence activities 5) Pencil push-ups 6) 3 Dot cards 1) Aperture -rule training:  Used to train vergence skills  Single aperture ( chiastopic or crossed or BO fusion demand)  Double aperture ( orthopic or uncrossed or BI fusion demand) 2) Breads and strings: Uses the principle of physiological diplopia Used to improve sensory fusion , eliminate suppression Proper for home vision training Useful for intermittent strabismus, anisometropic amblyopia and hetrophoria White string 3m and 3 beads attached , green yellow and red Closer bead about 15 to 25 cm from the eye 3) Chiastopic-orthopic free space fusion card:  Used to train convergence and divergence ability  Three cats cards  Number of different cards are available  Eccentric circle card  (Colored circle card(red- green) with white or transparent background) 4) Gross convergence activities:  Used to teach voluntary convergence  Used with exotropic patient  Suitable for home vision training  Small toys or picture flash cards are randomly presented to the child at close working distance (10 to 15 cm) 5) Pencil push –ups:  Therapy procedure for physiological diplopia  Suitable as home training for all ages  Used in training patients with convergence insufficiency  Used in the initial training stages of convergence 6) 3-Dot card: Three sized dots (large,small,medium) Used with patients with exodeviations Card is 2.5 by 5.5 inch with three red dots on one side and 3 blue dots on the other side There is three size of dots, large medium and small The exercise is to fuse and blends the dots into single purplish dot Accommodative training: 1) Used to improve accommodative amplitude and facilities 2) All exercises are monocular so not influenced by Vergence , it includes: 3) Hart chart procedure 4) Lens flippers 5) Loose minus lens rock 1) Heart chart procedure: Consist of two charts , each block of 100 black letters printed on white background Large charts for distant fixation and smaller one for near Used ti improve accommodative amplitude by HC push up, and facility by changing fixation from distant to near One eye occluded, chart placed 40cm from the patient First done monocularly and then binocularly 2) Lens f lippers: Plus and minus lens flippers are used to produce rapid change in accommodative demand Lens flippers of equal accommodative power +5.00 to +2.50 are used Used to produce equality to monocular accommodative facility to the highest degree Patient wear his correction and fixate at reading chart Flippers introduced monocularly with minus lens and then with plus lens 3) Loose minus lens rock: Lens blank or trial is introduced into the patient`s open eye The patient reads the near print attempting to make it clear if it is blurred and then introduce the minus lens and try to make it clear again Rapid clearing of the print (1 to 2 second) without fatigue or discomfort is the goal The lens is - 2.50 done for distant and near Eccentric f ixation training: 1) Fast pointing exercise 2) Peg- Board games 3) Haidenger Brushes 4) Cupper`s pleoptic method 1) Fast pointing exercise:  Used to eliminate eccentric fixation and promote central fixation in amblyopic patients  Non amblyopic eye should be occluded  The test is useful for hand eye coordination  Need fixation targets with different sizes  The patient hold short thin stick at his 2) Peg –Board games: Used to promote central fixation in amblyopic eyes with eccentric fixation Need for page,colored pencil or pointer Instruct the patient to place the pegs(pencil) on the appropriate holes as quickly and accurately as possible with the amblyopic eye The other eye should be occluded 3) Haidenger Brushes: Visual phenomenon appears when the patient viewed rotating disc through deep blue filter Used to know if the patient has eccentric fixation or not, and to eliminate it if present Suitable for patients older than 8 years and the eccentric fixation not large Done with synptophore or macular integrity test trainer (MITT) 4) Cupper`s pleoptic method:  Used to eliminate eccentric fixation by re associating the principal visual direction with the fovea  Useful for cooperative patients above 7 years old  Useful for amblyopic with large eccentric fixation Anti-suppression training:  Single oblique mirror stereoscope  Pole mirror  Mirror superimposition 1) SOM:  Suitable for patients of all ages and types of suppression  Used to eliminate suppression and enhance sensor motor fusion by drawing method  Dominant eye fixating the picture and supressing eye fixate the drawing 2)Pole mirror:  Needs plane mirror and polarized spectacle  Useful for home vision training , patient as young as 3 years  Useful for all types of deviations 3) Mirror superimposition: Used to break down suppression and develop simultaneous perception Small hand held mirror TV screen Table lamp Useful for HVT with children younger as 4 years, and for strabismic patients with significant amount of suppression