exodeviation, intermittent exotropia by Dr. Khalil Al-Salem скачать в хорошем качестве

exodeviation, intermittent exotropia by Dr. Khalil Al-Salem

Now we will be talking about our second case 5 years old, Ahmad coming with his parents, complaining of eye deviation while in terms of visual inattention or when he is daydreaming and the thing is getting a little worse with time. So, on examination, as you can see his right eye is a little bit deviated outward, while he is looking with his left eye. Now let’s do our regular H test first, as you can see his ocular motility looks fine except for a very mild, let’s say adduction deficit in his right eye while things look fine. okay so let’s go back to the cover uncover testing, so this is the cover, the first thing we do is cover the right eye and see if there is any difference, so as you can see while doing the cover uncover test for the right eye there is no movement. let’s do the cover uncover test for the left eye, once we covered the left eye, the right eye took a fixation, while the left eye went outward with a comparable and equal amount of deviation between the right and left eye so, this is called comitant squint, comitant exotropia, comitant outward deviation of the eye commitment means the angle of the right eye and the left eye is the same so why do we do the cover uncover testing? there are three main important objectives that we do the cover uncover testing for: 1-to identify the direction of squint whether there is exotropia (hyper or hypo). 2-the amount of deviation in which we use a prism, either at the same side of the contralateral side of the cover in order to detect the amount of deviation. 3-the preference, the eye preference, whether the patient is always fixing with his right eye, fixing with his left eye or alternating between both eyes. So, lets but the prism now, and always when you but the prism, the apex should be directed always towards the side of deviation, so in this example, the base should be inward and the apex should be outward. Let's go again, once I move the cover, left eye took fixation and the right eye went outward so I have to increase little bit my prismatic power and try to see if I still have some movement and yes I still have some movement here, so I have to increase the prismatic power little bit now, I have 25 prism diopters, and now I’m covering the patient’s left eye and then uncover, so as you can see there is no movement, let’s try to increase little bit the prismatic power and as you can see here the eyes now are going inward so I’m over-squinting my patient so I’m going back to 25 prism diopters, and it’s the total amount of exodeviation the patient has, 25 prism diopters.