Clinical Orthoptics

Fiona J. Rowe is Lecturer in Orthoptics at the University of Liverpool and an Honorary Research Vision Scientist at the Department of Orthoptics and Ophthalmology, Warrington Hospital. Dr Rowe also lectures extensively to trainee and qualified ophthalmologists, ophthalmic nurses, and other members of the multi-disciplinary eye care team.

• Preface xiAcknowledgements xiiList of Figures xiiiList of Tables xviiSection I 11 Extraocular Muscle Anatomy and Innervation 3Muscle pulleys 3Ocular muscles 5Innervation 10Associated cranial nerves 12References 15Further reading 162 Binocular Single Vision 17Worth’s classification 17Development 17Retinal correspondence 19Physiology of stereopsis 20Fusion 23Retinal rivalry 24Suppression 24Diplopia 25References 27Further reading 283 Ocular Motility 29Saccadic system 29Smooth pursuit system 31Vergence system 33Vestibular-ocular response and optokinetic response 35Brainstem control 37Muscle sequelae 39Past-pointing 40Bell’s phenomenon 41References 41Further reading 434 Orthoptic Investigative Procedures 45Visual acuity 45Cover test 60Ocular motility 64Accommodation and convergence 68Retinal correspondence 73Fusion 77Stereopsis 82Suppression 89Synoptophore 91Aniseikonia 97Fixation 98Measurement of deviations 99Hess charts 105Field of binocular single vision 108Uniocular field of vision 110Measurement of torsion 111Parks-Helveston three-step test 113Diplopia charts 113Bielchowsky phenomenon (dark wedge test) 115Forced duction test 115Forced generation test 115Orthoptic exercises 115References 119Further reading 124Section II 1295 Heterophoria 131Classification 131Aetiology 131Causes of decompensation 132Esophoria 132Exophoria 132Hyperphoria/hypophoria 133Alternating hyperphoria 133Alternating hypophoria 133Cyclophoria 133Incomitant heterophoria 133Hemifield slide 133Investigation of heterophoria 134Management 135References 136Further reading 1376 Heterotropia 138Esotropia 138Factors necessary for development of binocular single vision 139Constant esotropia with an accommodative element 140Constant esotropia without an accommodative element 141Accommodative esotropia 146Relating to fixation distance 151Exotropia 155Hypertropia 168Hypotropia 168Cyclotropia 169Dissociated vertical deviation 170Dissociated horizontal deviation 172Quality of life 173Pseudostrabismus 174References 175Further reading 1847 Microtropia 189Terminology 189Classification 190Investigation 191Management 194References 194Further reading 1958 Amblyopia and Visual Impairment 197Classification 197Aetiology 197Investigation 198Management 199Eccentric fixation 205Cerebral visual impairment 205Delayed visual maturation 206PHACE syndrome 207References 207Further reading 2129 Aphakia 215Methods of correction 215Investigation 215Problems with unilateral aphakia 216Management 216References 218Further reading 219Section III 22110 Incomitant Strabismus 223Aetiology 223Aid to diagnosis 225Diplopia 226Abnormal head posture 227References 230Further reading 23111 A and V Patterns 232Classification 232Aetiology 232Investigation 236Management 238References 241Further reading 24312 Accommodation and Convergence Disorders 245Accommodative disorders 245Presbyopia – physiological 245Presbyopia – premature (non-physiological) 246Accommodative insufficiency 247Accommodative fatigue 248Accommodative paralysis 248Accommodative spasm 249Accommodative inertia 250Micropsia 251Macropsia 251Convergence anomalies 251Convergence insufficiency 252Convergence paralysis 254Convergence spasm 254Specific learning difficulty 254References 255Further reading 25713 Ptosis and Pupils 259Ptosis 259Marcus Gunn jaw-winking syndrome 263Lid retraction 264Pupils 264References 269Further reading 27114 Neurogenic Disorders 272III (third) cranial nerve 272IV (fourth) cranial nerve 280VI (sixth) cranial nerve 288Multiple sclerosis 292Acquired motor fusion deficiency 293Non-accidental injury 294Premature visual impairment 295Ophthalmoplegia 296References 300Further reading 30715 Mechanical Paralytic Strabismus 310Congenital cranial dysinnervation disorders 312Brown’s syndrome 319Adherence syndrome 324Moebius syndrome 325Strabismus fixus syndrome 327Thyroid eye disease 327Orbital injuries 333Blow-out fracture 334Soft tissue injury 339Supraorbital fracture 341Naso-orbital fracture 341Zygoma fracture 341Conjunctival shortening syndrome 342Retinal detachment 342Cataract 343Macular translocation surgery 344References 344Further reading 35016 Myogenic Disorders 354Thyroid eye disease 354Chronic progressive external ophthalmoplegia 354Myasthenia gravis 355Myotonic dystrophy 358Ocular myositis 358Kearns–Sayre ophthalmoplegia 359References 359Further reading 36117 Craniofacial Synostoses 362Plagiocephaly 362Brachycephaly 362Scaphocephaly/dolichocephaly 362Occipital plagiocephaly 362Apert’s syndrome 363Craniofrontonasal dysplasia 363Crouzon’s syndrome 363Pfeiffer syndrome 363Saethre–Chotzen syndrome 364Unicoronal syndrome 364General signs and symptoms 364Ocular signs and symptoms 365Management 365References 366Further reading 36718 Nystagmus 368Aetiology 368Classification 368Investigation 373Management 375References 378Further reading 38019 Supranuclear and Internuclear Disorders 382Saccadic movement disorders 382Smooth pursuit movement disorders 384Vergence movement disorders 385Gaze palsy 386Optokinetic movement disorders 394Vestibular movement disorders 395Brainstem syndromes 395Skew deviation 397Ocular tilt reaction 398Ocular investigation 398Management options 400References 401Further reading 405Section IV Appendices 407Diagnostic Aids 409Abbreviations of Orthoptic Terms 418Diagrammatic Recording of Ocular Motility 424Diagrammatic Recording of Nystagmus 426Glossary 428Case Reports 441Index 459