المساعد الشخصي الرقمي

مشاهدة النسخة كاملة : squint step by step


Opto.Amani Habib
25-03-2006, 10:04 PM
السلام عليكم ورحمة الله وبركات
سنخصص هذا الموضوع عن الحول بالتدريج وكل يوم سنناقش موضوع ان شاء الله ( يعني نتعلم ونراجع سوا وحدة وحدة من السهل للصعب )

1.01 Equipment for Examination of the Patient With Strabismus
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The equipment requirements for examination of the patient with strabismus are few, but those elements required are essential. This starts with a quiet examination lane, preferably of 6 M length and with a light source that can be dimmed. A comfortable, adjustable chair is needed for the patient, who may be seated either alone or on the parent's lap. The examiner also needs an adjustable chair with freely movable coasters. The examiner may wear the traditional white coat or other, possibly less "threatening" attire. Both authors wear the traditional garb. The equipment list should include the following items:
• Loose prisms, from 1/2 diopter to 30 diopters
• One horizontal and one vertical plastic prism bar (1diopter to 25 diopters)
• Rotary prism
• Opaque occluder
• A variety of small near fixation targets, silent or noise-producing and animated, with capabilities of maintaining attention and stimulating accommodation
• Animated distance fixation targets
• A trial lens set with plus cylinders and prisms (to fit in a trial frame)
• Adult and pediatric trial frames
• Red and white Maddox rods
• Stereo test (Titmus, Randot, Lang, TNO)
• Handheld fixation light
• Pinhole
• Worth 4-dot test and red-green spectacles
• Bagolini lenses
• Halberg clips
• Retinoscope
• Refraction lens bar with convex and concave lenses
• Portable biomicroscope
• Direct and indirect ophthalmoscopes
• Hertel exophthalmometer
• Visual acuity chart (B-VAT is strongly recommended)
• Near vision cards
• Optokinetic drum or tape
• Fine-tooth forceps for passive ductions and estimation of generated muscle force
• Afterimage tester (modified handheld camera flash)
• Reading comprehension charts and word lists
o Major amblyoscope*
o Deviometer
o Hess or Lees' screen
o Spielmann translucent occluders
o Contrast sensitivity acuity chart
o Neutral density filters
o Visuscope or similar device to test fixation pattern
o Perimeter to determine field of single binocular vision
This equipment list is relatively small and, for the most part, inexpensive. The "first-line" instruments should be available to anyone who evaluates a patient with strabismus. The "second-line" equipment (shown indented) is for special documentation, research and for medicolegal purposes. Some items of "second-line" equipment represent the personal preference of an individual examiner. In addition to this equipment, a systematic recording scheme should be used. In most cases this includes a printed data collection sheet. 24, p.359 Drops for dilating the pupil and obtaining cycloplegia include cyclopentolate 1%, phenylephrine hydrochloride 10% and 2.5%, tropicamide 1%, and Cycloid. Drops used to anaesthetizing the conjunctiva include proparacaine hydrochloride, tetracaine hydrochloride, lidocaine hydrochloride 4%, and cocaine 4%. We prefer to use lidocaine. Fresnel press-on prisms in powers ranging from 1 diopter to 40 diopters should be available, as well as +1.00, +2.00, and +3.00 diopter spherical lenses.

مغ خالص حبي واحترامي
اماني حبيب

golden eye
25-03-2006, 10:22 PM
اشكرك على هذي الاساسيات التي
كل اخصائي ان يعمل بها
---------------------------
تحياتي للجميع

Opto.Amani Habib
25-03-2006, 11:06 PM
لا شكر على واجب وارجو ان تكون فيها الفائدة لكم
تحياتي

Opto.Amani Habib
25-03-2006, 11:13 PM
ملاحظة اذا اي حدا بيتصعب من فهم مقال بالانجليزية يسال اي حدا بالمنتدى واكيد الكل جاهز ليجاوب بدون تردد

تحياتي

BrIgHt lIgHt
25-03-2006, 11:22 PM
thank u Amani

سما
25-03-2006, 11:38 PM
thanks شغل حلو يعطيك العا جزاك الله

marwan
26-03-2006, 01:41 AM
احنا حتى الأن ما أخدنا موضوع الحول ع انفصال ...
ولكن أكيد كل موضوع إلو يوم ويلزم ...

Opto.Amani Habib
26-03-2006, 11:12 AM
السلام عليكم ورحمة الله وبركاته

1.02 History
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1. Family photographs are often very helpful to document the age of onset. Parents often report that the eyes have crossed continuously since birth. However, it has been shown that even infantile esotropia occurs infrequently at birth.

2. This information provides an important clue in strabismic infants because amblyopia is absent in alternating strabismus. Strong preference for fixation with the same eye, on the other hand, implies strabismic amblyopia in the nonpreferred eye.

3. For example, a history of a bump on the head, a fall, or one of the usual febrile childhood diseases preceding the onset of strabismus is usually insignificant. However, acute strabismus, usually estropia, in an older child always requires a careful evaluation to rule out neurologic abnormalities.

4. Intermittent strabismus indicates that fusion is present part of the time. The prognosis for recovery of normal binocular vision is better in such cases.

5. Closure of one eye in bright sunlight and reports of light sensitivity are commonly encountered in patients with intermittent exodeviations. Although this symptom occurs also in esotropic and normal subjects, its presence should alert the examiner to search for the intermittent exotropia. It is caused by a decreased binocular photophobia threshold. 73 Any complaint about photophobia requires a search for nonstrabismic causes, such as hypopigmentation of the eye or corneal or conjunctival disease.

6. A history of malignant hyperthermia, a familial hepatic porphyria, suxamethonium sensitivity, or allergic reactions to dilating drops requires special precautions because of serious, or even fatal anesthetic complications.

7. Low birth weight suggests the possibility of retinopathy of prematurity with pseudostrabismus from ectopia of the macula. Myasthenia gravis, although infrequent in childhood, may mimic almost any type of strabismus, and reports of easy fatigability require an investigation for myasthenia.

مع خالص حبي واحترامي
اماني حبيب

Areej
26-03-2006, 07:05 PM
الله يوفقك يا امانى والله انا كنت فاقدة الامل من هالناحيه وكنت متوقعه اتخرج ما بعرف اشى يالله منكم نستفيد
الله يكتر من امثالك

سما
26-03-2006, 07:08 PM
مشكورين بارك الله فيكي يا اماني...

أ.محمد العشي
26-03-2006, 08:25 PM
شكرا كتير عالموضوع

*Floating**Angel*
26-03-2006, 10:21 PM
مشكورة ............شاطر

Opto.Amani Habib
27-03-2006, 12:24 AM
السلام عليكم ورحمة الله وبركاته

1.03 Does This Baby See?


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(1) This fundamental question should be asked at the beginning of the examination. A sequence of tests is necessary if this question cannot be answered satisfactorily.

(2) Evaluation starts with simple observation. The infant may be cradled in the parent's arms, or the examiner may gently hold the child facing him or her. If the room light is subdued, the infant is more likely to open his or her eyes.

(3) The examiner should establish eye contact with the infant and once this is accomplished, interpret the response. In most cases the infant will smile when eye contact is made. At this point, an assessment is made of the fixation, which is either steady or unsteady. Nystagmoid searching eye movements should be distinguished from true nystagmus.

(4) The examiner then moves his or her head from side to side, observing whether the infant's eyes follow this stimulus. It is important to use nonauditory stimuli.

(5) The examiner then rotates the child rapidly but smoothly to one side and then to the other. When this movement ceases, normal infants have one or two beats of nystagmus and then resume steady fixation. Infants with poor vision have prolonged postrotatory nystagmus that persists for several beats.

(6) The pupillary light reaction indicates an intact anterior visual loop (retina-optic nerve-pupillomotor nerves. 25, p. 4

(7) The optokinetic nystagmus (OKN) response tests resolution visual acuity and evaluates the intactness of the posterior visual loop (occipital cortex-brain stem-extraocular muscles). 25, p. 4

(8) The forced preferential looking test is a technique for quantifying recognition visual acuity. 15 This technique has limited practical clinical application.

(9) The electroretinogram (ERG) test is a measure of retinal function. It is an important diagnostic step in confirming Leber's congenital amaurosis and retinitis pigmentosa. However, subnormal visual acuity can be compatible with a normal ERG and vice versa.

(10) Visual evoked potential (VEP) registers the cortical response to retinal stimulation. The stimulus is either a light flash or a checkerboard with black and white blocks. Quantification is difficult, and this test is rarely used in a clinical setting to establish the presence of vision in an infant.41

مع خالص حبي واحترامي
اماني حبيب