dos_dec_2013

5 Editorial Miscellaneous

Experts’ Corner 67 Visual Acuity Assessment in Children
Neelima Aron
11 Neuro-ophthalmology
Evolution
Theme: Squint/Neuro-Ophthalmology
73 Pulley: Birth of A New Concept
29 Tips and Tricks for Successful Outcome in
Vipin Rana, Anirudh Singh
Squint J.K.S. Parihar Pradeep Sharma
Rohit Saxena, Ankur Sinha
PG Corner
39 Amblyopia
77 Management of Superior Oblique Palsy
Anirudh Singh, Vipin Rana, S.K. Mishra,
J.K.S. Parihar Nayana Potdar, Sanjay Kumar Dhar, Abhijit Rasal

49 Pattern Strabismus Monthly Meeting Corner

Sanjay Kumar Dhar, Vishnukant Ghonsikar, 81 A Rare Case of Bilateral Central Serous
Pradeep Sharma
Chorioretinopathy in Patient of Thalassemia
53 Cortical Visual Impairment Ankur Singh, M.C. Agarwal, Amit Mehtani,
J.S. Bhalla
Aashrai S.V. Gudlavalleti, Rohit Saxena
83 Newer Trends in Management of Diabetic
Diagnostics
Retinopathy
59 Squint Diagnostics M.C. Agarwal

Vishnukant Ghonsikar, Pradeep Sharma, Tear Sheet
Rohit Saxena, M.M. Sachdeva
93 Causes of Bilateral Poor Vision in Childhood

Sanjay Kumar Dhar

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“Regardless of who wins, an election should be a time for optimism
and fresh approaches”

-Gary Johnson

Respected Seniors & Dear Friends,

The beginning of 2014 has seen some intense canvasing for various posts in
the national ophthalmic community. While some people have felt irritated
with the vast amount of SMSs, emails, untimely phone calls; others have
enjoyed the attention of those seeking votes. Lots of people have suggested
a single window agency from AIOS for all the future campaigning while they
may have forgotten that it may restrict the candidat’s basic right to showcase
his/her previous work and vision for the position he/she is contesting.
India being a large country and candidates being from diverse regions of
the country need a chance to introduce themselves to all and put forth their
future plans for the position they are contesting. Untimely calls and bulk
mails are no doubt irritating, but is a small price to pay for the opportunity to
conduct one to one conversation and know your representative. On the other
hand, a moral code of conduct has to be followed by those contesting the
elections where they do not intrude into anyone`s privacy and do not hurt
the sentiments of the members whose vote they are soliciting.

As the AIOC gets over, the focus is once again on DOS and its activities; the
prime activity being the Annual conference of DOS – “OphthaVaganza 2014”.
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time we will be having Subspecialty sessions. Further, there will be dedicated
Young Ophthalmologists sessions, which will increase their participation and
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various scenarios.

We hope that with the constant efforts of the members of Delhi
Ophthalmological Society, its forthcoming Annual event is going to be a
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of ophthalmology.

Sincerely Yours

Rajesh Sinha
Secretary,
Delhi Ophthalmological Society

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Squint/Neuro-ophthalmology

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32 l DOS Times - Vol. 19, No. 6 December, 2013













































Diagnostics

streaks seen by each eye are not parallel, then the rods can simple to do using a kinetic perimeter, or to approximate
be rotated until the streaks become parallel and horizontal, from ocular motility. The patient is asked to seat in front
thus giving a measure of the rotation required and hence QH RGTKOGVGT YKVJ VJG EJKP EGPVTCN VQ ſZCVKQP 6JG VCTIGV KU
the torsion. This test is maximally dissociating and can moved outwards until the patient recognizes diplopia, and
produce erroneous results (possibly as a result of small the point is marked. The target is then moved further until
angles of head tilt). one image disappears, normally due to occlusion by facial
contours, and this point is marked. The inner ring describes
Bielschowsky’s head tilt test the area of BSV, the outer ring describes the limits of the
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Due to the development of the muscle sequelae, the eye
movement pattern in a longstanding SO palsy in one eye can Forced Duction Test
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# RQUKVKXG $KGNUEJQYUM[ JGCF VKNV VGUV ECP EQPſTO VJG EWNRTKV It is used for diagnosing the presence of mechanical
as the SO, but a negative result is inconclusive. Normally, restriction of ocular motility. Conjunctiva is anaesthetized
as the head is tilted towards the right shoulder, for example, with topical anesthetic drops. The eyes are grasped with
the right SR and right SO work in partnership to intort toothed forceps near the limbus in the direction opposite to
the eye, the opposing vertical actions of the two muscles which mechanical restriction is suspected. If no resistance
cancelling out. If a patient has a SO palsy, as the head is tilted is encountered the mobility defect is due to paralysis if
towards the affected side, the SR acts unopposed, so it not resistance is encountered mechanical restriction exist. It
only intorts the eye but also elevates it. To perform the test, is important not to press the globe into the orbit during
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CJGCF CV C FKUVCPEG QH O UQ VJCV ſZCVKQP FQGUPŏV HCXQWT force duction test- This is done for knowing the tightness of
either the SO or SR. Tilt the head towards the eye with the QDNKSWG OWUENGU +V YCU ſTUV FGUETKDGF D[ )W[VQP (QT VJKU
suspected SO palsy (the hypertropic eye) and if the vertical test eye must be pushed inside the orbit and then rocked
angle of the deviation increases, the defective muscle is back and forth by extorting and intorting the globe.
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a three step test for differentiating the four vertically acting Conclusion
extra-ocular muscles. Parks 3-step test helps to elucidate
which of the 4 extraocular muscles responsible for vertical Although examinatin of squint patient requires very few
eye movements may be weak, thereby causing vertical special equipments appropriate understanding of the
diplopia. To simplify, determine which eye appears higher available examination techniques and investigation is
with the head in a normal position, with the head turned necessary to make a correct diagnosis and hence to decide
to the left and to the right, and with the head tilted left and proper management.
tilted right.
References
Fusional Reserves
5JCTOC 2 5VTCDKUOWU 5KORNKſ GF PF GFKVKQP %$5 2WDNKUJGTU 0GY
Measurement of fusional reserves can be of diagnostic Delhi 2013
value when differentiating a long standing vertical muscle
palsy from one of recent onset. Congenital SO palsies, for 2. Walsh and Hoyts Clinical Neuro-Ophthalmology. 4th ed. Baltimore,
example, can have vertical fusional reserves in excess of MD: Lippincott Williams & Wilkins; 1985:707-715.
10D, whereas a recent onset deviation will usually have
a normal vertical fusion range (4D - 6D). Vertical fusion 3. Rosenbaum AL, Santiago AP. Clinical Strabismus Management.
ranges can also increase over a long period of gradual Principles and Surgical Techniques. WB Saunders Co, 1999,
change in the direction of the visual axes, such as in Philadelphia
dysthyroid eye disease.
4. Ed. Gunter K. Von Noorden MD, Emilio C Campos MD, Binocular
Field of binocular single vision (BSV) Vision and ocular motility. Theory and management of strabismus
6TH edition, Publishers, Mosby-St. Louis. Am Orthopt J.
6JG ſGNF QH $58 KU C VGUV WUGF VQ FGUETKDG VJG CTGCU QH 2001;51:161-2.
BSV, and hence diplopia in incomitant squint. It is very
5. Strabismus, Julio Prieto Diaz, Carlos Souza Dias, 4th edition 1999,
Publishers. Butterworth Heinemann, New Delhi.

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