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Strabismus
Strabismus is an eye disorder in which the eyes do not properly align with each other when looking at an object. The eye that is pointed at an object can alternate. The condition may be present occasionally or constantly. If present during a large part of childhood, it may result in amblyopia, or lazy eyes, and loss of depth perception. If onset is during adulthood, it is more likely to result in diplopia, double vision. Strabismus can occur out of muscle dysfunction (e.g., myasthenia gravis), farsightedness, problems in the brain, trauma, or infections. Risk factors include premature birth, cerebral palsy, and a family history of the condition. Types include esotropia, where the eyes are crossed ("cross eyed"); exotropia, where the eyes diverge ("lazy eyed" or "wall eyed"); and hypertropia or hypotropia, where they are vertically misaligned. They can also be classified by whether the problem is present in all directions a person looks (comitant) or varies by direction (inco ...
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Strabismus Surgery
Strabismus surgery (also: ''extraocular muscle surgery'', ''eye muscle surgery'', or ''eye alignment surgery'') is surgery on the extraocular muscles to correct strabismus, the misalignment of the human eye, eyes. Strabismus surgery is a one-day procedure that is usually performed under general anesthesia most commonly by either a neuro- or pediatric ophthalmologist. The patient spends only a few hours in the hospital with minimal preoperative preparation. After surgery, the patient should expect soreness and redness but is generally free to return home. History The earliest successful strabismus surgery intervention is known to have been performed on 26 October 1839 by Johann Friedrich Dieffenbach on a 7-year-old esotropic child; a few earlier attempts had been performed in 1818 by William Gibson of Baltimore, a general surgeon and professor at the University of Maryland. The idea of treating strabismus by cutting some of the extraocular muscle fibers was published in American n ...
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Amblyopia
Amblyopia, also called lazy eye, is a disorder of sight in which the brain fails to fully process input from one eye and over time favors the other eye. It results in decreased vision in an eye that typically appears normal in other aspects. Amblyopia is the most common cause of decreased vision in a single eye among children and younger adults. The cause of amblyopia can be any condition that interferes with focusing during early childhood. This can occur from poor alignment of the eyes (strabismic), an eye being irregularly shaped such that focusing is difficult, one eye being more nearsighted or farsighted than the other (refractive), or clouding of the lens of an eye (deprivational). After the underlying cause is addressed, vision is not restored right away, as the mechanism also involves the brain. Amblyopia can be difficult to detect, so vision testing is recommended for all children around the ages of four to five as early detection improves treatment success. Glas ...
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Esotropia
Esotropia () is a form of strabismus in which one or both eyes turn inward. The condition can be constantly present, or occur intermittently, and can give the affected individual a "cross-eyed" appearance. It is the opposite of exotropia and usually involves more severe axis deviation than esophoria. Esotropia is sometimes erroneously called "lazy eye", which describes the condition of amblyopia; a reduction in vision of one or both eyes that is not the result of any pathology of the eye and cannot be resolved by the use of corrective lenses. Amblyopia can, however, arise as a result of esotropia occurring in childhood: In order to relieve symptoms of diplopia or double vision, the child's brain will ignore or "suppress" the image from the esotropic eye, which when allowed to continue untreated will lead to the development of amblyopia. Treatment options for esotropia include glasses to correct refractive errors (see accommodative esotropia below), the use of Prism (optics), pris ...
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Suppression (eye)
Suppression of an eye is a subconscious adaptation by a person's brain to eliminate the symptoms of disorders of binocular vision such as strabismus, convergence insufficiency and aniseikonia. The brain can eliminate double vision by ignoring all or part of the image of one of the eyes. The area of a person's visual field that is suppressed is called the suppression scotoma (with a scotoma meaning, more generally, an area of partial alteration in the visual field). Suppression can lead to amblyopia. Effect Nobel-prize winner David H. Hubel described suppression in simple terms as follows: :"Suppression is familiar to anyone who has trained himself to look through a monocular microscope, sight a gun, or do any other strictly one-eye task, with the other eye open. The scene simply disappears for the suppressed eye."David H. Hubel: ''Eye, Brain, and Vision'', Chapter 9 "Deprivation and development"section "Strabismus" Published online by Harvard Medical School (downloaded 30 Septembe ...
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Diplopia
Diplopia is the simultaneous perception of two images of a single object that may be displaced in relation to each other. Also called double vision, it is a loss of visual focus under regular conditions, and is often voluntary. However, when occurring involuntarily, it results from impaired function of the extraocular muscles, where both eyes are still functional, but they cannot turn to target the desired object. Problems with these muscles may be due to mechanical problems, disorders of the neuromuscular junction, disorders of the cranial nerves ( III, IV, and VI) that innervate the muscles, and occasionally disorders involving the supranuclear oculomotor pathways or ingestion of toxins. Diplopia can be one of the first signs of a systemic disease, particularly to a muscular or neurological process, and it may disrupt a person's balance, movement, or reading abilities. Causes Diplopia has a diverse range of ophthalmologic, infectious, autoimmune, neurological, and neoplasti ...
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Exotropia
Exotropia is a form of strabismus where the eyes are deviated outward. It is the opposite of esotropia and usually involves more severe axis deviation than exophoria. People with exotropia often experience crossed diplopia. Intermittent exotropia is a fairly common condition. "Sensory exotropia" occurs in the presence of poor vision in one eye. Infantile exotropia (sometimes called "congenital exotropia") is seen during the first year of life, and is less common than "essential exotropia" which usually becomes apparent several years later. The brain's ability to see three-dimensional objects depends on proper alignment of the eyes. When both eyes are properly aligned and aimed at the same target, the visual portion of the brain fuses the two forms from the two eyes into a single image. When one eye turns inward, outward, upward, or downward, two different pictures are sent to the brain. Thus, the brain can no longer fuse the two images coming from the two eyes. This causes lo ...
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Hypertropia
Hypertropia is a condition of misalignment of the eyes (strabismus), whereby the visual axis of one eye is higher than the fellow fixating eye. Hypotropia is the similar condition, focus being on the eye with the visual axis lower than the fellow fixating eye. Dissociated vertical deviation is a special type of hypertropia leading to slow upward drift of one or rarely both eyes, usually when the patient is inattentive. Presentation Associated defects Refractive errors such as hyperopia and anisometropia may be associated abnormalities found in patients with vertical strabismus. The vertical miscoordination between the two eyes may lead to * strabismic amblyopia due to cerebral suppression of the deviating eye, particularly when onset occurs well before adolescence, while neural pathways are still highly plastic * impaired depth perception, especially in the same instances * diplopia or double vision, particularly when onset occurs after childhood, when corresponding neural pat ...
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Hirschberg Test
In the fields of optometry and ophthalmology, the Hirschberg test, also Hirschberg corneal reflex test, is a screening test that can be used to assess whether a person has strabismus (ocular misalignment). A photographic version of the Hirschberg test is used to quantify strabismus. Technique It is performed by shining a light in the person's eyes and observing where the light reflects off the corneas. In a person with normal ocular alignment the light reflex lies slightly nasal from the center of the cornea (approximately 11 prism diopters—or 0.5mm from the pupillary axis), as a result of the cornea acting as a temporally-turned convex mirror to the observer. When doing the test, the light reflexes of both eyes are compared, and will be symmetrical in an individual with normal fixation. For an abnormal result, based on where the light lands on the cornea, the examiner can detect if there is an exotropia (abnormal eye is turned out), esotropia (abnormal eye is turned in), h ...
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Eye Care Professional
An eye care professional is an individual who provides a service related to the eyes or vision. It is any healthcare worker involved in eye care, from one with a small amount of post-secondary training to practitioners with a doctoral level of education. Types Ophthalmologist Ophthalmology ( /ˌɒfθælˈmɒlədʒi/ ''OFF-thal-MOL-ə-jee'') is a surgical subspecialty within medicine that handles the diagnosis and treatment of eye disorders. Ophthalmologists are physicians (M.D./D.O/have a doctorate in medicine) that undergo subspecialty training in medical and surgical eye care. To become an ophthalmologist the provider must first become a physician. To become a physician, after college they must go through 4 years of medical and surgical training where they are extensively educated in treating all parts of the human anatomy, including the eye. Their training includes, but is not limited to, coursework (classroom, clinical, and community experiences) that covers science, the lat ...
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