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Case 11

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					female patient about 60 years old came to hospital complaining from
painless progressive diminution of vision for 1 month ago in her rt. eye
& squint in her lt. eye since childhood .

there is no history of previous operations & she is not known to be
diabetic nor hypertensive.

on examination we found the following signs :



Rt. eye:

in cornea
there was nasal nebula
leucoma (i cant remember its features)
arcus senilis



in lens
there was nuclear cataract (ãÔ áÇÒã äÞæá ÃÐÇ ßÇä nuclear or cortical )


the vision was more than 1/60




Lt. eye:

cornea showed arcus senilis

lens showed nuclear cataract

the vision was CF ( áßä åì ãÔ ÈÊÔÊßì ãäåÇ áÃäåÇ ãÔ ÈÊÓÊÎÏãåÇ squinted )

the eye also showed squint with the following features:

1-unilateral

by doing Cover-Uncover test (we cover the normal eye ask patient to look
at light by squinted eye which will fix with pupil & when we remove the
cover it return to the squint position)



NB:
if vision is similar in both eyes -----bilateral squint
if there is a great difference -------unilateral


2- convergent (Eso.)
3-angle of deviation is more than 45 (light fall in sclera)

4-one of the most important point to determine if squint is concomitant
or paralytic
on this case we put the light on the lat. side of the lt. squinted eye
and asked patient to look at light by both eyes
the rt. normal eye(ÌÇÈÊ ÂÎÑåÇ) but the lt. squinted one made a slight
movement towards the light

so it may be paralytic (due to paralysis of lat. rectus) or contructure
(due to contructure of med. rectus)


to differentiate we cover the healthy eye & ask patient to continue
looking at the lateral light by squinted one
if it crosses the middle line -----it is contructure type
if it doesnt cross the middle line -----it is paralytic type


in this case it was contructure

NB: other methods of diff. bet. contructure & paralytic
1-forced duction test
2-electromyography to know if there is action in muscle or not


management of this squinted eye:

we will not do the operation to correct squint bec. the eye is deeply
amblyopic


íÇ Ñ

				
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Description: female patient about 60 years old came to hospital complaining from painless progressive diminution of vision for 1 month ago in her rt. eye & squint in her lt. eye since childhood . there is no history of previous operations & she is not known to be diabetic nor hypertensive.