STRABISMUS

• Horizontal strabismus
– Esotropia
– Exotropia
• Vertical strabismus
– Monocular elevation deficit (Double elevator
palsy)
– Brown syndrome
• Paralytic strabismus
– N. III, N.IV, N.VI
 KLASIFIKASI
• COMMITANT

• INCOMMITANT
 KLASIFIKASI
• PHORIA

• TROPIA
 Klasifikasi
• ESODEVIASI
– ESOPHORIA
– ESOTROPIA
• EXODEVIASI
– EXOPHORIA
– EXOTROPIA
• HIPERDEVIASI
– HYPERPHORIA
– HYPERTROPIA
• HIPODEVIASI
– HIPOPHORIA
– HYPOTROPIA
ASSESSMENT DALAM STRABISMUS
• Visus
• Koreksi refraksi dengan cycloplegik
• Motorik
– Cover test
– Uncover test
– Alternate cover test
– Aternate prism cover test
– GBM
• Sensorik
– WFDT
– STereoskopis
Cover Test
Cover Uncover Test
Alternate cover test + APCT
Alternate Prism Cover test
 Krimsky

• Base in >< Base out

Pengukuran dilakukan pada fiksasi jauh
dan dekat
• PCT Near (33 cm) : ……………………
• PCT Distance (6 m) : ………………………

• Intermittent Exotropia
– Divergence excess : D > N
– Basic type : D = N
– Convergence insufficiency : N > D
Pengukuran dilakukan pada 6 cardinal
gaze

50
30
30

A Pattern or V Pattern
Pattern Strabismus
 A Patterrn ET
• MALE
• Medial To Apex
• Lateral to Empty Space
 ESOTROPIA
• ACCOMMODATIVE ESOTROPIA
– FULLY ACCOMMODATIVE ESOTROPIA
– PARTIALLY ACCOMMODATIVE ESOTROPIA
• NON ACCOMMODATIVE ESOTROPIA
– CONGENITAL ESOTROPIA
– DUANE SYNDROME
– PARESE N.VI
– MOBIUS SYNDROME
 Accommodative Esotropia
• Onset
• Visus
• Cycloplegic refraction
• Amblyopia
• GBM
• Konstan / alternate / intermittent
• Besarnya deviasi
• Stereoskopis
 Accommodative ET
• Fully accommodative ET
• Partially accommodative ET
Early-onset accommodative esotropia
 Fully accommodative esotropia
• Besar deviasi tanpa kaca mata : 50 PD
• Besar deviasi dengan kacamata : 0 PD
Partially accommodative esotropia
• Besar deviasi tanpa kaca mata : 50 PD
• Besar deviasi dengan kacamata : 20 PD
 CONGENITAL ESOTROPIA
• Onset
• Visus
• Cycloplegic refraction
• Amblyopia
• GBM
• Konstan / alternate / intermittent
• Besarnya deviasi
• Stereoskopis
 Gambaran Klinis
• Alternate Fixation
• Cross Fixation
• Inferior Oblique Overaction (IOOA)
• DVD (dissociated Vertical Deviation)
• Latent Nystagmus
Alternate Fixation
Cross-Fixation
DVD(Dissociated Vertical Deviation)
• SR IO IO SR

IR SO SO IR
IOOA
 Konfirmasi IOOA
• GBM
• Pemeriksaan Upgaze dan downgaze
• Funduskopi untuk melihat torsi
 SENSORY ESOTROPIA
• Onset
• Visus
• Cycloplegic refraction
• Amblyopia
• GBM
• Konstan / alternate / intermittent
• Besarnya deviasi
• Stereoskopis
PSEUDOESOTROPIA
 Pseudo esotropia
• Onset
• Visus
• Cycloplegic refraction
• Amblyopia
• GBM
• Konstan / alternate / intermittent
• Besarnya deviasi
• Stereoskopis
Duane’s retraction syndrome
Duane type 1
Duane Type 2
Duane type 3
• Onset
• Visus
• Cycloplegic refraction
• Amblyopia
• GBM
• Konstan / alternate / intermittent
• Besarnya deviasi
• Stereoskopis
Mobius syndrome
Congenital 6th
nerve palsy
• Onset
• Visus
• Cycloplegic refraction
• Amblyopia
• GBM
• Konstan / alternate / intermittent
• Besarnya deviasi
• Stereoskopis
 • Nystagmus Blockage Syndrome
(Ciancia Syndrome)

• Sensoy Esotropia Esotropia in the

neurologically impaired
Strabismus Fixus
Brown Syndrome
• Congenital esotropia
• Fully accommodative esotropia
• Partially accommodative esotropia
• Sensory esotropia
• Parese N. VI
• Duane Syndrome
• Mobius Syndrome
 A Pattern Congenital ET tipe
Convergence Excess
• Bilateral medial rectus recession

• VOD 6/6
• VOS 1/60
 A Pattern Congenital ET tipe
Convergence Excess
• MALE
• Medial To Apex
• Lateral to Empty Space
 A Pattern
• Vertical placement
• Inferior oblique anterior positioning
 ISO
• Miop : > -8.00 D
• Hipermetrop > +5.00 D
• Astigmat > 2.5 D

• AANISO
• Miop > 3 D
• Hipermetrop > 1.5 D
• Astigmat > 1.5 D
• +7.50 C -2.50
• +8.00 C-3.50