By Walimbe, Prasad
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There should be a mention of developmental milestones if it is normal or delayed. Family history is extremely important in cases of certain hereditary forms of strabismus and response of other family members to surgery will give a clue to patient’s response to surgery. Leading questions should be asked about associated neurological signs and symptoms like seizures, ataxia, muscle weakness, fatigue, ptosis, etc. ba s m al This is one of the most important parts of the examination. It can often be a test of patience for the examiner if the patient happens to be a child.
T k Strabismus: Anatomical Pearls ba s m al Fig. 8: Anterior ciliary blood vesels. Cross-section relationship of vessels to sclera (S), muscle and intermuscular septum (M), Tenon’s fascia (T) and conjunctiva (C). (Courtesy: Complications in Ophthalmic Surgery) Fig. 9: Thickness of sclera at different sites. e. whether infantile esotropia, restrictive or paralytic causes. z To assess binocular sensory status. z To measure the deviation. z To diagnose amblyopia. Thus, an evaluation which is done with these goals in mind will prevent lengthy examination which often results in an uncooperative patient and a confused clinician.
Further, the shape of palpebral fissure (mongoloid, antimongoloid) causes the appearance of patterns in squints (A or V pattern) and it should be considered during surgical planning. CONJUNCTIVA The bulbar conjunctiva loosely covers the anterior part of the globe from the fornices above and below and from the canthi medially and laterally. It becomes fused with the anterior Tenon’s capsule and sclera at the limbus. t k Conjunctiva is thick in infancy and childhood and becomes thin and more friable in adulthood.