NONCOMITANT STRABISMUS

 a non-comitant strabismus is a strabismus that is not comitant!

comitant vs non-comitant strabismus

• effect of gaze direction
  • well, it's non-comitant
• type of onset
  • sudden
  • congenital
• age of onset
  • adult
  • congenital

   

   

• primary vs secondary angle

• EOM status
  • all noncomitant deviations do not have an EOM defect, but
  • all EOM defects produce a noncomitant deviation

  ----------------------------------------------------------------

• symptoms
  • diplopia
• sensory adaptations
• torticollis
• cyclodeviations

DIAGNOSIS

1. EOM analysis

2. Head tilt test, Parks' three step

3. Hess-Lancaster screen

1. underaction of the agonist (paretic muscle)

2. overaction of the ipsilateral antagonist

3. overaction of the contralateral synergist (yoke muscle)

4. underaction of the contralateral antagonist

TORTICOLLIS

• EOM paresis
• muscular, skeletal anomalies
• nystagmus
• anisometropia
• visual-motor difficulties

A-V SYNDROMES

• not related to fixation distance
• 25-30 degrees above & below primary gaze

• causes
  • A - overaction of the SOs
  • V - overaction of the IOs

MANAGEMENT OF NON-COMITANT STRABISMUS

• occlusion
  • to minimiz symptoms of diplopia
  • which eye to patch?
  • beware past pointing
  • beware contractures

   

• lenses

• prisms
  • not as easy as it looks
  • strabismic angle varies with fixation direction

• oculomotor calesthenics
  • oculomotor physical therapy

   

• motor fusion (i.e. vergence therapy)
  • you try to expand the range of single vision

• functional head position adjustment
  • point face in direction of field of action of paretic muscle

• surgery

• combination