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Clinical Orthoptics,9781444339345
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Clinical Orthoptics



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'Clinical Orthoptics has become established as a basic reference text providing fundamental information on anatomy, innervation and orthoptic investigation, plus diagnosis and management of strabismus, ocular motility and related disturbances. It is aimed at trainee ophthalmologists and orthoptic undergraduate students. Qualified orthoptists, general ophthalmologists and optometrists will also find valuable guidance in these pages. In this edition, the author has maintained the goal of producing a user-friendly, clinically relevant and succinct book, while revising it to reflect a variety of developments in the field. FEATURES Essential reading for students of orthoptics and ophthalmolology Now fully revised and updated Generously illustrated with photographs and line drawings Includes diagnostic aids, case reports, and helpful glossary

Author Biography

Fiona J. Rowe is a Senior Lecturer in Orthoptics at the University of Liverpool, and lecture extensively to undergraduate and postgraduate orthoptists, trainee and qualified ophthalmologists, ophthalmic nurses and other members of the multi-disciplinary eye care team.

Table of Contents

Prefacep. xi
Acknowledgementsp. xii
List of Figuresp. xiii
List of Tablesp. xvii
p. 1
Extraocular Muscle Anatomy and Innervationp. 3
Muscle pulleysp. 3
Ocular musclesp. 5
Innervationp. 10
Associated cranial nervesp. 12
Referencesp. 15
Further readingp. 16
Binocular Single Visionp. 17
Worth's classificationp. 17
Developmentp. 17
Retinal correspondencep. 19
Physiology of stereopsisp. 20
Fusionp. 23
Retinal rivalryp. 24
Suppressionp. 24
Diplopiap. 25
Referencesp. 27
Further readingp. 28
Ocular Motilityp. 29
Saccadic systemp. 29
Smooth pursuit systemp. 31
Vergence systemp. 33
Vestibular-ocular response and optokinetic responsep. 35
Brainstem controlp. 37
Muscle sequelaep. 39
Past-pointingp. 40
Bell's phenomenonp. 41
Referencesp. 41
Further readingp. 43
Orthoptic Investigative Proceduresp. 45
Visual acuityp. 45
Cover testp. 60
Ocular motilityp. 64
Accommodation and convergencep. 68
Retinal correspondencep. 73
Fusionp. 77
Stereopsisp. 82
Suppressionp. 89
Synoptophorep. 91
Aniseikoniap. 97
Fixationp. 98
Measurement of deviationsp. 99
Hess chartsp. 105
Field of binocular single visionp. 108
Uniocular field of visionp. 110
Measurement of torsionp. 111
Parks-Helveston three-step testp. 113
Diplopia chartsp. 113
Bielchowsky phenomenon (dark wedge test)p. 115
Forced duction testp. 115
Forced generation testp. 115
Orthoptic exercisesp. 115
Referencesp. 119
Further readingp. 124
p. 129
Heterophoriap. 131
Classificationp. 131
Aetiologyp. 131
Causes of decompensationp. 132
Esophoriap. 132
Exophoriap. 132
Hyperphoria/hypophoriap. 133
Alternating hyperphoriap. 133
Alternating hypophoriap. 133
Cyclophoriap. 133
Incomitant heterophoriap. 133
Hemifield slidep. 133
Investigation of heterophoriap. 134
Managementp. 135
Referencesp. 136
Further readingp. 137
Heterotropiap. 138
Esotropiap. 138
Factors necessary for development of binocular single visionp. 139
Constant esotropia with an accommodative elementp. 140
Constant esotropia without an accommodative elementp. 141
Accommodative esotropiap. 146
Relating to fixation distance
Exotropiap. 155
Hypertropiap. 168
Hypotropiap. 168
Cyclotropiap. 169
Dissociated vertical deviationp. 170
Dissociated horizontal deviationp. 172
Quality of lifep. 173
Pseudostrabismusp. 174
Referencesp. 175
Further readingp. 184
Microtropiap. 189
Terminologyp. 189
Classificationp. 190
Investigationp. 191
Managementp. 194
Referencesp. 194
Further readingp. 195
Amblyopia and Visual Impairmentp. 197
Classificationp. 197
Aetiologyp. 197
Investigationp. 198
Managementp. 199
Eccentric fixationp. 205
Cerebral visual impairmentp. 205
Delayed visual maturationp. 206
PHACE syndromep. 207
Referencesp. 207
Further readingp. 212
Aphakiap. 215
Methods of correctionp. 215
Investigationp. 215
Problems with unilateral aphakiap. 216
Managementp. 216
Referencesp. 218
Further readingp. 219
p. 221
Incomitant Strabismusp. 223
Aetiologyp. 223
Aid to diagnosisp. 225
Diplopiap. 226
Abnormal head posturep. 227
Referencesp. 230
Further readingp. 231
A and V Patternsp. 232
Classificationp. 232
Aetiologyp. 232
Investigationp. 236
Managementp. 238
Referencesp. 241
Further readingp. 241
Accommodation and Convergence Disordersp. 245
Accommodative disordersp. 245
Presbyopia-physiologicalp. 245
Presbyopia - premature (non-physiological)p. 246
Accommodative insufficiencyp. 247
Accommodative fatiguep. 248
Accommodative paralysisp. 248
Accommodative spasmp. 249
Accommodative inertiap. 250
Micropsiap. 251
Macropsiap. 251
Convergence anomaliesp. 251
Convergence insufficiencyp. 252
Convergence paralysisp. 254
Convergence spasmp. 254
Specific learning difficultyp. 254
Referencesp. 255
Further readingp. 257
Ptosis and Pupilsp. 259
Ptosisp. 259
Marcus Gunn jaw-winking syndromep. 263
Lid retractionp. 264
Pupilsp. 264
Referencesp. 269
Further readingp. 271
Neurogenic Disordersp. 272
III (third) cranial nervep. 272
IV (fourth) cranial nervep. 280
VI (sixth) cranial nervep. 288
Multiple sclerosisp. 292
Acquired motor fusion deficiencyp. 293
Non-accidental injuryp. 294
Premature visual impairmentp. 295
Ophthalmoplegiap. 296
Referencesp. 300
Further readingp. 307
Mechanical Paralytic Strabismusp. 310
Congenital cranial dysinnervation disordersp. 312
Brown's syndromep. 319
Adherence syndromep. 324
Moebius syndromep. 325
Strabismus fixus syndromep. 327
Thyroid eye diseasep. 327
Orbital injuriesp. 333
Blow-out fracturep. 334
Soft tissue injuryp. 335
Supraorbital fracturep. 341
Naso-orbital fracturep. 341
Zygoma fracturep. 341
Conjunctival shortening syndromep. 342
Retinal detachmentp. 342
Cataractp. 343
Macular translocation surgeryp. 344
Referencesp. 344
Further readingp. 350
Myogenic Disordersp. 354
Thyroid eye diseasep. 354
Chronic progressive external ophthalmoplegiap. 354
Myasthenia gravisp. 355
Myotonic dystrophyp. 358
Ocular myositisp. 358
Kearns-Sayre ophthalmoplegiap. 359
Referencesp. 359
Further readingp. 361
Craniofacial Synostosesp. 352
Plagiocephalyp. 362
Brachycephalyp. 362
Scaphocephaly/dolichocephalyp. 362
Occipital plagiocephalyp. 362
Apert's syndromep. 363
Craniofrontonasal dysplasiap. 363
Crouzon's syndromep. 363
Pfeiffer syndromep. 363
Saethre-Chotzen syndromep. 364
Unicoronal syndromep. 364
General signs and symptomsp. 364
Ocular signs and symptomsp. 365
Managementp. 365
Referencesp. 366
Further readingp. 367
Nystagmusp. 368
Aetiologyp. 368
Classificationp. 368
Investigationp. 373
Managementp. 375
Referencesp. 378
Further readingp. 380
Supranuclear and Internuclear Disordersp. 382
Saccadic movement disordersp. 382
Smooth pursuit movement disordersp. 384
Vergence movement disordersp. 385
Gaze palsyp. 386
Optokinetic movement disordersp. 394
Vestibular movement disordersp. 395
Brainstem syndromesp. 395 Skew dev
Ocular tilt reactionp. 398
Ocular investigationp. 398
Management optionsp. 400
Referencesp. 401
Further readingp. 405
Appendicesp. 407
Diagnostic Aidsp. 409
Abbreviations of Orthoptic Termsp. 418
Diagrammatic Recording of Ocular Motilityp. 424
Diagrammatic Recording of Nystagmusp. 426
Glossaryp. 428
Case Reportsp. 441
Indexp. 459
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