Reverse squint

Introduction to reverse strabismus Antipodeansquint is a rare special type of strabismus. In the same eye, the eyeball sometimes slanted and sometimes slanted; or when one eye gaze, the other eye slanted, while the other eye gaze, the eye slanted This specific anomaly is reverse strabismus. basic knowledge The proportion of illness: 0.02% Susceptible people: more common in children Mode of infection: non-infectious Complications: astigmatism

Cause of reverse strabismus

Refractive (25%):

Reverse strabismus is seen in anisometropia. Previously, eye muscle surgery, unequal adjustment, partial paralysis or movement limitation of the extraocular muscles, and pseudoextratropia caused by ectopic macular ectopic disease can also be seen in the retrograde ocular syndrome.

Due to abnormal eye movement (30%):

According to the different directions of gaze, esotropia sometimes occurs, sometimes exotropia occurs, intermittent exotropia is easy to miss diagnosis, appearance is sometimes positive, sometimes esotropia, intermittent exotropia combined with excessive esotropia caused by esotropia, seen in the interval with double correspondence Sexual exotropia, that is, abnormal retinal correspondence in the external oblique state, normal omental correspondence in the positive position, due to excessive temporal convergence, causing esotropia, and visual ocular nystagmus (OKN) in patients with reverse strabismus, Vestibular visual reflex (VOR).

Reflection (30%):

Visual vestibular eye movement reflex (VVOR) and vestibular ocular reflex gaze inhibition (VOR fix), clinically based on the results of these four examinations of eye movement to identify ocular disorders, vestibular disorders and central disorders, for reflecting the strength of eye movement The most commonly used indicator is the gain, the decrease in gain indicates a decrease in the speed of movement of the eyeball, and the increase in gain indicates hyperactivity.

Reverse squint prevention

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Reverse strabismus complications Complications astigmatism

Generally no special complications

Symptoms of reverse strabismus Common symptoms Rhomboid - phenomenon internal oblique A sign exotropis V sign myopia astigmatism myopia

Classification

(1) Intermittent exotropia combined with accommodative esotropia: This type is rarely seen clinically.

(2) Separate vertical deviation combined with esotropia and exo-tropia: This type is clinically more common.

(3) Dissociated horizontal deviation (DHD) refers to the skewed state of horizontal eye separation that violates Hering's law. For example, when the right eye is gazing, the left eye is deflected inward or outward, when the left eye is gazing. The right eye should also be deflected inward or outward, but in DHD it is deflected outwards or inwards, and can be accompanied by recessive nystagmus. If the prism is placed in front of the eye, the eye that is neutralized by the prism is not moving. The contralateral eye is reversed, and the separation horizontal deviation is a newly proposed reverse strabismus. It is different from the separation vertical deviation combined with esotropia and exotropia. This type is more common after strabismus correction. The merger has adjustment factors.

2. Clinical features

(1) The age of onset is earlier, exotropia occurs at birth or early in life, and esotropia occurs at 2 to 3 years of age. Most patients see a doctor before 7 years of age.

(2) Both have the characteristics of both internal strabismus and exotropia. Early onset of exotropia is related to congenital factors, and esotropia is related to regulatory factors.

(3) The refractive state is the most farsighted, and 56% of patients have hyperopia above moderate.

(4) strabismus often changes, sometimes exotropia, sometimes esotropia, sometimes orthotopic, it is difficult to obtain a fixed degree, generally esotropia in 5 ° ~ 20 °, exotropia in 10 ° ~ 25 °.

(5) Most of the eyes with poor visual function are poor, and most of the visual acuity is amblyopia.

(6) The AC/A ratio is normal or below normal.

(7) After wearing a farsighted correction mirror, most internal obliques can be corrected or reduced.

(8) The disease is common in intermittent exotropia with accommodative internal oblique or on the basis of separation vertical deviation combined with internal oblique and external oblique, while simple separation horizontal deflection is extremely rare.

Reverse squint examination

No special laboratory tests are required.

Including eye position, vision, strabismus and other checks.

Reverse strabismus diagnosis

Diagnostic criteria

The diagnosis of this disease should be based on the characteristics of intermittent exotropia and accommodative internal oblique strabismus, pay attention to observation and examination, and pay attention to the identification of internal oblique and external oblique with DVD. Although the patient has esotropia, it is matched. After the mirror is positive, some have a small internal inclination or have a certain binocular monocular function. It is necessary to use an optotype or read a book of interest to show esotropia; and intermittent exotropia often occurs in patients with mental disorientation or It is only induced when looking at distant objects, or when using single-eye cover and unmasked test. Therefore, it is necessary to repeatedly and carefully check the patients to make a correct diagnosis. In addition, the following should be excluded.

Differential diagnosis

1. Exotropia caused by long-term wearing of a hyperopic ocular with corrective accommodative esotropia leading to adjustment and diminished function.

2. Due to strabismus caused by abnormal eye movement, the patient has internal oblique and exotropia in different gaze directions.

3. Patients who look far and see near strabismus have a strabismus (internal or external strabismus) after surgery and another strabismus when they are close.

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