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Squint


It is deviation of eyeball and is broadly divided as:
  1. Concomitant                
  2. Incomitant (Paralytic).
Pseudo squint : eyeball appears deviated but on HIshberg test no devitaion observed
Causes:



Tests for squint
  1. Hishberg test
  2. Cover test
  3. Cover – uncover test
  4. Alternate cover test
  5. Prism cover test
    1. Prism bar cover test
    2. Krimsky test ( done in non- fixating eyes)
  • Both these tests used to measure objective angle of squint
  • Subjective angle measured with
    • Maddox wing
    • Maddox rod tests
Table: Differentiating features between incomitant and comitant squint
Clinical features
 
Incomitant squint (paralytic or restrictive) Comitant squint
 
Magnitude of squint
Diplopia
Ocular movements
False projection
Abnormal head posture
Secondary deviation
Varies with eye position
Usually present
Restricted
Present
Usually present
More than primary
Same in all positions
Usually absent*
Full
Absent
Absent
Equal to primary
Features of Paralytic Squint
  1. Diplopia
  2. Confusion
  3. Ocular deviation
  4. Primary deviation is less than secondary deviation according to Hering’s Law (There is equal amount of innervation in yoke muscles.*
*exception: Dissociated vertical deviation

Sherrington’s Law*
Sherrington's law of reciprocal innervation states that increased innervation of a muscle is automatically associated with a reciprocal decrease in innervation (relaxation) of its antagonist.
*exception : Duane retraction syndrome

Management of Squint





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