Strabismus & Paediatric Ophthalmology

Treatments

TREATMENT OF STRABISMUS IN ADULTS:

Adult strabismus can be treated with the eye muscle exercises, glasses which are containing prisms, botulinum toxin (Botox) injections & eye muscle surgery. You will need to be discussed with ophthalmologist to decide which the best treatment choice for your squint was.

1. Eye muscle exercise will be useful in the adults who are having weak convergence. This may occur when eye have difficulty to focus inward by aligning themselves for near work or while reading. These exercises can strengthen the eye muscles by that they can focus inward together.

2. Prisms which were incorporated into the glasses can be also used to correct the double vision, particularly when the squint was relatively small. Temporary prisms (Fresnel) were useful if the squint was variable as the strength of the prisms will be adjusted easily.

3. Botox injection was an effective treatment in certain types of the adult squint like patients who already had multiple squint surgeries. This may be performed in the ophthalmologists office. The eye was numbed with the anesthetic eye drops; Botox was then introduced into the overactive eye muscle with the help of a small needle. It is usually a safe & well tolerated by the patients.

4. Strabismus operation may involve either by loosening or tightening the muscles which attached to the eyeball. This surgery was done in a single day in operating theatre. This generally involves a minor discomfort in post-operatively. Eye drops were needed for few weeks to prevent the swelling & infection after the procedure.

5. Adjustable sutures can be used to achieve accurate results in squint operation, particularly in adult patients who had already a previous surgery. This is performed in 2 stages. The first stage was performed when the patient was asleep under the general anesthesia. The suture was tied in a bow at the end of the surgery.

6. When the patient was awake, the ophthalmologist will check the eye alignment to decide any adjustment was needed. The second stage was done by using anesthetic eye drops. The sutures were untied & adjusted to fine-tune the eye position. This was not a painful procedure but in some patients they may experience a mild discomfort while performing the adjustment.

7. Not all the adult strabismus was suitable for the adjustable sutures, your eye doctor may advise you whether it was suitable to you or not.

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Congenital nasolacrimal duct obstructions instinctively resolve in 90% of cases during the first year of birth. Some of the physicians have advocated massage with the digital pressure as an aid to speeding this natural resolution. Other than massage, topical antibiotics were used for the mucopurulent discharge, but the only treatment of the efficacy for those patients who don’t resolve spontaneously is surgery.

Probing:

Probing will cures 95% of the congenital nasolacrimal obstruction cases. Prognosis for the probing will decreases exponentially with increasing number of the probings & the age of the patient. Occasionally, it is successful after the 3rd time or after 3 years.

Nasolacrimal intubation:

It is been advocated as an alternate technique to dacryocystorhinostomy (DCR) in the children who are failed probing.
Success rates of this procedure was 80-95% is been reported, but majority of the patients is only been probed twice or less & are younger than 2 years. Prognosis is poor for those patients who have previous dacryocystitis & for those patients in which the obstruction is been encountered during the procedure.

Ballon catheter dilatation of the nasolacrimal system with or without silicon tubing

This procedure is having bit better results when compared to the intubation alone. Most probing failures will occur as the result of the upper sac or mid duct obstructions & were not open to cure by the instrumentation. Repeat probing techniques & intubation may cause serious complications or risks, which includes false passages, canalicular scarring & stenosis.

Conjunctival dacryocystorhinostomy

If the upper system is scarred or otherwise not amenable to the opening, then it will be bypassed by using prosthesis, like Lester-Jones tube. This procedure probably should be avoided till the child is older than 10 years because of the prosthesis require care from the patient & usually has minor complications & revisions. In punctal agenesis where there is no canalicular tissue is been identified, the insertion of a Lester-Jones tube is necessary.

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