STRABISMUS

Dr. Marliyanti N. Akib, Sp.M, M.Kes

Bagian Ilmu Kesehatan Mata
Fakultas Kedokteran Universitas
Hasanuddin
2012
Definisi

Strabismus :
Misalignment of the
eye
Classification
Commitant : The angle or degree
of misalignment is approximately
equal in all directions of gaze
Classification
Incommitant /Paralytic/Restrictive
: When the degree of
misalignment varies with the
direction of gaze
Classification
Heterophoria : Latent tendency
for misalignment of the two eyes
that becomes manifest only if
binocular vision is interrupted
such as by covering one eye

Heterotropia : Manifest deviation

that is present when both eyes
are open (no covers). Binocular
vision is reduced.
Commitant Strabismus
Etiology
Genetic factors
Uncorrected refractive error
Insufficient fusion (anisometropia,
anisokonia, heterophoria)
Unilateral visual impairment
(cataract, retinal disorders)
Other possible causes : Perinatal
lession such as preterm and
asphyxia, cerebral trauma
encephalitis
Commitant Strabismus
Patophysiology
Suppression
Sensory Adaptation
Forms of commitant
strabismus
Esotropia
Exotropia
Hypertropia and hypotropia
Cyclotropia
Classification
Esodeviation
Exodeviation

Commitant
Incommitant
 Assessment
Anamnesis
Visual Acuity
Nystagmus
Anterior segment
Posterior segment (Coloboma, optic nerve
hypoplasia, macular hypoplasia, Retinal
dystrophy)
Ocular movement
Cover test
Prism test
Sensory test : supression, stereoscopis
Esodeviatio
n
Klasifikasi Esodeviasi
Pseudoesotropia
Congenital-infantile esotropia
Accommodative esotropia
naccommodative acquired esotropia
Basic
Acute
Cyclic
Sensory deprivation
Divergence Insufficiency and divergence paralysis
Surgicl (consecutive)
Incomitant
6th nerve paresis
Medial rectus restriction
Duane syndrome
Mobius syndrome
 Commitant
Strabismus
Esodeviatio
n
Tes Pergerakan Bola Mata
Pseudoesotropia
Etiologi
Broad nasal bridge
Epikantus
Telekantus
Akan membaik seiring
perkembangan anak
Visus baik
Tidak ada kelainan intraokuler
Pseudoesotropia
Congenital-Infantile
Esotropia
Primary esotropia not associated
with 6th nerve palsy, neurological
condition or a signifficant
restriction, and occurs before 6
month of age.
Etiology :
Worths theory : Tidak ada
kemungkinan fusi kortikal
Cavasses theory : Primary motor
misalignment
Congenital-Infantile
Esotropia
Status refraksi : sama dengan
anak normal
Alternate fixation
Besar deviasi > 40 PD
Gerakan bola mata : normal
Accomodative esotropia
Onset : > 1 tahun
Status refraksi : Hipermetrop
tinggi > 3 D
Besar deviasi : 10-30 PD
GBM : Normal
Sensory deprivation :
Ada kelainan organik : kekeruhan
kornea, katarak
Consecutive/surgical esotropia
Sebelumnya exotropia
Setelah operasi koreksi exotropia
Incommitant Esotropia

6th nerve paresis

Medial rectus
restriction
Duane syndrome
Mobius syndrome
Duanes retraction syndrome
Duane type 1
Duane Type 2
Duane type 3
Congenital 6th
nerve palsy
Mobius syndrome
Exodeviation
Congenital Exotropia
Intermittent Exotropia
Sensory Exotropia
Consecutive Exotropia
Congenital Exotropia
Sangat jarang
Biasa terdapat pada pasien
dengan penyakit sistemik,
anomali kraniofasial, albinism
atau cerebral palsy
Insiden Ambliopia tinggi
Stereoskopis jelek
Intermittent Exotropia
Gejala klinis
Penglihatan kabur
Astenopia
Fotofobia
XT muncul jika penderita lelah,
konsentrasi atau sakit
Kelainan refraksi : miopia
GBM : normal
Sensory deprivation :
Ada kelainan organik : kekeruhan
kornea, katarak
Consecutive/surgical esotropia
Sebelumnya exotropia
Setelah operasi koreksi exotropia
Third nerve palsy
Third nerve palsy
This condition may be congenital
Pupil may be spared
Associated with posterior
cerebral artery aneurysms or
vascular malformationa.
Traumatic
Fourth nerve palsy
Terapi
Non operatif :
Management of amblyopia
Spectacles
Amblyopia management
Convergence Exercise
Operatif
Reses
Resect
Terapi
Weakening Procedures
Recession
Hang-back recession
Myectomy
Tenectomy
Strengthening Procedures
Resection
Advancing its insertion toward the
limbus
Limbal approach pada resesi
m. rectus medial.

Gambar 3. Insisi konjungtiva pada limbal

approach
 Gambar 4. Isolasi otot
 Gambar 5. Memisahkankan ligamen Check
 Gambar 6. Insisi septum intermuskularis
Gambar 7. Memisahkan kapsula Tenon
 Gambar 8.Menguatkan otot dengan jahitan
 Gambar 9. Memotong otot


Gambar 10. Membuat tempat insersi baru

 Gambar 11. Menguatkan otot
 Gambar 12. Menguatkan otot
Complications of strabismus
surgery
Orbital cellulitis

Granuloma
Allergic reaction to chromic gut

Postoperative conjunctival
epithelial inclusion cyst
Superotemporal segmental
anterior segment ischemia

Slipped muscles
Thank You