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Binocular Vision and Ocular Motility


Gunter K. von Noorden, MD

Emeritus Professor of Ophthalmology
Cullen Eye Institute
Baylor College of Medicine
Houston, Texas

Clinical Professor of Ophthalmology
University of South Florida College of Medicine
Tampa, Florida

Emilio C. Campos, MD

Professor of Ophthalmology
University of Bologna
Chief of Ophthalmology
S. Orsola-Malpighi Teaching Hospital
Bologna, Italy






Physiology of the Sensiorimotor Cooperation of the Eyes

  1. General Introduction

    The Eyes as a Sensorimotor Unit
    The Tasks of the Motor System
    Nature and Control of Ocular Movements
    Empiricism and Nativism

  2. Binocular Vision and Space Perception

    Fusion, Diplopia, and the Law of Sensory Correspondence
    Retinal Rivalry
    Objective (Physical) and Subjective (Visual) Space
    Distribution of Corresponding Retinal Elements
    Physiologic Diplopia
    Panum's Area of Single Binocular Vision
    Fixation Disparity
    Monocular (Nonstereoscopic) Clues to Spatial Orientation
    Experimental Determination of the Longitudinal Horopter and the Criteria of Retinal Correspondence
    Egocentric (Absolute) Localization
    Theories of Binocular Vision
    Advantages of Binocular Vision

  3. Summary of the Gross Anatomy of the Extraocular Muscles

    Rectus Muscles
    Oblique Muscles
    Fascial System
    Developmental Anamolies of Extraocular Muscles and the Fascial System
    Innervation of Extraocular Muscles
    Blood Supply of Extraocular Muscles

  4. Physiology of the Ocular Movements

    Basic Kinematics
    The Fundamental Laws of Ocular Motility
    Survey of Ocular Movements and Their Characteristics
    Fixation and the Field of Fusion

  5. The Near Vision Complex

    Pupillary Constriction

  6. Histology and Physiology of the Extraocular Muscles

    Structure and Function of the Extraocular Muscles
    Structural and Functional Correlations
    Muscle Spindles and Palisade Endings in the Extraocular Muscles
    Sources of Tonus of the Extraocular Muscles

  7. Visual Acuity, Geometric Optical Effects of Spectacles, and Aniseikonia

    Visual Acuity
    Geometric Optical Effects of Spectacles


    Introduction to Neuromuscular Anomalies of the Eyes

  8. Classification of Neuromuscular Anomalies of the Eyes

    Heterophoria and Heterotropia
    Relative and Absolute Position of Rest
    Ocular Alignment
    Direction of Deviation
    Comitance and Incomitance
    Constancy of Deviation
    State of Vergence Systems
    Type of Fixation
    Time of Onset of Deviation
    Paralytic Strabismus
    Mechanical-Restrictive Strabismus
    Orbital Strabismus

  9. Etiology of Heterophoria and Heterotropia

    Factors Reponsible for the Manifestation of a Deviation
    Factors Causing the Underlying Deviation
    Genectics of Comitant Strabismus
    Concluding Remarks

  10. Symptoms in Heterophoria and Heterotropia and the Physiological Effects of Strabismus

    Asthenopia and Diplopia
    Phsychological Effects of Strabismus

  11. Examination of the Patient - I

    Assessment of Visual Acuity in Children

  12. Examination of the Patient - II
    Motor Signs in Heterophoria and Heterotropia

    Inspection of the Eyes and Head Position
    Determination of Presence of a Deviation - Cover and Cover-Uncover Tests
    Measurement of Deviation
    Examination of the Motor Cooperation of the Eyes

  13. Examination of the Patient - III
    Sensory Signs, Symptoms, and Binocular Adaptations in Strabismus

    Confusion and Diplopia
    Blind Spot Mechanism
    Anomalous Correspondence

  14. Examination of the Patient - IV

    Prevalence, Social and Psychosocial Factors
    Classification and Terminology
    Clinical Features of Strabismus Amblyopia
    Pathogenesis and Pathophysiology of Amblyopia
    Amblyopia vs. Suppression
    Experimental Amblyopia in Animal Models and Histologic Abnormalities in Brains of Human Amblyopes
    The Essence of Amblyopia

  15. Examination of the Patient - V
    Depth Perception

    Development of Stereopsis
    Steropsis and Strabismus
    Testing for Stereopsis


    Clinical Characteristics of Neuromuscular Anomalies of the Eye

  16. Esodeviations

    Esophoria and Intermittent Esotropia
    Accommodative Esotropia
    Partially Accommodative Esotropia
    Nonaccommodative Esotropia
    Recurrent Esotropia
    Secondary Esotropia
    Management of Surgical Overcorrections
    Esotropia Associated with Vertical Deviation

  17. Exodeviations

    Classification and Etiology
    Primary Exodeviations
    Dissociated Exodeviations
    Secondary Exodeviations

  18. Cyclovertical Deviations

    Comitant Hyperdeviations
    Dissociated Vertical Deviations
    Dissociated Horizontal Deviations
    Elevation in Adduction (Strabismus Sursoadductorius)
    Depression in Adduction (Strabismus Deorsoadductorius)

  19. A and V Patterns

    Clinical Findings and Diagnosis

  20. Paralytic Strabismus

    Diagnosis and Clinical Characteristics
    Paralysis of Individual Extraocular Muscles
    Skew Deviation
    Double Elevator Paralysis
    Double Depressor Paralysis
    Supranuclear and Internuclear Paralysis
    Therapy of Paralytic Strabismus

  21. Paralytic Strabismus

    Retraction Syndrome (Duane Syndrome
    Brown Syndrome
    Adherence Syndrome
    Strabismus Fixus
    Strabismus in High Myopia
    Fibrosis of the Extraocular Muscles
    Graves' Endocrine Ophthalmology
    Acute Orbital Myositis
    Cyclic Heterotropia
    Acquired Motor Fusion Deficiency
    Fracture of the Orbital Floor
    Fracture of the Medial Orbital Wall
    Superior Oblique Myokymia
    Ocular Myasthenia Gravis
    Chronic Progressive External Ophthalmoplegia (Ocular Myopathy of von Graefe)

  22. Anomalies of Convergence and Divergence

    Anomalies of Convergence
    Anomalies of Divergence

  23. Nystagmus

    Manifest Congenital Nystagmus
    Latent and Manifest-Latent Congenital Nystagmus


    Principals of Therapy

  24. Principles of Nonsurgical Treatment

    Optical Treatment
    Pharmacologic Treatment

  25. Chemodenervation of Extraocular Muscles - Botulinum Toxin

    Mechanisms of Action
    Injection Technique

  26. Principles of Surgical Treatment

    History and General Comments
    Choice of Operation
    Single vs. Multiple Procedures
    Preparation of Patient and Parents for Surgery
    Instruments, Sutures, Needles
    Surgical Techniques
    Postoperative Care