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Binocular Vision and Ocular Motility
THEORY AND MANAGEMENT OF STRABISMUS
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
CONTENTS
Preface
PART ONE
Physiology of the Sensiorimotor Cooperation of the Eyes
- General Introduction
The Eyes as a Sensorimotor Unit
The Tasks of the Motor System
Nature and Control of Ocular Movements
Empiricism and Nativism
- 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
Stereopsis
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
- 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
- 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
- The Near Vision Complex
Accomodation
Convergence
Pupillary Constriction
- 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
Electromyography
Sources of Tonus of the Extraocular Muscles
- Visual Acuity, Geometric Optical Effects of Spectacles, and Aniseikonia
Visual Acuity
Geometric Optical Effects of Spectacles
Aniseikonia
PART TWO
Introduction to Neuromuscular Anomalies of the Eyes
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
Etiology of Heterophoria and Heterotropia
Factors Reponsible for the Manifestation of a Deviation
Factors Causing the Underlying Deviation
Genectics of Comitant Strabismus
Concluding Remarks
Symptoms in Heterophoria and Heterotropia and the Physiological Effects of Strabismus
Asthenopia and Diplopia
Phsychological Effects of Strabismus
Examination of the Patient - I
Preliminaries
History
Assessment of Visual Acuity in Children
Refraction
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
Examination of the Patient - III
Sensory Signs, Symptoms, and Binocular Adaptations in Strabismus
Confusion and Diplopia
Suppression
Blind Spot Mechanism
Anomalous Correspondence
Examination of the Patient - IV
Amblyopia
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
Examination of the Patient - V
Depth Perception
Development of Stereopsis
Steropsis and Strabismus
Testing for Stereopsis
PART THREE
Clinical Characteristics of Neuromuscular Anomalies of the Eye
Esodeviations
Esophoria and Intermittent Esotropia
Accommodative Esotropia
Partially Accommodative Esotropia
Nonaccommodative Esotropia
Microtropia
Recurrent Esotropia
Secondary Esotropia
Management of Surgical Overcorrections
Esotropia Associated with Vertical Deviation
Exodeviations
Classification and Etiology
Primary Exodeviations
Dissociated Exodeviations
Secondary Exodeviations
Cyclovertical Deviations
Comitant Hyperdeviations
Dissociated Vertical Deviations
Dissociated Horizontal Deviations
Elevation in Adduction (Strabismus Sursoadductorius)
Depression in Adduction (Strabismus Deorsoadductorius)
Cyclodeviations
A and V Patterns
Etiology
Prevalence
Clinical Findings and Diagnosis
Treatment
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
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)
Anomalies of Convergence and Divergence
Anomalies of Convergence
Anomalies of Divergence
Nystagmus
Manifest Congenital Nystagmus
Latent and Manifest-Latent Congenital Nystagmus
Treatment
PART FOUR
Principals of Therapy
Principles of Nonsurgical Treatment
Optical Treatment
Pharmacologic Treatment
Orthoptics
Chemodenervation of Extraocular Muscles - Botulinum Toxin
Mechanisms of Action
Injection Technique
Indications
Principles of Surgical Treatment
History and General Comments
Choice of Operation
Single vs. Multiple Procedures
Preparation of Patient and Parents for Surgery
Anesthesia
Instruments, Sutures, Needles
Surgical Techniques
Complications
Overcorrections
Postoperative Care
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