Friday, December 23, 2011

Esotropia - nystagmus blockage syndrome

5/M/M came to the IIUM Optometry Clinic for follow up visit.
  • Prescription from last visit: 
  • RE: -6.00DS/-1.00DCX174      (6/15)
  • LE: -6.00DS/-1.00DCX15        (6/15)
  • mother complained that his performance is better after wearing the glasses
 
Test
RE
LE
VA with LEA Symbols (aided)
6/15
6/15
Hirschberg
Center and symmetrical
Cover test
Dist: cannot be obtained
Near: moderate esotropia with fast recovery
OMT
Nystagmus intensity increase upon abduction
Worth Four Dot
Dist: seen 5 light
Near: seen 4 light (2R,2G)
Stereopsis (Frisby)
300”
PCT
Dist: cannot be obtained
Near: 25∆ BO

from the examination, we found that he is;
  • BE amblyopia
  • Nystagmus intensity increase upon abduction
  • Nystagmus obvious at distance than near
  • Cover test at near reveal esotropia
Diagnosis
  • Esotropia nystagmus blockage syndrome
Management
  •  Alternate patching at least 2 hours/ day with near task
  • wear correction full time
TCA: 3/52 to review VA

By: Group 1

6 comments:

  1. can the hirschberg be central and symmetricaleven if the pt is esotropia????? eh????

    ReplyDelete
  2. it's probably because he's having nystagmus..since the eyes keep oscillating we got the reflex at central even with several trials..

    ReplyDelete
  3. btul tu, with pct u got around 25prism diopter, significant gak tu, and u said esotropia not phoria, normally hirchberg kita buat kat dekat kan, about same distance at pct near,
    and i think a few tentatif dx is
    v pattern or convergen exsess
    sorry kl my opian ni tak btul....or tak tetap
    kita blajaq sama2 kan

    ReplyDelete
  4. yep..supposedly it shud not be central & symmetry la kn..tp this is what we got..may be anyone could suggest the appropriate way to do hirschberg on nystagmus eyes?hee..i think it's hard to track the reflex when the eyes keeps moving.. ~x(

    ReplyDelete
  5. Opps sorry... there was a typo error... the hirschberg is actually 25 degree to temporal..now it make sense that this patient has esotropia...

    ReplyDelete
  6. izzah, maybe we can try to fit the pt with CL as it can reduce the nystagmus then we do the hirshberg (hehehe). there is a website stated that nystagmus pt, usually have some position where the nystagmus is decrease, mybe when he's at the position where the nystagmus decrease we can do the hirshberg http://www.lowvision.org/nystagmus.htm

    ReplyDelete

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