SENSORY TEST. 1. [image] Orbit Eye Center for Pediatrics & Oculoplasty. 

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[image] Orbit
Eye Center
for Pediatrics & Oculoplasty

1. Worth Four Lights. This is a dissociation test which can be used with both distance & near fixation to differentiate b/w BSV, ARC & suppression. Results can only be interpreted if the presence or absence of a manifest squint is known at time of testing.. 

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This is a dissociation test which can be used with both distance & near fixation to differentiate b/w BSV, ARC & suppression.   Results can only be interpreted if the presence or absence of a manifest squint is known at time of testing.

Worth Four Lights. Apparatus: It consist of four circular lights two green one red and one white which are viewed through complementary red and green goggles. The red light is seen through the red filter and the green lights through the green filter, the white light is common to both eyes.. 

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Apparatus:  It consist of four circular lights two green one red and one white which are viewed through complementary red and green goggles.   The red light is seen through the red filter and the green lights through the green filter, the white light is common to both eyes.

Worth Four Lights. Procedure: • A patient wears a red green goggles with the red lens in front of the right eye, which filters out all colors except red ,and a green lens in front of the left eye, which filter out all colors except green . • The patient then views a box with four lights , one red, two green and one white.. 

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Procedure:  • A patient wears a red green goggles with the red lens in front of the right eye, which filters out all colors except red ,and a green lens in front of the left eye, which filter out all colors except green .  • The patient then views a box with four lights , one red, two green and one white.

Worth Four Lights. Results If BSV is present all four lights are seen If all four lights are seen in the presence of a manifest strabismus, ARC If two red lights are seen, left suppression is present If three green lights are seen, right suppression is present 5 dots, 2 Red in the left eye, 3 Green in the right eye, Uncrossed Diplopia. 5 dots, 3 Green dots in the left eye, 2 Red dots in the right eye-Crossed Diplopia, If the red and green lights are seen alternatively, alternating suppression is present. 

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Results If BSV is present all four lights are seen  If all four lights are seen in the presence of a manifest strabismus, ARC  If two red lights are seen, left suppression is present  If three green lights are seen, right suppression is present  5 dots, 2 Red in the left eye, 3 Green in the right eye, Uncrossed Diplopia. 5 dots, 3 Green dots in the left eye, 2 Red dots in the right eye-Crossed Diplopia, If the red and green lights are seen alternatively, alternating suppression is present

[image] o
In normal orthophoric eye
Suppression in left eye
suppression in right eye
Uncrosed diplopia with exotropia
Uncrosed diplopia with esotropi

Bagolini Striated Glasses. This is the test for detecting BSV, ARC Or suppression. The test can be used at 6m, 33cm. 

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This is the test for detecting BSV, ARC Or suppression.  The test can be used at 6m, 33cm

Bagolini Striated Glasses. 7. The apparatus consists of a pair of Plano glasses, marked with fine parallel striations at 45° on one glass & 135° on the other. When a spotlight is viewed through the glasses each produces a line image at 90°to the axis of the striation. 

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The apparatus consists of a pair of Plano glasses, marked with fine parallel striations at 45° on one glass & 135° on the other. When a spotlight is viewed through the glasses each produces a line image at 90°to the axis of the striation

Bagolini Striated Glasses. Procedure : The two lenses are placed at 45°& 135°in front of each eye & patient fixates a small light source Each eye perceives an oblique line of light , perpendicular to that perceived by the fellow eye Dissimilar images are thus presented to each eye under binocular viewing conditions.. 

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Procedure :  The two lenses are placed at 45°& 135°in front of each eye & patient fixates a small light source  Each eye perceives an oblique line of light , perpendicular to that perceived by the fellow eye  Dissimilar images are thus presented to each eye under binocular viewing conditions.

Bagolini Striated Glasses. Results: • If the two streaks intersects at their centers in the form of an oblique cross the patient has straight eyes with BSV or squint with ARC • If the lines do not cross in center, the patient has squint with NRC and diplopia • If only one streak is seen there is no simultaneous perception and suppression is present •If a small gap is seen in one of the streaks, a central suppression scotoma (as found in microtropia) is present. 

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Results:  • If the two streaks intersects at their centers in the form of an oblique cross the patient has straight eyes with BSV or squint with ARC  • If the lines do not cross in center, the patient has squint with NRC and diplopia • If only one streak is seen there is no simultaneous perception and suppression is present •If a small gap is seen in one of the streaks, a central suppression scotoma (as found in microtropia) is present

[image] \omal BSV
Suppression of onc Single linc
Esotropia with NRC
central scotoma

Purpose To confirm or rule out the presence of a small central scotoma.. 

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Purpose To confirm or rule out the presence of a small central scotoma.

A small central suppression zone should be suspected in a patient with 1. A slight reduction in visual acuity (20/25 to 20/40) in one eye 2. Mildly reduced stereopsis (30 to 80 seconds of arc). 3. Monofixation syndrome secondary to a small angle strabismus. 4. Macular diseases affecting the foveal area will create a similar clinical presentation.. 

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A small central suppression zone should be suspected in a patient with 1. A slight reduction in visual acuity (20/25 to 20/40) in one eye 2. Mildly reduced stereopsis (30 to 80 seconds of arc). 3. Monofixation syndrome secondary to a small angle strabismus. 4. Macular diseases affecting the foveal area will create a similar clinical presentation.

> Loose 4Δprism. > A distance visual acuity chart that can isolate letters.. 

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> Loose 4Δprism.


 > A distance visual acuity chart that can isolate letters.

LVN
ELZO
NO Y PA
X ODF
NV L TY
T F OH RADC

13. Mechanism of 4Δ BASE OUT TEST. Place 4Δ in front of one eye and observe the presence of a biphasic corrective movement of the other eye.. 

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Place 4Δ in front of one eye and observe the presence of a biphasic corrective movement of the other eye.

14. [image]. [image]. inward rotation of Right eye to re-fixate on fovea,. 

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inward rotation of Right eye to re-fixate on fovea,

What happen if we place Prism in front of one eye

The other eye will make a concomitant outward movement as predicted by Hering's law. The patient will then see double, so the left eye will make an inward refixation movement to avoid diplopia.

15. 115). Result: - No foveal suppression in both the eyes. 

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Result: - No foveal suppression in both the eyes

Refixation movement of Left eye indicating absence of foveal suppression in left eye

Levoversion occurs indicating absence of foveal suppression in Right eye

16. Case 2. Place 4Δ in front of one eye and observe the presence of a biphasic corrective movement of the other eye. 

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Place 4Δ in front of one eye and observe the presence of a biphasic corrective movement of the other eye

Levoversion occurs indicating absence of foveal suppression in right eye

No Refixation movement of Left eye indicating presence of loveal suppression in left eye

17. No movement of left eye indicating presence of foveal suppression in right eye. 

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No movement of left eye indicating presence of foveal suppression in right eye

Result: - Foveal suppression in Right eye

TITMUS FLY TEST /RANDOM DOTSTEREBUTTERFLY. It is based on the principle of linear polarization. Polaroid filters are worn, and a vertical image of a light source is seen through one filter and a horizontal image of light is seen through the other filter. The target are presented as vectographs The disparity produced by either eye results in stereopsis. 

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TITMUS FLY TEST /RANDOM DOTSTEREBUTTERFLY

It is based on the principle of linear polarization. Polaroid filters are worn, and a vertical image of a light source is seen through one filter and a horizontal image of light is seen through the other filter. The target are presented as vectographs The disparity produced by either eye results in stereopsis

TITMUS FLY TEST /RANDOM DOTSTEREO BUTTERFLY. One plate contains the image of a fly The second plate consists of nine boxes each containing four circles and three rows of animals One circle is displaced to produce disparity The image of one animal in each row also appears to stand out. 

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TITMUS FLY TEST /RANDOM DOTSTEREO BUTTERFLY

One plate contains the image of a fly The second plate consists of nine boxes each containing four circles and three rows of animals One circle is displaced to produce disparity  The image of one animal in each row also appears to stand out

A black and white sign with white text Description automatically generated. 

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A black and white sign with white text

Description automatically generated

TITMUS FLY TEST /
RANDOM DOT STEREO BUTTERFLY

The patient wears his /her correction and wears polaroid lenses over it The patient is first shown the fly ,asked to catch the fly by its wings If the fingers reach above the plate's patient has stereopsis if not the finger will touch the plate   In the second part of the test there are three rows of animals The patient is asked to push down the animal that stands out The third part of the test consists of nine squares with four circle in each of square  In each square one of the circle appears to stand out which the patient is asked to push down

After-image test. When using the afterimage test, a vertical bright light is directed at the left fovea and a horizontal bright light at the right fovea for 15 seconds each. The patient is then asked to draw the position of the afterimages. Perception of the afterimages is easiest when the patient closes their eyes or looks at a blank screen.. 

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When using the afterimage test, a vertical bright light is directed at the left fovea and a horizontal bright light at the right fovea for 15 seconds each.  The patient is then asked to draw the position of the afterimages.  Perception of the afterimages is easiest when the patient closes their eyes or looks at a blank screen.

22. Lea eF NRC NRC eye ate Patert•s. The results are interpreted as follows: Normal Retinal Correspondence: The patient will draw a cross (Fig.B). Right Esotropic Patient with Anomalous Retinal Correspondence (ARC): The patient will draw the vertical image to the left of the horizontal image (Fig.C). Right Exotropic Patient with ARC: The patient will draw the vertical image to the right of the horizontal image (Fig.D). ARC and Eccentric Fixation: In exotropia: The images will be in a crossed position (Fig.E). In esotropia: The images will be in an uncrossed position (Fig.F). Suppression: Left suppression: The patient may only draw the vertical image. Right suppression: The patient may only draw the horizontal image. Alternate suppression: The patient sees vertical and horizontal lines alternately.. 

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The results are interpreted as follows: Normal Retinal Correspondence: The patient will draw a cross (Fig.B). Right Esotropic Patient with Anomalous Retinal Correspondence (ARC): The patient will draw the vertical image to the left of the horizontal image (Fig.C). Right Exotropic Patient with ARC: The patient will draw the vertical image to the right of the horizontal image (Fig.D). ARC and Eccentric Fixation: In exotropia: The images will be in a crossed position (Fig.E). In esotropia: The images will be in an uncrossed position (Fig.F). Suppression: Left suppression: The patient may only draw the vertical image. Right suppression: The patient may only draw the horizontal image. Alternate suppression: The patient sees vertical and horizontal lines alternately.

23. Disadvantages: The afterimage test is the most un physiologic of all the tests for ARC, as afterimages and normal visual stimulation are so different that they cannot be easily compared. Small children often do not understand what they are supposed to observe.. 

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Disadvantages:
 The afterimage test is the most un physiologic of all the tests for ARC, as afterimages and normal visual stimulation are so different that they cannot be easily compared.
 Small children often do not understand what they are supposed to observe.

28. Reference. Leela Ahuja - Manual of Squint (2008) Pradeep Sharma MD FAMS / Sherwin Isenberg - Strabismus Simplified - 2nd Edition (2016) Sameera Irfan - Understanding Strabismus ( 2014) A.K. Khurana - Theory and Practice of Squint and Orthoptics 3rd Edition (2018) Dr. Subhash Dadeya /Dr. Savleen Kaur - Basic Examination of Strabismus. 

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Leela Ahuja - Manual of Squint (2008) Pradeep Sharma MD FAMS / Sherwin Isenberg - Strabismus Simplified - 2nd Edition (2016) Sameera Irfan - Understanding Strabismus ( 2014) A.K. Khurana - Theory and Practice of Squint and Orthoptics 3rd Edition (2018) Dr. Subhash Dadeya /Dr. Savleen Kaur - Basic Examination of Strabismus

6. Evaluation of a case of strabismus - Part 2