mx for incom + drugs

mx

Short term

-          Prisms – diplopia

-          Occlusion therapy if prism fails

-          AHP

-          Life style/ advice

-          Tx underlying condition

Long term

-          Sx for >20 angle

-          BT

Conservative

-          Observation

-          Orthoptic exercise

-          Occlusion therapy

-          Gls for RE

-          Prism

-          BT

sx incom

Surgical intervention

-          Weakening

o    Recession

o    Myectomy – partial/ complete muscle removal

o    Fadenisaton – posterior fixation w suture

Strengthening

-          Resection- shorten + reattach

-          Tuck – folded to shorten

-          Plication – suture muscle to sclera without cutting

Additional

-          Harada ito – torsion

-          Faden – AHP

-          Burification – up + down shoots

-          Fells modification – fine tune

-          Jensen – increase Abduction

additional sx

Adjustable sx

-          Suture fine tune after post op

Complication

-          Eyelid issue

-          Intractable dip

-          Endophthalmitis - infection

Goal

-          Orthotropic

-          Restore BSV

-          Reduce symp

-          Minimise risk

anaesthetics

Lidocaine 4% - local anesthetic, IOP, mx, Staining

• initial sting: avoid nenonates + hypersensitivity

Oxybuprocaine - IOP mx

• reversible Na+ channel blockee

Tetracaine - deep anesthetic

• avoid in neonates, hypersensitive

cyclo/ mydriatics

• cycloplentate - cyclo refraction - 24hrs - 1% (3-12yrs), 0.5% 12yrs+

• Tropicamide - clyco/mydriatric - shorter - fewe side effects - 0.5%-1%

• atropine - amblyopia tx, strong dilation - up to 7 days - avoid in cardiac ossies, causes photophobia

• phenylephrine - mydriatric only - avoid in heart/ asthma pts

stains

fluorescein - corneal staining, IOP mx

Antibiotic

chloramphenicol - bacterial conjunctivitis - systemic absorbtion, avoid neonates/ preg

fusidic acid - gram +Ve conjunctivitis - 2x/day dosing

storage

• keep lower than 25c

• out of sunglight

• keep in original packaging

• often refrigerated