|Year : 1979 | Volume
| Issue : 4 | Page : 141-143
Concomitant alternating squint
JN Rohatgi, CM Prasad, BK Prasad, Alok Kumar
Patna Med. College Patna, India
J N Rohatgi
Professor of Ophthalmology, Patna Med. College, Patna
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rohatgi J N, Prasad C M, Prasad B K, Kumar A. Concomitant alternating squint. Indian J Ophthalmol 1979;27:141-3
A study has been made on cases of alternating squint during the past ten years (1967-76) at the Patna Medical College Hospital. The incidence was found to be 23.6% of all concomitant squint cases (118 cases out of a total number of 500 cases of concomitant squint examined and treated).
(a) Alternating convergent cases: 56 (b) Alternating divergent cases: 62
It was found that a large percentage (52.5%) of these alternators were divergent in nature as compared to 47.5% of the convergent.
Saxena et al have also found a slightly higher figure for divergent alternators, Malik et al on the other hand, given a much higher figure of 68.51% for convergent alternators in their series.
The age at onset of deviation
The age at onset of deviation in majority of cases of convergent group was before the end of 2nd birth day whereas, in the divergent group of cases it was generally after the age of 2 years.
Age at the time of examination
We are all familiar with the various factors that prevent these children with squints from being examined and treated at an early age (when the deviation has just become obvious):
Factors like supcrsition, wrath of God, poverty, ignorance, inadequate medical facilities for ocular examination of school going children and to crown all an erroneous belief of our general medical practitioners that the squinting child may "grow out" of squint in course of time.
This would be clear from the tables given below:
Thus, a large number of cases with alternating convergent squints sought treatment at an earlier age (0-10 years) compared to cases of squint in which case, advise and treatment was requested for at a higher age (16 years or above).
A high angle of deviation of above 15° was commonly present in different age groups of both convergent and divergent series. Thus, out of 118 cases of alternating cases examined as many as 98 had large angle of squint between 15 to 45° and only 20 cases a deviation of less than 15° was recorded.
This concept of visual acquity being more or less equal but not necessarily normal in both eyes in such cases was found to be true in majority of cases where the visual acquity could be assessed.
That convergence is more common in hypermetropia and divergence more common in myopia is clearly borne out in this study, as shown in [Table - 4] below. There was, however, no definite relationship between the amount of deviation and the degree of refractive error.
Majority of the hypermetropic cases showed an error upto+2 Dioptres and myopic cases upto-1 Dioptre. The highest figure of hypermetropia recorded was- 6 Dioptre and myopia. upto-4 Diopre. Emmetropia condition was observed in 6 (10.7%) of convergent 14 cases (22.6%) of divergent series. Anisometropia with marked difference of the refractive error in the two eyes was found only in a few cases.
Simultaneous macular perception (SMP) could, however, be elicited in four or five cases with late onset of squint.
Correction of refractive error by appropriate glasses, orthoptic exercises and surgery are the sheet anchors of treatment in concomitant squint.
But all said and done the only line of treatment in such cases was found to be surgical correction of the deviation in one or both eyes which may in itself be of cosmetic value only. This at least provided the patient-children or young adults-with two good seeing eyes having normal ocular appearance and which moved together symmetrically and equally in all direction.
The minimum age at which a child was operated upon by us was four (4) years though the majority of the cases undergoing surgery were above the age of 10 years in both convergent and divergent group of case.
In our cases we have followed the principle of recession in order to weaken stronger muscle. For strengthening purposes we did resection of muscles in 15 cases only (9 convergent and 6 divergent) and in rest of the cases we have done tenoplication (buckling) which consistently gave a good result in our hand. We feel (Rchatgi, 1966) that buckling is an easy and safer operation which resulted in better correction. Any overcorrection could be rectified and modified easily.
| References|| |
Saxena, R.B. et al. 1971, Ind. J. of Orih. & Pleop. 8, 12.
Malik, S.R.K. et al., 1966, Ind. J. of Orth. & Pleop. 3,
Duke-Elder, S., 1949, Text Book of Ophthalmology, Vol. 14, Henry Kimpton Lond. 3809-41 and 3999-4025.
Rohatgi, J.N., 1966, Proceedings of All India O ph. Soc. 23,
[Table - 1], [Table - 2], [Table - 3], [Table - 4]