Table of Content
CCS2 Infantiel Scheelzien
2018-19 Orthoptie Jaar 2
Elise de Ruiter
HOGESCHOOL UTRECHT
,1 INFANTIELE ESOTROPIE...................................................................................................6
LEERDOELEN.................................................................................................................................6
LITERATUUR.................................................................................................................................6
DEFINITION & CLASSIFICATION.....................................................................................................6
ETIOLOGY.....................................................................................................................................7
ESSENTIAL INFANTILE (CONGENITAL) ESOTROPIA........................................................................8
Kenmerken......................................................................................................................................................8
Differentiaal Diagnosen................................................................................................................................10
Onderzoek.....................................................................................................................................................10
Behandeling..................................................................................................................................................11
NYSTAGMUS BLOCKAGE SYNDROME..........................................................................................13
Features........................................................................................................................................................13
Differentiaal Diagnose Infantiele ET en NBS.................................................................................................13
Management.................................................................................................................................................14
Casus Meisje 18 Maanden (WC5).................................................................................................................14
INFANTIELE ACCOMMODATIEVE ESOTROPIE..............................................................................15
Kenmerken....................................................................................................................................................15
Management.................................................................................................................................................15
CONGENITALE NERVUS VI PARESE..............................................................................................15
Kenmerken....................................................................................................................................................15
Differentiaal Diagnosen................................................................................................................................15
SECONDARY ESOTROPIA.............................................................................................................16
Kenmerken....................................................................................................................................................16
2 NYSTAGMUS.................................................................................................................17
LITERATUUR...............................................................................................................................17
DEFINITION AND CLASSIFICATION..............................................................................................17
OBSERVATION OF NYSTAGMUS..................................................................................................18
NYSTAGMUS NOTATION.............................................................................................................19
VORMEN VAN NYSTAGMUS.......................................................................................................20
Fysiologische Nystagmus..............................................................................................................................20
Vroeg Verworven Nystagmus.......................................................................................................................20
Op Volwassen Leeftijd Ontstane Nystagmus................................................................................................20
3 DISSOCIATED VERTICAL DEVIATION...............................................................................21
LEERDOELEN...............................................................................................................................21
LITERATUUR...............................................................................................................................21
DISSOCIATED VERTICAL DEVIATION............................................................................................21
Features........................................................................................................................................................21
Differential Diagnosis of DVD and Inferior Oblique Overaction...................................................................22
Investigation.................................................................................................................................................23
DVD ONDERZOEK EN BEREKENINGEN.........................................................................................25
Zuivere DVD..................................................................................................................................................25
DVD + Andere Verticale Deviaties................................................................................................................25
VD = DVD + RVD............................................................................................................................................25
Voorbeeld Opdrachten.................................................................................................................................26
1
, Schema Oogbewegingen..............................................................................................................................28
Bielschowsky bij DVD....................................................................................................................................30
CASUSSEN...................................................................................................................................31
Casus Patient 2 Jaar......................................................................................................................................31
Casus Meisje 19 Maanden............................................................................................................................32
4 DISSOCIATED HORIZONTAL DEVIATION.........................................................................33
LITERATUUR...............................................................................................................................33
DISSOCIATED HORIZONTAL DEVIATION......................................................................................33
Features........................................................................................................................................................33
Variants of DHD............................................................................................................................................33
Pathogenesis.................................................................................................................................................34
Differentiaal Diagnose..................................................................................................................................35
Investigation.................................................................................................................................................36
Management.................................................................................................................................................38
5 CHIRURGIE BIJ INFANTIELE ESOTROPIE EN DVD.............................................................39
LEERDOELEN...............................................................................................................................39
INFANTILE ESOTROPIA................................................................................................................40
NONSURGICAL MANAGEMENT....................................................................................................................40
SURGICAL MANAGEMENT............................................................................................................................41
DISSOCIATED VERTICAL DISSOCIATION.......................................................................................44
SURGICAL MANAGEMENT............................................................................................................................44
SURGICAL RECOMMENDATIONS FOR DVD..................................................................................................45
OPERATIEPLAN BEREKENEN.........................................................................................................................47
CHIRURGIE CASUSSEN................................................................................................................48
Casus DVD en Nervus IV Parese....................................................................................................................48
Casus DVD en V-Patroon...............................................................................................................................48
Casus DVD en A-Patroon...............................................................................................................................48
Casus DVD en Diepe Amblyopie...................................................................................................................48
Casus Job *....................................................................................................................................................49
Casus Kirsten.................................................................................................................................................50
FILMPJES INFANTIELE ESOTROPIE, DVD EN DHD.........................................................................51
Film 00058....................................................................................................................................................51
Film 00020....................................................................................................................................................51
Film 00039....................................................................................................................................................52
Film 00021....................................................................................................................................................52
Film 00005....................................................................................................................................................52
Film 00001....................................................................................................................................................53
Film 00055....................................................................................................................................................60
6 TORTICOLLIS & INFANTIELE EXOTROPIE.........................................................................62
LEERDOELEN...............................................................................................................................62
LITERATUUR...............................................................................................................................62
TORTICOLLIS...............................................................................................................................62
Componenten van een Torticollis.................................................................................................................62
Oorzaken van een Torticollis........................................................................................................................62
Onderzoek.....................................................................................................................................................63
Monocular Versus Binocular Origin of Torticollis.........................................................................................64
Schema Torticollis.........................................................................................................................................65
2
, INFANTILE (EARLY-ONSET) EXOTROPIA.......................................................................................66
Features........................................................................................................................................................66
Investigation.................................................................................................................................................66
Management.................................................................................................................................................66
Casus Baby 4 Maanden.................................................................................................................................67
CASUSSEN...................................................................................................................................68
1 INFANTIELE ESOTROPIE...................................................................................................4
LEERDOELEN.................................................................................................................................4
LITERATUUR.................................................................................................................................4
DEFINITION & CLASSIFICATION....................................................................................................4
ETIOLOGY.....................................................................................................................................5
ESSENTIAL INFANTILE (CONGENITAL) ESOTROPIA........................................................................6
Kenmerken.....................................................................................................................................................6
Differentiaal Diagnosen..................................................................................................................................8
Onderzoek......................................................................................................................................................8
Behandeling....................................................................................................................................................9
NYSTAGMUS BLOCKAGE SYNDROME.........................................................................................11
Features........................................................................................................................................................11
Differentiaal Diagnose Infantiele ET en NBS................................................................................................11
Management................................................................................................................................................12
Casus Meisje 18 Maanden (WC5).................................................................................................................12
INFANTIELE ACCOMMODATIEVE ESOTROPIE..............................................................................13
Kenmerken...................................................................................................................................................13
Management................................................................................................................................................13
CONGENITALE NERVUS VI PARESE..............................................................................................13
Kenmerken...................................................................................................................................................13
Differentiaal Diagnosen................................................................................................................................13
SECONDARY ESOTROPIA............................................................................................................14
Kenmerken...................................................................................................................................................14
2 NYSTAGMUS.................................................................................................................15
LITERATUUR...............................................................................................................................15
DEFINITION AND CLASSIFICATION..............................................................................................15
OBSERVATION OF NYSTAGMUS.................................................................................................16
NYSTAGMUS NOTATION............................................................................................................17
VORMEN VAN NYSTAGMUS.......................................................................................................18
Fysiologische Nystagmus..............................................................................................................................18
Vroeg Verworven Nystagmus.......................................................................................................................18
Op Volwassen Leeftijd Ontstane Nystagmus...............................................................................................18
3 DISSOCIATED VERTICAL DEVIATION...............................................................................19
LEERDOELEN...............................................................................................................................19
LITERATUUR...............................................................................................................................19
DISSOCIATED VERTICAL DEVIATION...........................................................................................19
Features........................................................................................................................................................19
Differential Diagnosis of DVD and Inferior Oblique Overaction...................................................................20
3
, Investigation.................................................................................................................................................21
DVD ONDERZOEK EN BEREKENINGEN.........................................................................................23
Zuivere DVD..................................................................................................................................................23
DVD + Andere Verticale Deviaties................................................................................................................23
VD = DVD + RVD............................................................................................................................................23
Voorbeeld Opdrachten.................................................................................................................................24
Schema Oogbewegingen..............................................................................................................................26
Bielschowsky bij DVD....................................................................................................................................28
CASUSSEN..................................................................................................................................29
Casus Patient 2 Jaar......................................................................................................................................29
Casus Meisje 19 Maanden............................................................................................................................30
4 DISSOCIATED HORIZONTAL DEVIATION.........................................................................31
LITERATUUR...............................................................................................................................31
DISSOCIATED HORIZONTAL DEVIATION......................................................................................31
Features........................................................................................................................................................31
Variants of DHD............................................................................................................................................31
Pathogenesis.................................................................................................................................................32
Differentiaal Diagnose..................................................................................................................................33
Investigation.................................................................................................................................................34
Management................................................................................................................................................36
5 CHIRURGIE BIJ INFANTIELE ESOTROPIE EN DVD.............................................................37
LEERDOELEN...............................................................................................................................37
INFANTILE ESOTROPIA................................................................................................................38
NONSURGICAL MANAGEMENT....................................................................................................................38
SURGICAL MANAGEMENT............................................................................................................................39
DISSOCIATED VERTICAL DISSOCIATION......................................................................................42
SURGICAL MANAGEMENT............................................................................................................................42
SURGICAL RECOMMENDATIONS FOR DVD..................................................................................................43
OPERATIEPLAN BEREKENEN.........................................................................................................................45
CHIRURGIE CASUSSEN................................................................................................................46
Casus DVD en Nervus IV Parese...................................................................................................................46
Casus DVD en V-Patroon..............................................................................................................................46
Casus DVD en A-Patroon..............................................................................................................................46
Casus DVD en Diepe Amblyopie...................................................................................................................46
Casus Job......................................................................................................................................................47
Casus Kirsten................................................................................................................................................48
FILMPJES INFANTIELE ESOTROPIE, DVD EN DHD.........................................................................49
Film 00058....................................................................................................................................................49
Film 00020....................................................................................................................................................49
Film 00039....................................................................................................................................................50
Film 00021....................................................................................................................................................50
Film 00005....................................................................................................................................................50
Film 00001....................................................................................................................................................51
Film 00055....................................................................................................................................................52
6 TORTICOLLIS & INFANTIELE EXOTROPIE.........................................................................53
LEERDOELEN...............................................................................................................................53
LITERATUUR...............................................................................................................................53
4
, TORTICOLLIS...............................................................................................................................53
Componenten van een Torticollis................................................................................................................53
Oorzaken van een Torticollis........................................................................................................................53
Onderzoek....................................................................................................................................................54
Monocular Versus Binocular Origin of Torticollis.........................................................................................55
Schema Torticollis.........................................................................................................................................56
INFANTIELE (EARLY-ONSET) EXOTROPIA.....................................................................................57
Features........................................................................................................................................................57
Investigation.................................................................................................................................................57
Management................................................................................................................................................57
Casus Baby 4 Maanden................................................................................................................................58
CASUSSEN..................................................................................................................................59
5
,1 INFANTIELE ESOTROPIE
LEERDOELEN
Na het volgen van deze les kun je:
infantiele esotropie indelen volgens het COD
de kenmerken van essentiële infantiel esotropie benoemen en hoe te onderzoeken
de relatie aangeven tussen essentiële infantiele esotropie en geassocieerde tekenen
verschillende behandelingsmogelijkheden aangeven met betrekking tot de visus en
de oogstand met daarbij de voor- en nadelen.
LITERATUUR
Ansons & Davis (2014) Hoofdstuk 14, p. 380-391
Ansons & Davis (2014) Hoofdstuk 6, p. 124-126
DEFINITION & CLASSIFICATION
Infantile esotropia is used to describe a persistent esotropic deviation with an onset in the
first six months of life. It may take various forms:
Essential infantile esotropia
With DVD
Without DVD
Nystagmus blockage syndrome
Accommodative infantile esotropia
Congenital sixth nerve palsy
Secondary infantile esotropia
Note: Reports demonstrate that the eyes are quite instable in the first 6 months of life and
emphasize the unreliability of the given age of onset.
6
, ETIOLOGY
Research implicates cerebral cortex maldevelopment as the cause of infantile esotropia.
Proper alignment of the eyes requires fusion between monocular visual input
channels in the striate cortex (area V1).
o Rechte oogstand => uitwisseling van twee monoculaire inputkanalen in V1
V1 binocular connections are immature at birth, maturing
during a critical period in the first months of life. Maturation
of fusion and V1 binocular connections requires correlated
(synchronized) input from each eye.
o Bij geboorte geen binoculaire connectie en
fusiereflexen. Kritische periode in de eerste maanden.
Vereist gesynchroniseerde input van beide ogen.
Nasalward biases (nasal retina is stronger and more mature at birth) are present
before maturation of binocularity. If maturation of binocularity gets impeded, the
nasalward biases take over and esotropia results.
o Congenitaal nasal gedreven bias (nasale retinahelft sterker/eerder
ontwikkelt) in neurale banen aanwezig.
o Belemmering maturatie => nasale bias => infantiele esotropie
Risk factors for cerebral cortex maldevelopment (=> impeded maturation of binocularity,
leading to esotropia due to nasalward biases):
Vroeg cerebrale beschadiging
o Parieto-occipitale cortex en onderliggende gebieden
o Periventriculaire en intraventriculaire bloedingen
o Downsyndroom
o Laag geboortegewicht
Cytotoxische insulten van cerebrale zenuwvezels
o De isolatiecellen tussen de CGL en oculaire dominantiekolommen zijn erg
gevoelig voor cytotoxische beschadiging
o V1 hoog neuro-glia ratio => hoge glucoseconsumptie => gevoelig voor
hypoxische beschadiging
Genetische invloed op formatie van cerebrale connecties
o Ouder strabismus: kind 30% kans
o Monozygote tweeling: 73%
o Multifactorieel erfelijk
Abnormale ontwikkeling van corticale binoculaire
verbindingen
Metabolische suppressie
7
CCS2 Infantiel Scheelzien
2018-19 Orthoptie Jaar 2
Elise de Ruiter
HOGESCHOOL UTRECHT
,1 INFANTIELE ESOTROPIE...................................................................................................6
LEERDOELEN.................................................................................................................................6
LITERATUUR.................................................................................................................................6
DEFINITION & CLASSIFICATION.....................................................................................................6
ETIOLOGY.....................................................................................................................................7
ESSENTIAL INFANTILE (CONGENITAL) ESOTROPIA........................................................................8
Kenmerken......................................................................................................................................................8
Differentiaal Diagnosen................................................................................................................................10
Onderzoek.....................................................................................................................................................10
Behandeling..................................................................................................................................................11
NYSTAGMUS BLOCKAGE SYNDROME..........................................................................................13
Features........................................................................................................................................................13
Differentiaal Diagnose Infantiele ET en NBS.................................................................................................13
Management.................................................................................................................................................14
Casus Meisje 18 Maanden (WC5).................................................................................................................14
INFANTIELE ACCOMMODATIEVE ESOTROPIE..............................................................................15
Kenmerken....................................................................................................................................................15
Management.................................................................................................................................................15
CONGENITALE NERVUS VI PARESE..............................................................................................15
Kenmerken....................................................................................................................................................15
Differentiaal Diagnosen................................................................................................................................15
SECONDARY ESOTROPIA.............................................................................................................16
Kenmerken....................................................................................................................................................16
2 NYSTAGMUS.................................................................................................................17
LITERATUUR...............................................................................................................................17
DEFINITION AND CLASSIFICATION..............................................................................................17
OBSERVATION OF NYSTAGMUS..................................................................................................18
NYSTAGMUS NOTATION.............................................................................................................19
VORMEN VAN NYSTAGMUS.......................................................................................................20
Fysiologische Nystagmus..............................................................................................................................20
Vroeg Verworven Nystagmus.......................................................................................................................20
Op Volwassen Leeftijd Ontstane Nystagmus................................................................................................20
3 DISSOCIATED VERTICAL DEVIATION...............................................................................21
LEERDOELEN...............................................................................................................................21
LITERATUUR...............................................................................................................................21
DISSOCIATED VERTICAL DEVIATION............................................................................................21
Features........................................................................................................................................................21
Differential Diagnosis of DVD and Inferior Oblique Overaction...................................................................22
Investigation.................................................................................................................................................23
DVD ONDERZOEK EN BEREKENINGEN.........................................................................................25
Zuivere DVD..................................................................................................................................................25
DVD + Andere Verticale Deviaties................................................................................................................25
VD = DVD + RVD............................................................................................................................................25
Voorbeeld Opdrachten.................................................................................................................................26
1
, Schema Oogbewegingen..............................................................................................................................28
Bielschowsky bij DVD....................................................................................................................................30
CASUSSEN...................................................................................................................................31
Casus Patient 2 Jaar......................................................................................................................................31
Casus Meisje 19 Maanden............................................................................................................................32
4 DISSOCIATED HORIZONTAL DEVIATION.........................................................................33
LITERATUUR...............................................................................................................................33
DISSOCIATED HORIZONTAL DEVIATION......................................................................................33
Features........................................................................................................................................................33
Variants of DHD............................................................................................................................................33
Pathogenesis.................................................................................................................................................34
Differentiaal Diagnose..................................................................................................................................35
Investigation.................................................................................................................................................36
Management.................................................................................................................................................38
5 CHIRURGIE BIJ INFANTIELE ESOTROPIE EN DVD.............................................................39
LEERDOELEN...............................................................................................................................39
INFANTILE ESOTROPIA................................................................................................................40
NONSURGICAL MANAGEMENT....................................................................................................................40
SURGICAL MANAGEMENT............................................................................................................................41
DISSOCIATED VERTICAL DISSOCIATION.......................................................................................44
SURGICAL MANAGEMENT............................................................................................................................44
SURGICAL RECOMMENDATIONS FOR DVD..................................................................................................45
OPERATIEPLAN BEREKENEN.........................................................................................................................47
CHIRURGIE CASUSSEN................................................................................................................48
Casus DVD en Nervus IV Parese....................................................................................................................48
Casus DVD en V-Patroon...............................................................................................................................48
Casus DVD en A-Patroon...............................................................................................................................48
Casus DVD en Diepe Amblyopie...................................................................................................................48
Casus Job *....................................................................................................................................................49
Casus Kirsten.................................................................................................................................................50
FILMPJES INFANTIELE ESOTROPIE, DVD EN DHD.........................................................................51
Film 00058....................................................................................................................................................51
Film 00020....................................................................................................................................................51
Film 00039....................................................................................................................................................52
Film 00021....................................................................................................................................................52
Film 00005....................................................................................................................................................52
Film 00001....................................................................................................................................................53
Film 00055....................................................................................................................................................60
6 TORTICOLLIS & INFANTIELE EXOTROPIE.........................................................................62
LEERDOELEN...............................................................................................................................62
LITERATUUR...............................................................................................................................62
TORTICOLLIS...............................................................................................................................62
Componenten van een Torticollis.................................................................................................................62
Oorzaken van een Torticollis........................................................................................................................62
Onderzoek.....................................................................................................................................................63
Monocular Versus Binocular Origin of Torticollis.........................................................................................64
Schema Torticollis.........................................................................................................................................65
2
, INFANTILE (EARLY-ONSET) EXOTROPIA.......................................................................................66
Features........................................................................................................................................................66
Investigation.................................................................................................................................................66
Management.................................................................................................................................................66
Casus Baby 4 Maanden.................................................................................................................................67
CASUSSEN...................................................................................................................................68
1 INFANTIELE ESOTROPIE...................................................................................................4
LEERDOELEN.................................................................................................................................4
LITERATUUR.................................................................................................................................4
DEFINITION & CLASSIFICATION....................................................................................................4
ETIOLOGY.....................................................................................................................................5
ESSENTIAL INFANTILE (CONGENITAL) ESOTROPIA........................................................................6
Kenmerken.....................................................................................................................................................6
Differentiaal Diagnosen..................................................................................................................................8
Onderzoek......................................................................................................................................................8
Behandeling....................................................................................................................................................9
NYSTAGMUS BLOCKAGE SYNDROME.........................................................................................11
Features........................................................................................................................................................11
Differentiaal Diagnose Infantiele ET en NBS................................................................................................11
Management................................................................................................................................................12
Casus Meisje 18 Maanden (WC5).................................................................................................................12
INFANTIELE ACCOMMODATIEVE ESOTROPIE..............................................................................13
Kenmerken...................................................................................................................................................13
Management................................................................................................................................................13
CONGENITALE NERVUS VI PARESE..............................................................................................13
Kenmerken...................................................................................................................................................13
Differentiaal Diagnosen................................................................................................................................13
SECONDARY ESOTROPIA............................................................................................................14
Kenmerken...................................................................................................................................................14
2 NYSTAGMUS.................................................................................................................15
LITERATUUR...............................................................................................................................15
DEFINITION AND CLASSIFICATION..............................................................................................15
OBSERVATION OF NYSTAGMUS.................................................................................................16
NYSTAGMUS NOTATION............................................................................................................17
VORMEN VAN NYSTAGMUS.......................................................................................................18
Fysiologische Nystagmus..............................................................................................................................18
Vroeg Verworven Nystagmus.......................................................................................................................18
Op Volwassen Leeftijd Ontstane Nystagmus...............................................................................................18
3 DISSOCIATED VERTICAL DEVIATION...............................................................................19
LEERDOELEN...............................................................................................................................19
LITERATUUR...............................................................................................................................19
DISSOCIATED VERTICAL DEVIATION...........................................................................................19
Features........................................................................................................................................................19
Differential Diagnosis of DVD and Inferior Oblique Overaction...................................................................20
3
, Investigation.................................................................................................................................................21
DVD ONDERZOEK EN BEREKENINGEN.........................................................................................23
Zuivere DVD..................................................................................................................................................23
DVD + Andere Verticale Deviaties................................................................................................................23
VD = DVD + RVD............................................................................................................................................23
Voorbeeld Opdrachten.................................................................................................................................24
Schema Oogbewegingen..............................................................................................................................26
Bielschowsky bij DVD....................................................................................................................................28
CASUSSEN..................................................................................................................................29
Casus Patient 2 Jaar......................................................................................................................................29
Casus Meisje 19 Maanden............................................................................................................................30
4 DISSOCIATED HORIZONTAL DEVIATION.........................................................................31
LITERATUUR...............................................................................................................................31
DISSOCIATED HORIZONTAL DEVIATION......................................................................................31
Features........................................................................................................................................................31
Variants of DHD............................................................................................................................................31
Pathogenesis.................................................................................................................................................32
Differentiaal Diagnose..................................................................................................................................33
Investigation.................................................................................................................................................34
Management................................................................................................................................................36
5 CHIRURGIE BIJ INFANTIELE ESOTROPIE EN DVD.............................................................37
LEERDOELEN...............................................................................................................................37
INFANTILE ESOTROPIA................................................................................................................38
NONSURGICAL MANAGEMENT....................................................................................................................38
SURGICAL MANAGEMENT............................................................................................................................39
DISSOCIATED VERTICAL DISSOCIATION......................................................................................42
SURGICAL MANAGEMENT............................................................................................................................42
SURGICAL RECOMMENDATIONS FOR DVD..................................................................................................43
OPERATIEPLAN BEREKENEN.........................................................................................................................45
CHIRURGIE CASUSSEN................................................................................................................46
Casus DVD en Nervus IV Parese...................................................................................................................46
Casus DVD en V-Patroon..............................................................................................................................46
Casus DVD en A-Patroon..............................................................................................................................46
Casus DVD en Diepe Amblyopie...................................................................................................................46
Casus Job......................................................................................................................................................47
Casus Kirsten................................................................................................................................................48
FILMPJES INFANTIELE ESOTROPIE, DVD EN DHD.........................................................................49
Film 00058....................................................................................................................................................49
Film 00020....................................................................................................................................................49
Film 00039....................................................................................................................................................50
Film 00021....................................................................................................................................................50
Film 00005....................................................................................................................................................50
Film 00001....................................................................................................................................................51
Film 00055....................................................................................................................................................52
6 TORTICOLLIS & INFANTIELE EXOTROPIE.........................................................................53
LEERDOELEN...............................................................................................................................53
LITERATUUR...............................................................................................................................53
4
, TORTICOLLIS...............................................................................................................................53
Componenten van een Torticollis................................................................................................................53
Oorzaken van een Torticollis........................................................................................................................53
Onderzoek....................................................................................................................................................54
Monocular Versus Binocular Origin of Torticollis.........................................................................................55
Schema Torticollis.........................................................................................................................................56
INFANTIELE (EARLY-ONSET) EXOTROPIA.....................................................................................57
Features........................................................................................................................................................57
Investigation.................................................................................................................................................57
Management................................................................................................................................................57
Casus Baby 4 Maanden................................................................................................................................58
CASUSSEN..................................................................................................................................59
5
,1 INFANTIELE ESOTROPIE
LEERDOELEN
Na het volgen van deze les kun je:
infantiele esotropie indelen volgens het COD
de kenmerken van essentiële infantiel esotropie benoemen en hoe te onderzoeken
de relatie aangeven tussen essentiële infantiele esotropie en geassocieerde tekenen
verschillende behandelingsmogelijkheden aangeven met betrekking tot de visus en
de oogstand met daarbij de voor- en nadelen.
LITERATUUR
Ansons & Davis (2014) Hoofdstuk 14, p. 380-391
Ansons & Davis (2014) Hoofdstuk 6, p. 124-126
DEFINITION & CLASSIFICATION
Infantile esotropia is used to describe a persistent esotropic deviation with an onset in the
first six months of life. It may take various forms:
Essential infantile esotropia
With DVD
Without DVD
Nystagmus blockage syndrome
Accommodative infantile esotropia
Congenital sixth nerve palsy
Secondary infantile esotropia
Note: Reports demonstrate that the eyes are quite instable in the first 6 months of life and
emphasize the unreliability of the given age of onset.
6
, ETIOLOGY
Research implicates cerebral cortex maldevelopment as the cause of infantile esotropia.
Proper alignment of the eyes requires fusion between monocular visual input
channels in the striate cortex (area V1).
o Rechte oogstand => uitwisseling van twee monoculaire inputkanalen in V1
V1 binocular connections are immature at birth, maturing
during a critical period in the first months of life. Maturation
of fusion and V1 binocular connections requires correlated
(synchronized) input from each eye.
o Bij geboorte geen binoculaire connectie en
fusiereflexen. Kritische periode in de eerste maanden.
Vereist gesynchroniseerde input van beide ogen.
Nasalward biases (nasal retina is stronger and more mature at birth) are present
before maturation of binocularity. If maturation of binocularity gets impeded, the
nasalward biases take over and esotropia results.
o Congenitaal nasal gedreven bias (nasale retinahelft sterker/eerder
ontwikkelt) in neurale banen aanwezig.
o Belemmering maturatie => nasale bias => infantiele esotropie
Risk factors for cerebral cortex maldevelopment (=> impeded maturation of binocularity,
leading to esotropia due to nasalward biases):
Vroeg cerebrale beschadiging
o Parieto-occipitale cortex en onderliggende gebieden
o Periventriculaire en intraventriculaire bloedingen
o Downsyndroom
o Laag geboortegewicht
Cytotoxische insulten van cerebrale zenuwvezels
o De isolatiecellen tussen de CGL en oculaire dominantiekolommen zijn erg
gevoelig voor cytotoxische beschadiging
o V1 hoog neuro-glia ratio => hoge glucoseconsumptie => gevoelig voor
hypoxische beschadiging
Genetische invloed op formatie van cerebrale connecties
o Ouder strabismus: kind 30% kans
o Monozygote tweeling: 73%
o Multifactorieel erfelijk
Abnormale ontwikkeling van corticale binoculaire
verbindingen
Metabolische suppressie
7
