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The cause of congenital fourth nerve palsy is unclear in most cases. It may be neurogenic in origin, due to a dysgenesis of the CN IV nucleus or nerve, but a clinically similar palsy may result from absence or mechanical dysfunction (e.g., abnormal laxity) of the superior oblique tendon.
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Accommodative insufficiency (AI) involves the inability of the eye to focus properly on an object. Accommodation is the adjustment of the curvature of the lens to focus on objects near and far. In this condition, amplitude of accommodation of a person is lesser compared to physiological limits for his age. [ 1 ]
Management can occur with eyeglasses, contact lenses, or refractive corneal surgeries. [2] Glasses are easiest while contact lenses can provide a wider field of vision. [2] Surgery works by changing the shape of the cornea. [5] Far-sightedness primarily affects young children, with rates of 8% at 6 years old and 1% at 15 years old. [9]
Fixation disparity is a tendency of the eyes to drift in the direction of the heterophoria.While the heterophoria refers to a fusion-free vergence state, the fixation disparity refers to a small misalignment of the visual axes when both eyes are open in an observer with normal fusion and binocular vision. [1]
Patients who have accommodative spasm may benefit from being given glasses or contacts that account for the problem or by using vision therapy techniques to regain control of the accommodative system. Possible clinical findings include: Normal Amplitude of accommodation; Normal Near point of convergence; Reduced Negative relative accommodation
Keratoglobus (from Greek: kerato-horn, cornea; and Latin: globus round) is a degenerative non-inflammatory disorder of the eye in which structural changes within the cornea cause it to become extremely thin and change to a more globular shape than its normal gradual curve.
It consists of a white string of approximately 10 feet in length with three small wooden beads of different colors. [1] The Brock string is commonly employed during treatment of convergence insufficiency and other anomalies of binocular vision. It is used to develop skills of convergence as well as to disrupt suppression of one of the eyes. [1]