I. Purpose: To detect vision loss, eye position deviation, abnormal head position, diplopia, etc.
II. Relevant medical history
1.Time: The earlier the onset, the greater the possibility of producing amblyopia.
2. Causes: fever, shock, trauma, malnutrition, etc.
3. Symptoms: eye position deviation, diplopia, monocular photophobia, tilted head or side vision.
4.Personal history: birth status, presence of birth injury, hypoxia.
5.Family history: about one-fourth have family history.
C. Visual acuity
Distance visual acuity, near visual acuity, frontal visual acuity, compensatory head position visual acuity.
IV. Eye muscle examination
1.Ocular position.
(1) Corneal reflection method: distance 33cm, three points into a line. Simple and convenient, large error.
Recording method: external oblique “-“, internal oblique “+”, left high right “L/R”, right high left “R/L” The method of recording: internal rotation IN, external rotation EX.
Note: Pediatric internal obliquity should be viewed with a small visual scale for near obliquity; intermittent exotropia should be viewed for far obliquity; pupil size and deformation.
(2) Masking method.
Alternating masking-judge the presence of occlusion, qualitative examination.
Monocular masking de-masking-identify apparent and occult obliquity, quantitative examination; observe whether the first and second oblique perspectives are equal; determine the dominant eye.
(3) Synoptic machine examination.
Determination of strabismus angle and tertiary visual function of both eyes, accurate examination of horizontal strabismus, vertical strabismus and rotational strabismus, qualitative and quantitative.
Normal fusion point 0～+5°. Range of fusion: pooling range +25°～+35°. Separation range -4° to -8°.
Stereopsis: 60 arcs.
Horizontal strabismus: 15° of turn each for examination of frontal and horizontal.
Vertical strabismus: check 15 degrees each of frontal and horizontal and vertical turn, nine directions.
AV phenomenon: check 25 degrees of turn each directly above and directly below.
(4) Trigeminal examination.
Normal person looking near -8Δ external oblique, looking far +5Δ internal oblique.
Normal retinal counterparts: trigonometry + marsupial, subjective examination.
Abnormal retinal counterparts: trigonometry + masking method, objective examination.
The following are examined separately: left and right eye gaze strabismus; distance and near strabismus; naked eye and spectacle strabismus.
2.Ocular movement
Monocular movement: check the compensatory function of eye movement.
Binocular movement: to determine the coordination of a group of mate muscles in both eyes (nine diagnostic eye positions).
3.AV phenomenon
V sign ≥ 15Δ and A sign ≥ 10Δ at 25Ο up and 25Ο down rotation of the same eye machine.
4.Double marsupial rods: quantitative examination of rotational strabismus.
Diplopia image examination: qualitative examination of fresh paralytic strabismus, three-step method.
1.The nature of diplopia: ipsilateral, cross, horizontal, vertical
2.What direction of object image has the greatest separation
3.Which eye is the peripheral object image