Question

A 65 old male with a history of hypertension and diabetes, presents to the OPD with complaints of diplopia and squint. On examination, the secondary deviation is more than the primary deviation. Which of the following is most likely diagnosis

• A. concomitant squint
• B. paralytic squint
• C. Restrictive squint
• D. Pseudo squint

Answer 1

The Correct Option is B

A 65-year-old male has been presented with symptoms including diplopia (double vision) and squint. During the examination, it was noted that the secondary deviation is greater than the primary deviation. To determine the correct diagnosis from the given options, we need to understand the characteristics of each type of squint:

• Concomitant squint: In this type, the angle of deviation remains the same irrespective of the direction of gaze. The secondary deviation is equal to the primary deviation.
• Paralytic squint: This occurs due to paralysis of one or more extraocular muscles. It is characterized by the secondary deviation being more than the primary deviation, due to the normal muscle working against the paretic muscle.
• Restrictive squint: This occurs due to mechanical restriction of eye movements, rather than a deviation in the angle of squint.
• Pseudo squint: An apparent squint where there is no actual deviation of the visual axes; thus, angle deviations are not a concern.

Given that the examination shows the secondary deviation being more than the primary deviation, the most likely diagnosis is a paralytic squint, which aligns with the symptoms and examination findings provided.