8 - ET XT Flashcards
When to give full cylco rx
Any ET
Giving a partial prescription of cyclo
- plus rx
- minus rx
Less plus
-e.g. +4.00 D cyclo = +3.00 rx
More minus
-e.g. -7.00 D cylco = -8.00 rx
(Both add minus)
Non-refractive accomm ET
- due to
- appearance
- rx seen
High AC/A
ET N>D (due to accomm at near)
Moderate hyperopia to myopia (similar to general pop)
Non-refractive accomm ET
-management
Full rx, bifocals based on AC/A ratio
Seg ht bisects pupil
Repeat cyclo yearly
Sx contraindicated (may be weaned off add)
Mixed accomm ET
-appearance/what it is
Combo of refractive accomm and non-refractive accomm findings
-high hyperopia and high AC/A
Mixed accomm ET
-management
Full hyperopic rx
Bifocal based on AC/A
Surgery contraindicated
Partially accomm ET
- accommodative contribution
- after tx
- when is it seen
Contributes to, but does not account for entire deviation
Reduction in angle w/ residual ET
May result after elayed tx of truly acccomm ET
Partially accomm ET
-appearance
Constant, unilateral
Suppression and ARC common
Early onset non-accomm ET
- onset
- appearance
After 6mo, before 2 years
-clinically similar to infantile ET, with later onset
ET same at D and N
Insignificant amount of hyperopia
Early onset non-accomm ET
-management
Refractive error, consider prism or bifocals
Amblyopia tx
VT for ranges
Consider surgery
Consider neuro causes (even if app healthy)
Acute aquired ET
- onset
- appearance
Sudden, 3-5 yo (or more)
Can be a result of illness, stress, aging
Comitant
Unilateral, constant, moderate angle (20-30pd)
Refractive error ~gen pop
Acute aquired ET
-management
Neuro eval ASAP
Correction
Prism/surgery to restore BV
Amblyopia tx if needed
Sensory ET
- cause
- appearance
Vision loss in one eye (cataract, K scarring, etc.)
Poor VA in affected eye
Constant, unilateral, 10-45pd
Poor cosmesis
Sensory ET
-management
Eliminate pathology if possible
Polycarb FTW
Tx secondary amblyopia
Surgery for residual deviation (cosmesis)
Divergence insufficiency ET
- appearance
- onset
Non-accomm ET D>N Comitant Diplopia at D HA Refractive error ~gen pop
Adults
Divergence insufficiency ET
-management
Neuro referral!!!!
Refractive error BO for diplopia at D VT Botox Surgery in some cases
Consecutive ET
-what
After strab surgery
Spontaneous improvement possible
BO prisms or plus lenses
Constant XT
- who
- tx
- examples
Older pts - sensory XT
Pts with longstanding XT that has decompensated
Surgery
Some pts appreciate enlarged VF
Infantile
Sensory
Infantile XT
- appearance
- onset
Large, constant (30-80pd)
Poor adduction versions, full on ductions
DVD, OIO common
Before 6mo
-less common than infantile ET
Infantile XT
- who
- tx
Often have neurological issues/craniofacial disorders
Refractive error
Amblyopia
Surgery
Sensory XT
- causes
- appearance
Anything causing vision loss in one eye
Poor VA, cosmesis
Constant, unilateral
Large angle
Sensory XT
-tx
If VA is improved -> surgery for alignment
If VA not correctable, sx will not help (will turn back)
Consecutive XT
- when
- likely result
Post surgery - months or years even
Atypical UHARC
Intermittent XT: divergence excess type
Childhood
N>D
Intermittent XT: basic type
Adults
D = N
Intermittent XT: convergence insufficiency type
Adults
N > D
Intermittent XT
- onset
- appearance
Before 5
Most common XT
Latent at times, becomes manifest (visual inattention, fatigue, stress, late in day)
Bright light may cause reflex closure of one eye
Intermittent XT
- associations
- untreated
- sensory adaptations
Small hypers
A/V pattern
Become constant
Diplopia -> suppression or ARC
Stereo and NRC present if control is good
Amblyopia not common unless constant early in life
Convergence insufficiency XT
- appearance/testing
- tx
N > D
Usually intermittent alternating at N
Low AC/A
Poor near fusional convergence amps, receded NPC
VT
BI reading glasses
