8 - ET XT

Question 1

When to give full cylco rx

Answer 1

Any ET

Question 2

Giving a partial prescription of cyclo

• plus rx
• minus rx

Answer 2

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)

Question 3

Non-refractive accomm ET

• due to
• appearance
• rx seen

Answer 3

High AC/A

ET N>D (due to accomm at near)

Moderate hyperopia to myopia (similar to general pop)

Question 4

Non-refractive accomm ET

-management

Answer 4

Full rx, bifocals based on AC/A ratio

Seg ht bisects pupil

Repeat cyclo yearly

Sx contraindicated (may be weaned off add)

Question 5

Mixed accomm ET

-appearance/what it is

Answer 5

Combo of refractive accomm and non-refractive accomm findings
-high hyperopia and high AC/A

Question 6

Mixed accomm ET

-management

Answer 6

Full hyperopic rx

Bifocal based on AC/A

Surgery contraindicated

Question 7

Partially accomm ET

• accommodative contribution
• after tx
• when is it seen

Answer 7

Contributes to, but does not account for entire deviation

Reduction in angle w/ residual ET

May result after elayed tx of truly acccomm ET

Question 8

Partially accomm ET

-appearance

Answer 8

Constant, unilateral

Suppression and ARC common

Question 9

Early onset non-accomm ET

• onset
• appearance

Answer 9

After 6mo, before 2 years
-clinically similar to infantile ET, with later onset

ET same at D and N
Insignificant amount of hyperopia

Question 10

Early onset non-accomm ET

-management

Answer 10

Refractive error, consider prism or bifocals

Amblyopia tx

VT for ranges

Consider surgery

Consider neuro causes (even if app healthy)

Question 11

Acute aquired ET

• onset
• appearance

Answer 11

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

Question 12

Acute aquired ET

-management

Answer 12

Neuro eval ASAP

Correction

Prism/surgery to restore BV

Amblyopia tx if needed

Question 13

Sensory ET

• cause
• appearance

Answer 13

Vision loss in one eye (cataract, K scarring, etc.)

Poor VA in affected eye
Constant, unilateral, 10-45pd
Poor cosmesis

Question 14

Sensory ET

-management

Answer 14

Eliminate pathology if possible

Polycarb FTW

Tx secondary amblyopia

Surgery for residual deviation (cosmesis)

Question 15

Divergence insufficiency ET

• appearance
• onset

Answer 15

Non-accomm ET D>N
Comitant
Diplopia at D
HA
Refractive error ~gen pop

Adults

Question 16

Divergence insufficiency ET

-management

Answer 16

Neuro referral!!!!

Refractive error
BO for diplopia at D
VT
Botox
Surgery in some cases

Question 17

Consecutive ET

-what

Answer 17

After strab surgery

Spontaneous improvement possible
BO prisms or plus lenses

Question 18

Constant XT

• who
• tx
• examples

Answer 18

Older pts - sensory XT
Pts with longstanding XT that has decompensated

Surgery
Some pts appreciate enlarged VF

Infantile
Sensory

Question 19

Infantile XT

• appearance
• onset

Answer 19

Large, constant (30-80pd)
Poor adduction versions, full on ductions
DVD, OIO common

Before 6mo
-less common than infantile ET

Question 20

Infantile XT

• who
• tx

Answer 20

Often have neurological issues/craniofacial disorders

Refractive error
Amblyopia
Surgery

Question 21

Sensory XT

• causes
• appearance

Answer 21

Anything causing vision loss in one eye

Poor VA, cosmesis
Constant, unilateral
Large angle

Question 22

Sensory XT

-tx

Answer 22

If VA is improved -> surgery for alignment

If VA not correctable, sx will not help (will turn back)

Question 23

Consecutive XT

• when
• likely result

Answer 23

Post surgery - months or years even

Atypical UHARC

Question 24

Intermittent XT: divergence excess type

Answer 24

Childhood

N>D

Question 25

Intermittent XT: basic type

Answer 25

Adults

D = N

Question 26

Intermittent XT: convergence insufficiency type

Answer 26

Adults

N > D

Question 27

Intermittent XT

• onset
• appearance

Answer 27

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

Question 28

Intermittent XT

• associations
• untreated
• sensory adaptations

Answer 28

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

Question 29

Convergence insufficiency XT

• appearance/testing
• tx

Answer 29

N > D
Usually intermittent alternating at N
Low AC/A
Poor near fusional convergence amps, receded NPC

VT
BI reading glasses