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Motility > B11 > Flashcards

B11 Flashcards

1
Q

a vision condition in which a person can not align both eyes simultaneously under normal conditions

A

Strabismus

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2
Q

When one or both of the eyes may turn in, out, up, or down

A

Strabismus

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3
Q

T/F: an eye turn can be constant or intermittent

A

True

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4
Q

What are the 4 causes of strabismus

A
  • congenital
  • accommodative ET
  • abnormal visual development
  • neurological
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5
Q

What are the 4 types of neurological strabismus

A
  • cranial nerve palsies
  • neurological disease
  • posterior fossa tumors or malformations
  • raised ICP
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6
Q

What are some symptoms someone with a strabismus may have

A
  • double vision
  • blurry vision
  • reduced peripheral vision
  • headaches
  • dizziness
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7
Q

CN3 innervates what? (EOMs, other muscles, etc.)

A

EOMs (SR, MR, IR, IO)
Superior palpebral levator muscle
Edinger-Westphal Nucleus

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8
Q

If someone has a CN3 palsy how will their eye be positioned or not be able to move?

A

Down and out

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9
Q

If someone has a CN3 palsy what will be some characteristics you will see?

A
  • the eye will be positioned down and out, or cant move down and out
  • there will be ptosis (due to SPL muscle not working)
  • dilated pupil and non-accommodative response (if EW nucleus isnt working)
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10
Q

What are the 4 etiologies in children with a CN3 palsy?

A
  • congenital
  • vascular
  • primary tumor
  • metastatic tumor
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11
Q

What are the 3 etiologies in young adults with a CN3 palsy?

A
  • demyelination
  • vascular
  • tumor
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12
Q

What are the 2 etiologies in older adults with a CN3 palsy?

A
  • vascular

- tumor

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13
Q

What are the 3 conditions related to an ischemic or vascular problem in a CN3 palsy?

A
  • diabetes
  • hypertension
  • pupil sparing
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14
Q

What the most common vascular related cause in adults with a CN3 palsy?

A

Diabetes

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15
Q

If the pupils arent affected in a CN3 palsy then its mostly what kind of problem?

A

Vascular

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16
Q

If there is something that is compressing on the nerve (more peripheral) then its probably a __ or an ___. If the cause is from these the patients eye will still be down and out but the pupils will be dilated with no accommodative response

A

Tumor or an aneurysm

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17
Q

What is the most common intracranial aneurysm in a CN3 palsy?

A

Posterior communicating artery

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18
Q

What are 2 types of non-pupil sparing etiologies for a CN3 palsy?

A
  • intracraninal aneurysm

- neoplasm

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19
Q

What are two other arteries that can be involved in an intracranial aneurysm? (CN3 palsy)

A

Internal carotid artery or basilar artery

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20
Q

What is an acute risk of an aneurysm rupturing in a CN3 palsy?

A

Subarachnoid hemorrhage (pain)

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21
Q

What are 2 types of neoplasms in a CN3 palsy?

A

Neuromas or schwannomas

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22
Q

What are 2 types of tumors that could be adjacent to the CN3 nerve?

A

Pituitary or sphenoid wing meningioma

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23
Q

What are 7 etiologies of a CN3 palsy?

A
  • Vascular
  • intracranial aneurysm
  • neoplasm (tumor)
  • trauma
  • migraine
  • inflammatory
  • infectious
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24
Q

What type of trauma could cause a CN3 palsy?

A

Severe blows to the head with skull fracture and/or loss of consciousness

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25
Q

What is a type of inflammatory condition that can cause a CN3 palsy?

A

MS

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26
Q

What are 2 types of infections that can cause a CN3 palsy?

A
  • meningitis

- viral

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27
Q

What are some tests you would want to do to evaluate a CN3 palsy?

A
  • case history
  • external observation
  • VA
  • cover test (would see exo, hypo)
  • EOMs
  • pupil testing
  • NPC
  • accommodation testing due to EWN
  • Hess Lancaster test
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28
Q

What muscle does CN4 innervate?

A

SO

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29
Q

If someone has a CN4 palsy what position will the eye be in or wont be able to move?

A

Eye up and in

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30
Q

People with a CN4 palsy usually has a head tilt to the ____ side of the palsy

A

Opposite

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31
Q

Someone with a CN4 palsy with a right head tilt will have an affected ____ SO palsy

A

Left SO palsy

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32
Q

What is the longest intracranial pathway?

A

CN4

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33
Q

Describe the CN4 pathway

A

Crosses in back of the brain stem–>partially encircling the midbrain–>decussates after midbrain

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34
Q

CN 4 nucleus is near ___ fibers

A

Descending sympathetic fibers

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35
Q

If there is a CN4 palsy it can lead to what kind of syndrome?

A

Ipsilateral pre-ganglionic horners syndrome

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36
Q

What is the horners syndrome triad?

A

miosis, ptosis, anhidrosis

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37
Q

What are the 8 etiologies of a CN4 palsy?

A
  • congenital
  • idiopathic
  • head trauma
  • microvasculopathy
  • tumor
  • aneurysm
  • MS
  • iatrogenic injury
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38
Q

What are the 2 ways someone can have a congenital CN4 palsy?

A
  • abnormal development of CN4 nucleus

- abnormal development of peripheral nerve or tendon

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39
Q

What is the most common cause of acquired isolated CN4 palsy?

2nd?

A

First: idiopathic
Second: head trauma (with a loss of consciousness)

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40
Q

What are some tests you do to evaluate a CN4 palsy?

A
  • case history
  • external observations
  • cover test
  • EOMs
  • pupils
  • P3S
  • NPC
  • Hess Lancaster
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41
Q

What EOM does CN6 innervate?

A

Lateral Rectus

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42
Q

If the LR is not working what will the eye look like?

A

The eye will be turned in (esotropia)

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43
Q

If someone has a CN6 palsy they will probably have a head turn towards the ____ eye

A

Affected eye

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44
Q

If someone has a CN6 palsy with a left head turn what muscle is affected?

A

LLR

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45
Q

CN6 is susceptible to what 5 things?

A
  • injury
  • increased ICP
  • mastoid infection
  • skull fracture
  • tumors
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46
Q

If someone has a lesion to CN6 nerve, root, or nucleus what are some presentations you may see?

A
  • ipsilateral paresis of LR
  • convergence strabismus increasing in temporal gaze
  • lateral diplopia
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47
Q

If someone has a ipsilateral paresis or paralysis of facial muscles for Nuclear lesions what type of palsy would you think?

A

CN6

- this is due to CN7 root encircles CN6 nucleus

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48
Q

If someone has lateral diplopia what palsy do you think this could be?

A

CN6

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49
Q

What is the most commonly affected oculomotor nerve in adults?

A

-CN6

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50
Q

What is the most common affected oculomotor nerve in children?

A

CN4

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51
Q

What is the second most commonly affected oculomotor nerve in children?

A

CN6

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52
Q

The how many anterior ciliary arteries supplies the LR?

A

1, all other EOMS are supplied by 2

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53
Q

The LR is more affected by ____ than other EOMs. And why?

A

Ischemia, because only 1 ACA is supplying it

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54
Q

What are the 8 etiologies of a CN6 palsy?

A
  • Trauma
  • Aneurysm
  • Ischemic (HTN, diabetes)
  • Idiopathic
  • Demyelination
  • Neoplasm
  • Inflammatory
  • Meningitis
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55
Q

What are some tests you would use to evaluate CN6 palsy?

A
  • case history
  • external observations
  • VA
  • cover test (eso)
  • EOMs (limited towards temporal gaze)
  • Hess Lancaster
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56
Q

What are 2 types of multiple cranial nerve palsies?

A
  • cavernous sinus

- orbital apex syndrome

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57
Q

What nerves are located in the cavernous sinus? What syndrome is related?

A

CN 3, 4, 5, (V1 and V2), 6

Horners

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58
Q

If the cavernous sinus is affected is the optic nerve affected?

A

Nope

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59
Q

What is the #1 cause of a cavernous sinus palsy?

A

Neoplasm

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60
Q

What are some other causes of a cavernous sinus palsy?

A
  • carotid cavernous fistula
  • aneurysm
  • Fungal infection
  • inflammatory
  • tolosa-Hunt
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61
Q

What nerves are affected in orbital apex syndrome?

What is a syndrome that can result from this?

A

CN 3, 4, 5 (V1), 6

Syndrome: horners

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62
Q

Is the optic nerve affected in an orbital apex syndrome?

A

Yes

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63
Q

What is the #1 cause of an orbital apex syndrome?

A

Neoplasm

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64
Q

What are some other causes of an orbital apex syndrome?

A
  • fungal infection

- inflammation

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65
Q

If someone has medial rectus problem what will they present with?

A

-exo deviation, greater at near

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66
Q

If someone has inferior rectus problem what will they present with?

A

Hyper and exo deviation

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67
Q

If someone has superior rectus problem what will they present with?

A

Bilateral, in V exo pattern

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68
Q

If someone has an inferior oblique problem what will they present with?

A

An eso pattern

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69
Q

What is affected in a double elevator palsy?

A

SR and IO of the same eye are affected

So they will have no elevation in abduction or adduction

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70
Q

What is usually present in a double elevator palsy?

A

Bells phenomenon

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71
Q

What are the two etiologies of a double elevator palsy?

A
  • congenital

- Supra nuclear defect

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72
Q

What is bells phenomenon?

A

When you ask someone to close their eye but they cant and the eye just moves up

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73
Q

What are 5 differential diagnoses of a double elevator palsy?

will they have a positive off negative forced duction test?

A
  • blowout fracture
  • thyroid eye disease
  • browns
  • congenital fibrosis of the IR
  • general fibrosis syndrome

they will have a positive forced duction

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74
Q

What is another name for a double depressor palsy?

A

Monocular depression deficiency

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75
Q

In a double depressor palsy what two muscles are affected?

A

IR and SO (so there will be no depression in abduction or adduction)

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76
Q

If someone has a double depressor palsy how will their head be tilted?

A

Down (chin depressed) to compensate of hypertropic eye

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77
Q

What are the 4 types of neurogenic palsies?

A
  • supranuclear (cortical control, BG, SC, thalamus, VA, cerebellum)
  • internuclear
  • nuclear (brainstem, ocular motor cranial nerve nuclei)
  • infranuclear (ocular motor nerves and EOMs)
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78
Q

What are the 8 etiologies of a neurogenic palsy?

A
  • congenital
  • traumatic
  • inflammatory
  • neoplastic
  • ischemic
  • toxic
  • demyelination
  • idiopathic
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79
Q

What are 7 supranuclear palsy classifications?

A
  • Lesions above the level of Ocular Motor Nerve Nuclei
  • Gaze palsies
  • Tonic gaze deviation
  • Saccadic and smooth pursuit disorders
  • Vergence abnormalities
  • Nystagmus
  • Ocular oscillations
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80
Q

An internuclear palsy can be caused by a lesion of what?

A

Medial longitudinal fasciculus

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81
Q

Internuclear palsies are caused by?

A
  • MS in younger patients

- vascular origin in elderly patients

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82
Q

If someone has a internuclear palsy can they converge?

A

Yes since the CN3 isnt affected

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83
Q

What are 5 presentations of a nuclear palsy?

A
  • Unilateral CN III with bilateral ptosis
  • Unilateral CN III with contralateral superior rectus underaction
  • Isolated extraocular muscle palsy of inferior rectus, inferior oblique, or medial rectus
  • Brown’s Syndrome
  • Bilateral CN III with spared levator function
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84
Q

What nerves are affected if someone has a infra-nuclear palsy?

A

CN 3, 4, 6

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85
Q

In a CN3 palsy, if the pupil is spared its most likely cause is?

A

Vascular

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86
Q

In a CN3 palsy, if the pupil is not spared its most likely cause is?

A

Aneurysm

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87
Q

If someone had a head trauma what is the most common CN palsy they will have?

A

CN4

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88
Q

If someone has diplopia in lateral gaze, what kind of palsy would you think this is?

A

CN6 palsy

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89
Q

If someone has diplopia in vertical gaze, what kind of palsy would you think this is?

A

CN3 or CN4

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90
Q

If you suspect an aneurysm or a neoplasm what should you do?

A

Seek immediate care

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91
Q

If you suspect an aneurysm what tests should you order?

A

Angiography or MRA

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92
Q

If you suspect someone as a neoplasm what tests should you order?

A

MRI or CT scan

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93
Q

When does an ischemia usually occur?

A

> 40 yoa

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94
Q

If someone had an ischemia will this be sudden or slow occurring?

A

Sudden

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95
Q

How long does it take an ischemia to resolve on its own?

A

3 months

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96
Q

What are some ways to manage a strabismus?

A
  • glasses
  • occlusion
  • Botox
  • surgery
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97
Q

What is the first step in managing strabismic symptoms?

A

Glasses

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98
Q

A prism used for short-term treatment of diplopia, but can also be used long term

A

Fresnel prism

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99
Q

Which eye do you place fresnel prism over?

A

Non-dominant eye

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100
Q

A common treatment for acute paralytic strabismus due to unilateral CN6 palsy

A

Botox

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101
Q

Neurotoxic protein that prevents the release of neurotransmitter acetylcholine from axon endings at the neuromuscular junction, resulting in paralysis

A

Botox

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102
Q

What are some temporary side effects of Botox?

A
  • Soreness at injection site
  • Weakness in the muscles that were injected
  • Muscle soreness that affects your whole body
  • Difficulty swallowing
  • A red rash that lasts several days after the injections
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103
Q

What is a treatment for long term fixing of a strabismus?

A

Surgery

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104
Q

A treatment meant to weaken, strengthen, or change the vector of force for a given muscle, based on the strabismus

A

Surgery

105
Q

What are some risks of surgery on someone with a strabismus?

A
  • Mild discomfort after
  • Continued strabismus
  • Endophthalmitis (infection)
  • Ocular ischemia
106
Q

EOM is tethered or a systemic disease reduces the elasticity of one or more muscles

A

Mechanically restrictive

107
Q

Are mechanical restrictive deviations incomitant or comitant?

A

Incomitant

108
Q

Can mechanical restrictions be congenital, acquired, or both

A

They can be acquired or congenital

109
Q

In mechanically restrictive deviations you will have gross limitations of ocular movement in___

A

One or more directions of gaze

110
Q

What type of deviation is usually present in mechanically restrictive deviations?

A

-small deviations or orthophoria in primary gaze

111
Q

In mechanically restrictive deviations, will you have a negative or positive forced duction test?

A

Positive

112
Q

What tests may be beneficial to measure mechanically restrictive deviations?

A
  • Maddox rod

- prism bar over the affected eye

113
Q

What tests are beneficial to measure if both eyes are mechanically restricted?

A
  • hirschberg

- krimskey

114
Q

What is the overall problem for someone with Duanes syndrome?

A

Not able to adduct, abduct, or both

115
Q

What are 3 congenital mechanical restriction conditions?

A
  • Duanes syndrome
  • browns syndrome
  • fibrosis syndrome
116
Q

What is the type in Duanes syndrome where the patient has limited ADDuction?

A

Type 2

117
Q

What is the type in Duanes syndrome where the patient has limited ABDuction?

A

Type 1

118
Q

What is the most common type of Duane syndrome?

A

Type 1

119
Q

T/F: patient with limited abduction in the absence of a significant strabismus in primary position should be considered Duane syndrome until proven otherwise

A

True

120
Q

What is the type in Duanes syndrome where the patient has limited ABDuction and ADDuction?

A

Type 3

121
Q

Will someone with Duane syndrome have a significant strabismus in primary gaze?

A

No

122
Q

Is Duane syndrome bilateral or unilateral?

A

Unilateral

123
Q

In Duane syndrome, the size of the deviation increases towards the _____ side

A

Affected

124
Q

If someone has Duane syndrome will they have an A or V pattern?

A

Possibly

125
Q

What are 2 characteristics of Duane syndrome regarding the globe and fissure?

A
  • the globe retracts (enophthalmos)

- eyelid fissure narrows on adduction

126
Q

What is the most common onset of Duane syndrome?

A

Sporadic, often presents during infancy

127
Q

What is the etiology of Duane syndrome?

A

-mechanical, anatomical, and innervation disorder

128
Q

What 2 muscles are inserted too far posteriorly in Duane syndrome?

A

-fibrotic LR or MR

129
Q

What type of innervation does Duane syndrome have?

A

Anomalous innervation

130
Q

Do people with Duane syndrome have binocularity?

A

Yes

131
Q

Will someone with Duane syndrome have amblyopia or diplopia?

A

It is very rare

132
Q

Do people with Duane syndrome have a head posture?

A

It depends on the amount of deviation in primary position but if they have type 1, they turn their head toward the affected side and type 2 they turn it towards the opposite side

133
Q

You may see an up/downshoot often affected eye during ____ in Duane syndrome. This mimics overaction of the ____ and/or ___

A

ADDuction

Overaction of the IO and/or SO

134
Q

What is a differential diagnosis of Duanes?

A

CN 6 Palsy

135
Q

Name 4 characteristics of a CN6 palsy (what makes it different than Duane)

A
  • negative FDT
  • absence of retraction with adduction
  • esotropic angle is larger (deviation in primary position)
  • rarely have vertical anomalous movements
136
Q

What are 2 treatments of Duane syndrome?

A
  • surgical

- prism

137
Q

If someone has a left Duane syndrome Type 1 what type of prism would you give this patient?

A
  • OS BO

- OD BI

138
Q

Does surgery improve adduction/abduction?

What about bino vision?

A

-it rarely improves the deviation but improves the field of bino vision

139
Q

What is the overall problem for someone with Browns syndrome?

A

They have restricted elevation in adducted eye around the mid horizontal plane

140
Q

Is browns syndrome unilateral or bilateral?

A

Usually unilateral

141
Q

Which eye is more likely affected in browns syndrome?

A

OD

142
Q

What is the etiology of browns syndrome?

A

the trochlear to the SO tendon insertion distance cannot be increased because of mechanical causes

Commonly due to a thickening of the SO tendon–> cant move through the trochlea effectively

143
Q

Can browns be acquired?

A

Yes (trauma, inflammatory disease processes, iatrogenic)

144
Q

T/F: browns doesn’t improve with time

A

False. It does improve

145
Q

Will someone with browns syndrome have a vertical deviation in the primary gaze?

A

Probably not, if so it is minimal

146
Q

Someone with browns will have a ___FDT with marked resistance to forcible elevation of the eye in ____ only

A
  • positive FDT

- adduction only

147
Q

You may hear an audible click with elevation with this syndrome

A

Browns syndrome

148
Q

What syndrome will you have a V-pattern exo deviation in up-gaze

A

Browns syndrome

149
Q

Will someone have a head posture with browns syndrome?

A

Chin elevation and pointing toward the opposite shoulder

150
Q

In browns syndrome, the patient will have a mild downshoot of the affected eye in?

A

Adduction

151
Q

In browns, there will be ___ of the palpebral fissure in adduction

A

Widening

152
Q

Will there be an absence of overaction of the ipsilateral SO in browns?

A

Yes

153
Q

T/F: there will be normal elevation in abduction for the affected eye in browns

A

True

154
Q

In browns there will be restricted elevation in ____

A

Adduction

155
Q

Does someone with browns have bino vision?

A

Yes, when the eyes are in primary position or downgaze

156
Q

T/F: someone with browns will probably be orthophoric in primary position

A

True

157
Q

Do people with browns have amblyopia?

A

Nope

158
Q

Do people with browns have diplopia?

A

No

159
Q

What is a differential diagnosis of browns?

A

IO paresis

160
Q

Name 4 characteristics of IO paresis

A
  • hypertropia in primary position
  • head tilt to the affected side along with possible head turn and chin elevation
  • A pattern: exotropia greater in downgaze
  • able to fulfill P3S
161
Q

Do most browns patients require treatment?

A

No

162
Q

When is treatment recommended for brown syndrome patients?

A

When they have significant hypotropia in primary position or compensatory head posture that is cosmetically displeasing

163
Q

What is the primary treatment for someone with browns?

A

Surgery

164
Q

What is the secondary treatment for someone with browns?

A

Prism (you want to move the image down so they dont have to move the eye up as much)

165
Q

Does VT usually work with patients with browns?

A

Not really

166
Q

What is the onset of Duanes?

A

Congenital

167
Q

What is the onset of browns?

A

Congenital or browns

168
Q

In someone with type 1 Duanes, what will be their head posture?

A

Turns head towards the affected side

169
Q

For someone with type 2 Duanes, what will be their head posture?

A

Turns head away from affected side

170
Q

For someone with browns, what will be their head posture?

A

Chin elevation

171
Q

What are the lid changes for duanes syndrome?

A

Narrowing of the fissure

172
Q

An autoimmune, neuromuscular disorder characterized by the fatiguability of voluntary striated muscle

A

Myasthenia Gravis

173
Q

This disease occurs secondary to the loss of ACh receptors at the NM junction which results in the failure to release/produce ACh

A

MG

174
Q

MG commonly affects women ____ and men ____

A

Women under 40 and men over 60

175
Q

T/F: MG can occur at any age

A

True

176
Q

T/F: MG can be neonatal or congenital

A

True

177
Q

When do people experience initial symptoms with MG?

A

During emotional upset

178
Q

Is MG hereditary?

A

No. Its sporadic

179
Q

What causes muscle weakness in MG?

A

the immune system releases antibodies that block and destroy ACh receptor sites along with tyrosine kinase–> fewer receptor sites–>less nerves signals–>muscle weakness

180
Q

What type of gland may trigger antibody production in MG?

A

Thymus gland

181
Q

T/F: the thymus is smaller in MG patients

A

False. It is larger

182
Q

What is the hallmark in MG?

A

Muscle weakness that worsens after periods of activity and improves after periods of rest

183
Q

What are the 2 forms of MG?

A
  • generalized

- ocular

184
Q

What are the signs and symptoms of generalized MG?

A
  • weakness of arm and leg muscles

- difficulties with speech, chewing, swallowing, and breathing

185
Q

T/F: Ocular MG may present before generalized MG

A

True

186
Q

What are the 3 signs and symptoms of ocular MG?

A
  • ptosis
  • diplopia
  • nystagmus movements
187
Q

What is the most common feature of ocular MG?

A

Ptosis

188
Q

Ptosis is MG is often due to what?

A

A palsy of the levator muscle

189
Q

Is ptosis in MG bilateral or unilateral?

A

Unilateral

190
Q

Ptosis in ocular MG will get ___ later in the day

A

Worse

191
Q

Will people with Ocular MG have horizontal or vertical diplopia?

A

They could have either, there is no definite pattern

192
Q

A disease of the skeletal muscle that can mimic many other ocular musculature paresis

A

MG

193
Q

What muscles will someone with MG have difficulty with?

And what will each of these present with?

A
  • orbicularis oculi: unable to resist a forced eye opening
  • masseter muscle: unable to open jaw
  • sternocleidomastoid: present with head droop
  • tounge: undulate to push sides of mouth, poor gag response
  • diaphragm: ventillary depression–> DEATH
194
Q

Wen the muscles are too weak to control breathing can lead to what?

A

Mysthenia Crisis

195
Q

What are 4 associations with MG?

A
  • thymomas (tumor of the thymus gland)
  • thymus hyperplasia (enlargement)
  • thyroid disease
  • autoimmune disorders
196
Q

What are some of the ocular diagnoses of MG?

A
  • use old photos

- fatigue during ocular movement

197
Q

What 2 ocular tests are used on patient with potential MG?

A
  • Cogan’s Lid Twitch

- Ice Test

198
Q

For someone with MG how will they react to cogans lid twitch?

A

While in downgaze, the upper eyelid twitches as a patient looks up

199
Q

T/F: ptosis will get worse in time with looking up in MG patients

A

True

200
Q

What will be the result of the ice test be for someone with MG?

A

At least 2mm of eyelid elevation after 2 minutes of application

201
Q

Will you see improvement during an ice test in someone with MG?

A

Yes

202
Q

What should you suspect if there is a presence of an inconsistent deviation along with ptosis and restricted ocular motility

A

MG

203
Q

Name future tests you should do on someone with MG (7)

A
  • electromyography
  • sleep test
  • systemic anticholinesterase agents
  • physical/neuro exam
  • blood test
  • diagnostic testing (MRI/CT)
  • pulmonary function
204
Q

What is the most sensitive test for MG?

A

electromyography

205
Q

Blocks ACh breakdown, should temporarily improve ptosis and eliminate motility restriction.

Name the 2 agents

A

Systemic Anticholinesterase agents

2 names:

  • edrophonium chloride
  • neostigmine
206
Q

Why would you want to do a blood test on someone with MG?

A

To detect increased ACh receptor antibodies

207
Q

Would you want to give someone with MG prism?

A

No due to variability throughout the day

208
Q

What are two ocular treatments you would potentially do for a MG patient?

A
  • occlusion

- surgery (not often)

209
Q

Name 4 systemic treatments for MG

A
  • anticholinesterase agents
  • immunosuppressive drugs
  • thymectomy
  • plasmapheresis and IV immunoglobulin
210
Q

Is there a cure for MG?

A

No

211
Q

T/F: patients with MG have a relatively high quality of life and a normal life expectancy

A

True

212
Q

An autoimmune disorder that results in the overproduction of the thyroid hormone

A

Graves’ disease

213
Q

What is the common cause of graves?

A

Hyperthyroidism

214
Q

What are the 2 subtypes of Graves’ disease?

A
  • graves dermopathy

- graves ophthalmopathy

215
Q

What are the common signs of graves?

A
  • goiter
  • weight loss
  • heat intolerance (sweating)
  • change in menstrual cycle
  • fatigue
  • thick, red skin
  • rapid, irregular heartbeat
  • bulging eyes
  • erectile dysfunction
216
Q

An autoimmune, inflammatory condition that involves mostly the orbital tissues and muscles

A

Graves ophthalmopathy

217
Q

Graves ophthalmopathy results from the overproduction of what?

A

Thyroid hormone

218
Q

This is believed to be the most common cause of spontaneous diplopia in middle aged people

A

Graves ophthalmopathy

219
Q

Describe the histology of graves ophthalmopathy

A

Autoantibodies bing to thyrotropin receptors onto stimulate excess production on thyroid hormone–> build up of carbs in muscles and tissues behind the eye–>changes in the lymphocytic infiltration and fibrosis of muscles which impair their elasticity->enlargement of EOMs–> incomitant deviation

220
Q

Is graves ophthalmopathy unilateral or bilateral?

A

Bilateral

221
Q

Is graves ophthalmopathy more common in men or women?

A

Women

222
Q

At what age do people usually get graves ophthalmopathy ?

A

<40

223
Q

Is graves ophthalmopathy hereditary?

A

Could be

224
Q

What are some risk factors of graves ophthalmopathy?

A
  • emotional/physical stress
  • pregnancy
  • autoimmune conditions
  • smoking
225
Q

Name the ocular signs of graves ophthalmopathy

A
  • periorbital congestion/chemosis
  • proptosis (lid retraction considered primary effect)
  • lid lag (von graefes sign)
  • exophthalmos (can cause SPK)
  • optic neuropathy
  • impaired ocular motility
226
Q

What are some symptoms a patients with graves ophthalmopathy may have

A
  • dry/gritty ocular sensation
  • photophobia
  • excessive tearing
  • double vision
  • pressure behind eyes
  • vision loss
227
Q

If someone has a graves ophthalmopathy will they have a + or - FDT?

A

+ FDT

228
Q

What muscles is most involved in graves ophthalmopathy

A

IR

229
Q

What muscle is the least involved in graves ophthalmopathy

A

LR

230
Q

When someone has limited elevation in abduction and adduction with both versions and duction

A

SR paresis

231
Q

Fibrous union between the __ and ___ may lead to a restriction in upgaze and hypotropia of the affected eye and in severe cases the eye will be tethered down

A

IR and IO

232
Q

What time of day will diplopia be worse for a graves ophthalmopathy patient?

A

In the morning

233
Q

T/F: patients with GO may develop compensating head posture (chin elevation) to maintain fusion and avoid diplopia

A

True

234
Q

The affected eye in GO patients often demonstrates what to things regarding eye alignment?

A
  • restriction of elevation and abduction

- hypotropia in primary position

235
Q

What are some tests that would help with your diagnosis of GO?

A
  • tonometry
  • herself exophthalmometer
  • slit lamp (exposure keratopathy)
  • ON evaluation
  • CT of orbits
  • Thyroid function tests
236
Q

Will someone with GO have improvement or reversal over time?

A

Yep

237
Q

Improvement in ocular motility in GO may occur with ___ or ___

A
  • resolution

- orbital edema

238
Q

What are some treatment options for GO patients

A
  • prism
  • surgery (for big deviations)
  • artificial tears
  • cold compresses (for edema)
  • stop smoking
239
Q

What are 4 systemic treatments you can use for GO?

A
  • radioactive iodine therapy
  • corticosteroids
  • anti-thyroid drugs
  • thyroidectomy
240
Q

Will Ocular symptoms improve with GO treatment?

A

Not always, they could worsen for 3-6 months

241
Q

If someone has a -2 action of the RLR what does this mean?

A

There is an underaction

242
Q

When the eye is deviated in and the light hits the nasal retina and projects temporally

A

Uncrossed diplopia in ESO

243
Q

When the eye is deviated out and the light hits the temporal retina and projects nasally, across and beyond the visual axis of the fixating eye

A

Crossed diplopia in EXO

244
Q

How would you treat an uncrossed diplopia in ESO?

A

BO prism

245
Q

How would you treat a crossed diplopia in EXO?

A

BI prism

246
Q

For worth 4 if the patient sees 2 red dots what does this mean?

A

They are suppressing the OS

247
Q

For worth 4 if the patient sees 3 green dots what does this mean?

A

The patient is suppressing their OD

248
Q

If the patient sees 5 dots with the red dots to their left and green dots to their right what does this mean?

A

Crossed diplopia (exo deviation)

249
Q

If the patient sees 5 dots with the green dots to their left and green dots to their right what does this mean?

A

Uncrossed diplopia (eso deviation)

250
Q

For W4D if the person see the red dots below the green dots why type of deviation is this?

A

Right hyper deviation

251
Q

For Maddox rod, if the patient sees the red line through the light what does this mean?

A

Ortho

252
Q

For Maddox rod, if the patient sees the red line to the right of the light what does this mean?

A

Uncrossed diplopia (eso)

253
Q

For Maddox rod, if the patient sees the red line to the left of the light what does this mean?

A

Crossed diplopia (exo)

254
Q

For Maddox rod, if the patient sees the red line below the light what does this mean?

A

Right hyper

255
Q

For Maddox rod, if the patient sees the red line above the light what does this mean?

A

Left hyper

256
Q

When the tissues of the EOMs are abnormal and replaced with fibrotic tissue?

A

Congential fibrosis of EOMs

257
Q

How would you treat someone with congenital fibrosis of EOMs?

A
  • amblyopia therapy

- surgery (only would do this for cosmetic reasons or comfort/abnormal head posture)

258
Q

Will someone with CFEOM have a + or - FDT?

A

+FDT

259
Q

Name the 5 main features/observation of someone with CFEOM

A
  • severely restricted eye movement
  • fibrosis in all or just one muscle
  • usually in both eyes
  • ptosis
  • chin elevation is common (because they are trying to look under ptosis)

Motility (6 decks)

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