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Motility > Block 10 > Flashcards

Block 10 Flashcards

1
Q

What is the purpose of cover test

A

To asses the prescence and magnitude of phoria and tropia

Amount is determined with prism bars

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2
Q

Constant strabismus is seen

A

All the time

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3
Q

Intermittent strabismus is seen

A

Intermittently
Patient has moment of binocularity
Present during cover test

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4
Q

In strabismus, fixation can alternate between eyes or maintain fixation only with one eye

A

True

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5
Q

What do you record with cover test

A 
Correction (sc, cc)
Magnitude
Eye (OD, OS)
P or T
Constant or (intermittent)
Distance or near'
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6
Q

What is the purpose of EOM

A

To asses the ability to perform conjugate eye movements

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7
Q

What do you want the patient to inform you of during EOM

A

Pain or diplopia

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8
Q

What do you record in EOMs

A

Eye (OD, OS)
Ability of muscles
Diplopia
Pain

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9
Q

What is the purpose of Hirschberg?

A

To determine the position of the visual axes under binocular conditions

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10
Q

How is hisrchberg done

A

Have patient look at pen light
Then look at each eye monocularly
Then look binocularly

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11
Q

Angle lambda in ortho

A

0

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12
Q

Angle lambda in Exo

A

+

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13
Q

Angel lambda in Eso

A

-

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14
Q

Angle lambda in hyper and hypo

A

N/A

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15
Q

What is krimsky?

A

Done after hirschberg to find the magnitude of axes deviation

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16
Q

How is Krimsky done

A

Place prism over the eye that fixates

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17
Q

What corrects Eso?

What corrects Exo?

A

Eso: BO
Exo: BI

REMEMBER: BORE BIRX

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18
Q

What is recorded fro Krimsky

A

Eye
Magnitude (1 mm; 22 prism diopter)
Direction

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19
Q

What is Buckner test purpose?

A

To evaluate the symmetry of binocular fixation

Great for infants and young proverbal children

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20
Q

how is Bruckner test done

A

Have patient look at ophthalmoscope

Look at the red reflex

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21
Q

Bruckner test is done

Results: equally bright

A

Binocular fixation

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22
Q

Hirschberg: there is a deviation
Bruckner: the eyes are no equal reflex

Dim eye:
Brighter eye:

A

Dim eye: fixating

Bright: non-fixating eye

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23
Q

Hirschberg: normal
Bruckner: not equal
Dimmer eye:
Brighter eye:

A

Dimmer: media opacity
Brighter: retinoblastoma

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24
Q

You perform Bruckner and see a crest towards the head of the ophthalmoscope

A

Hyperopia

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25
Q

You perform Bruckner test and there is a crest toward the handle of the ophthalmoscope

A

Myopia

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26
Q

What are the 2 types of Torsion

A

Cycloversion

Cyclovergences

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27
Q

Cycloversions are

A

Conjugate movements

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28
Q

What are cyclovergences

A

Dis-conjugate movements

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29
Q

What is the purpose of double Maddox rod

A

To detect torsional misalignment and cyclodeviation

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30
Q

What is the downside of double Maddox rod

A

It does not differentiate between phoria and tropia

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31
Q

In NSUCO to test saccades you would

A

Have them look back and forth between red and white bead

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32
Q

How many cycles are tested for NSUCO saccades

A

5

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33
Q

How do you test pursuits in NSUCO

A

Have patient follow bead 2 cycles clockwise, 2 counterclockwise

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34
Q

How many cycles are tested in pursuits for NSUCO

A

2

And 2

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35
Q

What do you observe in NSUCO

A

Eye movement
Head movement
Body movement

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36
Q

How do you score NSUCO

A

Ability
Accuracy
Head movement
Body movement

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37
Q

What is the best score in any category for NSUCO

A

5

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38
Q

What is the purpose of the developmental eye movement test

A

Visual verbal ocular motor assessment

Accounts for difficulties in naming numbers

Check vision therapy progress

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39
Q

How is DEM tested

A

Pt calls off a series of numbers quickly

You compare the response times
And numbers of errors

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40
Q

Should you administer DEM if the child fails the pre-test (cant read off numbers in 12 seconds)

A

NO

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41
Q

DEM subtlest A and B tests

A

Vertical saccades
40 #s
Record time it took

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42
Q

DEM subtest C tests

A

Horizontal saccades
80 #s
Record time it took

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43
Q

DEM substitution

A

Cross out number if error made, unless there was an immediate correction

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44
Q

DEM test transposition

A

Place an arrow where # read out in sequence

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45
Q

DEM omission

A

Circle is number was omitted

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46
Q

DEM additions

A

+ when extra number has been added or repeated

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47
Q

DEM type 1

A

Average performance

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48
Q

DEM type 2

A

High horizontal time, normal vertical time

Oculomotor dysfunction

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49
Q

DEM type 3

A

High horizontal and vertical times
Normal ratio

Difficult in automaticity of number naming

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50
Q

DEM type 4

A

All normal
Deficit in oculomotor skills and automaticity
Combo of 2 and 3

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51
Q

What is the purpose of King-Devick test:

A

Verbal visual ocular motor assessment

Rapid number naming

Tests saccadic eye movements

Concussion detection
Assess neurological fxn

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52
Q

What is Hartman distance

A

Elbow to middle knuckle

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53
Q

How is King-Devick done

A

Patent calls off a series of numbers as quickly as possible

Compare to expected values

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54
Q

If test card 1 takes longer than 50 seconds do you move on to the next card?

A

NO

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55
Q

If the total time for card 1 and 2 is greater than 100 secs should you stop at card 2?

A

YES

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56
Q

If the pt is younger than 10 y.o. And cannot complete card 3 how do you score them?

A

Sum of test cards 1,2 and errors

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57
Q

T/F you do not count the error in King Devick if the pt quickly corrects it

A

True

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58
Q

What is the purpose of Groffman tracings

A

Oculomotor assessment

Reading ability tested

Little cognitive ability

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59
Q

How is Groffman tracing test done

A

You have pt card
Harmon distance
Have them trace the line at A with ONLY their eyes, tell what number is at the end

Repeat for D

Do 5 more tracings

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60
Q

How do you score Groffman tracing

A

Incorrect number: 0
Correct number/used finger: 0
Correct number: score scale

Add scores together
Compare to normative data

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61
Q

How is Double Maddox rod tested?

A

Trial frames
OD red
OS: white

Lenses placed vertical

Make lines parallel

Right the angle that line must by rotated

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62
Q

Double Maddox rod: the red line tilts toward the nose

A

Eye is excyclodeviated

R SO underacting

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63
Q

What does the amblyoscope test

A

Obj/subj Angle of deviation

Cyclophoria, hyperphoria

Hor/vert vergences

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64
Q

In amblyoscpe the fixating eye sees the more detailed image? T/F

A

True

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65
Q

What does Parks 3 step look for

A

Muscle responsible for deviation

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66
Q

What are the 3 steps for Parks 3 step

A
  1. Which eye is hyper in primary
  2. Does it increase on R/L gaze?
  3. Does it increase on R/L head tilt
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67
Q

T/F the paretic muscle is the muscle circled 3 times on parks 3 step

A

True

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68
Q

How is Forced duction done?

A

Anesthesia
Pt looks toward limited gaze
Grab conj opposite dxn you are moving
Move eye toward limited gaze

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69
Q

If the eye moves in forced duction what does that tell you?

A

Paretic muscle

- forced duction

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70
Q

I’d the eye does not moved in forced duction what does that tell you?

A

Mechanical restriction

+ forced duction

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71
Q

How is Hess Lancaster test done

A
  • Pt wears R/G glasses
  • Gives the patient light wand
  • on target tester hold their light at a point
  • pt tries to match it with their light
  • mark this on form
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72
Q

If the pt has green light
Tester has red light
Hess Lancaster
What eye are you testing??

A

Left eye

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73
Q

If the pt has the red light
Tester has the green light
Hess Lancaster
What eye are you testing?

A

Right eye

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74
Q

Hess Lancaster The eye with the smaller field is_______

A

Affected eye
Underaction

The eye with the greatest underaction is the affected muscle

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75
Q

Hess Lancaster larger field ______

A

Unaffected eye
Muscle with greatest overaction: contralateral synergist

2nd greatest overaction: ipsilateral antagonist

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76
Q

In Hess Lancaster if you have differing sized fields what does this tell you

A

Recent condition

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77
Q

In Hess lancaster if you have similar sized fields what does this tell you

A

Long standing condition

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78
Q

What is Hess Lancaster comitancy

A

Deviation is the same in all positions of gaze

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79
Q

In Hess lancaster what can a mechanical restriction be seen as

A

Narrow fields in opposing directions

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80
Q

A/V patterns can occur n HEss Lancaster

A

Yes

81
Q

What is the most common sign of a neuromuscular problem

A

Dilation of visual axes (tropia/phoria)

82
Q

What is required for proper alignment

A

Good sensory and motor function

83
Q

What can abnormalities with sensory function cause?

A

Disruption in motor fusion

Deviation

84
Q

What is a phoria?

A

Latent tendency for the eyes to deviate when fusion is broken

85
Q

What is fusion needed for

A

Binocular vision

Prevent diplopia and suppression

86
Q

What can break fusion

A

Alternating CT
Fatigue
Illness
Stress

87
Q

What is a tropia

A

Manifest deviation of the eyes

88
Q

When is tropia seen

A

Unilateral cover test

89
Q

What does tropia cause?

A

Amblyopia
Diplopia
Suppression

90
Q

What is a unilateral tropia

A

Patient fixates with other eye

91
Q

What is a constant tropia

A

Fusion is inadequate to keep aligned

92
Q

What is intermittent tropia

A

Fusion functions at some times, but not all times

93
Q

Patients can have tropia or phoria both at different distances

A

True

94
Q

To correct Exo

A

BI

95
Q

To correct Eso

A

BO

96
Q

You correct Hypo

A

BU

97
Q

To correct Hyper

A

BD

98
Q

T/F if both eyes have BU or BD and the value isn’t split what can it cause

A

A version

99
Q

Why is the vertical prism split

A

You treat with the net binocular effect

BUT you DO have to keep the same base OU

100
Q

What happens if BO and BI are given

A

Version created
Will not correct the deviation because they are yoked prisms

Effect will be cancelled out

101
Q

What is torticollis

A

Abnormal head posture
Can been alone or in combination

Prolonged can cause permanent facial asymmetry and contracture of neck muscles

102
Q

What is ocular torticollis

A

A compensatory response to an ocular problem

Attempts to maintain bonocularity, VA, or limited VF

103
Q

What are some abnormalities that can cause ocular torticollis

A 
Nystagmus
Paretic strabismus
Restrictive strabismus
Supranuclear disorders
A/V patterns
Monocular blindess 
Ptosis
Refractive error
VF defect
104
Q

What is comitancy

A

Deviations are comitant or non-comitant

Deviation size remains the same in all positions of gaze

105
Q

Non-comitant:

A

deviation size is different in different positions of gaze

106
Q

How do you determine comitancy

A

CT in all gazes

107
Q

What can cause non-comitant

A

Innervation problems or mechanical restrictions

108
Q

What do vergences play a role in

A

Neuromuscular anomalies

109
Q

What are some sites of lesions

A

Supranuclear
Nuclear
Infrnuclear
Myogenic

110
Q

What else can cause strabismus

A

Anomalies of the face or orbit

Hydrocephalus, craniosynostosis, cranial conditions

111
Q

Congenital:

A

Onset at birth or during first 6 months of life

112
Q

Acquired:

A

Any strabismus that developed after 6 months

113
Q

Paralysis

A

Action o muscle or group of muscles completely eliminated

114
Q

Paresis

A

Action of muscle or muscels is impaired

115
Q

Palsy

A

General term for paralysis or paresis

116
Q

When do paralysis, paresis, and palsy cause?

A

Non-comitat deviation because of over or under action of involved muscles

117
Q

If there is difficulty moving the eye is a certain direction what should you consider?

A

Mechanical restriction

118
Q

What can cause fusion disruption by sensory impairment

A

Trauma

Disease

119
Q

What can cause mechanical restrictions

A 
Agenesis 
Abnormal insertion of EOM
Abnormal adhesions at tissue
Fibrosis of muscles
Tumor 
Sarcoidosis
120
Q

What can uncorrected refractive error cause?

A

Esophoria

121
Q

What does vestibular abnormalities cause

A

VOR

122
Q

T/F a patient may have a small phoria, but no symptoms because the sensorimotor system is able to cope with the deviation

A

True

123
Q

What are vertical deviations likely to cause symptoms

A

Vertical fusional amplitudes are naturally limited

124
Q

What can poor fusion be associated with

A 
Fatigue
Asthenopia
HA
avoidance
Diplopia
Suppression
125
Q

Is infant ocular instability normal?

When should you be concerned?

A

Yes

If it persists and is constant and large

126
Q

What is an ESP phoria

A

Latent esodeviation controlled by fusional vergences so the eyes are aligned in binocular conditions with fusion

127
Q

What is an esotropia

A

A manifest deviation that is not controlled by fusional vergences

128
Q

What can cause an esodeviation

A 
Innervation 
Anatomical
Mechanical
Refractive
Accommodative 
Genetic
129
Q

What do fusional vergences allow

A

Fusion and alignment

130
Q

What is pseudoesotropia

A

Appearance of ET when eyes are actually straight

HB and CT will be normal

Seen in children with wide, flat nose bridges and prominent epicanthal folds

131
Q

What is infantile ET

A

Onset is between birth and 6 months

Large constant ET

Family history?

132
Q

What do most children with infantile ET also have?

A

Neurological or developmental conditions

Cerebral palsy, hydrocephalus, prematurity

133
Q

What is cross fixation in relation to infantile ET

A

Using the adducted eye to look in to the contralateral view

134
Q

What can develop from a constantly deviate eye

A

Amblyopia

Low hypertrophic

135
Q

What can develop from infantile ET

A 
Amblyopia
AV pattern
DVD
Over action of IO
Nystagmus
AHP
136
Q

What can you do to manage strabismus

A

Correction of refractive error

Add power
Prism 
Occlusion- amblyopia treatment 
Vision therapy
Botox?
Surgery (large angles) 
Full cycloplegic refraction 
Comprehensive exam
137
Q

What is accommodative esotropia

A

Deviation associated with accommodative reflex

6mon-7yrs (avg: 2.5 yrs.)

It starts intermittently and can become constant

138
Q

What can cause accommodative esotropia

A

Hereditary

Trauma

139
Q

What can be present with accommodative ET

A

Amblyopia

Diplopia (active suppression)

140
Q

What are the types of accommodative esotropia

3

A

Refractive
Non-refractive
Mixed

141
Q

____% of all esotropia have an accommodative component

A

50%

142
Q

What is refractive accommodative ET due to

A 
High hyperopia (forces pt to accommodate) 
Insufficient fusional vergences to diverge
143
Q

What is non-refractive accommodative ET due to

A

High AC/A

Increase in accommodation at near drives convergence but there is insufficient vergence to diverge

144
Q

What is mixed accommodative ET due to

A

High hyperopia

High AC/C

145
Q

What does refractive accommodative ET lead to

A

Accommodative convergence

Pt doesn’t have enough fusional divergence to counter the increased convergence

146
Q

What is the average hyperopia that can cause refractive accommodative ET

A

+4.00

+3.00-+6.00

147
Q

What can occur is hyperopia is higher than +6.00D

A

Isometropic amblyopia

Patient has too much blur and will not be able to accommodate

148
Q

How would you manage refractive accommodative ET

A

Comprehensive exam
Cycloplegic refraction
Full hyperopic correction for full time wear, can reduce plus later

Start amblyopia treatment if VA doesn’t improve with Rx

149
Q

What is ET greater at near in non-refractive accommodative ET

A

Because of the need to accommodate at near

150
Q

What is accommodative convergence/accommodation ratio (AC/A)

A

Amount of convergence induced by a change in accommodation, can be accompanied by a change in vergence

151
Q

What do accommodation and vergences allow for

A

Clear, stable single binocular vision across a range of viewing distances

152
Q

What does AC/A help evaluate

A

The strength between the accommodative and vergence systems

153
Q

When are abnormal AC/A ratios seen

A

In binocular problems

154
Q

How do you calculate AC/A ratio

A

AC/A: absolute change/(absolute change in accommodation)

155
Q

How do you manage non-refractive accommodative ET

A

-Treat refractive error
-Bifocals (segheight bisect pupil) to reduce accommodation and accommodation convergence
- cyclo exam yearly
No surgery

156
Q

How do you mange mixed accommodative ET

A

Full hyperopic correction
Bifocal (based on AC/A)

NO surgery

157
Q

What is partially accommodative ET

A

Accommodative contributes to but does not account for the entire deviation

There is a reduction in the angle (residual ET remains after treatment)

Constant unilateral

158
Q

What is common in partial accommodative ET

A

Suppression

ARC

159
Q

What is early onset non-accommodative Esotropia

A

Similar to infantile ET, onset is later (6mo-2yrs)

ET same at D and N, comitant

No accommodative component
Insignificant amount of hyperopia

160
Q

How do you manage early onset non-accommodative ET

A

Correct refractive error (prisms, bifocals)
Amblyopia treatment
Vision therapy
Surgery

Neuro causes

161
Q

What is acute acquired ET

A

Comitant
3-5 yrs
Unilateral, constant

162
Q

What can cause acute acquired ET

A

Illness, stress, aging

163
Q

How do you manage acute acquired ET

A

NEURO eval ASAP
Correction
Prism/surgery
Amblyopia treatment if needed

164
Q

What is sensory ET

A

ET that develops due to vision loss in one eye

Prevents clear, focused retinal images
Prevents symmetrical visual stimulation OU

Poor VA
Constant unilateral deviation
Poor cosmesis

165
Q

What can decreased vision loss n sensory ET be due to

A 
Congenital cataract
Corneal scarring
Optic atrophy
Prolonged blur
Retinal/macular disease
Anisometropia amblyopia 
Ptosis
PHPV
166
Q

How do you manage sensory ET

A

Eliminate Pathology in critical period

Polycarbonate lenses for full time wear

Treat secondary amblyopia
Surgery can used for residual deviation

167
Q

What is divergence insufficient ET

A

Non accommodative
Greater at distance then near

Comitant
Adults
Decreases fusional divergence at D
Diplopia at D
HA

Refractive error present
No sensory adaptations

168
Q

How do you manage divergence insufficiency ET

A

NEURO REFERRAL

Through evaluation (trauma, elevated ICP)

Correct error
BO for diplopia at D
VT
Botox 
No surgery
169
Q

What is consecutive ET

A

After exo strabismus surgery

Could be symptomatic
Amblyopia can develop
Magnitude varies
Unilateral or alternating

Spontaneous improvement can occur
Treat error
Try BO prism or plus lenses
Repeat surgery for very large derivations

170
Q

What is non comitant esodeviation

A

6th nerve palsy

Duane’s syndrome

171
Q

What is an XP

A

Latent exodeviation controlled by fusional vergences

Treatment is needed if there is asthenopia or diplopia

172
Q

What is XT

A

Manifest deviation

173
Q

T/F exodeviations can vary among ethnic groups

A

True

174
Q

What is pseudoXT

A

There is proper alignment but postive angle kappa

Wide interpupillary distance makes it look like there is exodeviation

175
Q

What is divergence excess type XT

A

In childhood

Larger at D

176
Q

What is basic XT

A

In adults

XT same at D and N

177
Q

What is convergence insufficent XT

A

In adults

larger at near

178
Q

What is the most common XT

A

Intermittent

179
Q

What is intermittent XT

A

Deviation is latent at times and then it becomes manifest

Before 5 yoa

180
Q

When is intermittent XT manifest

A 
During visual in attention 
Fatigue
Stress
Fusional factors are not active 
Later in the day 
Day dreaming
181
Q

What effect can bright light have on intermittent XT

A

Reflex closure of one eye

182
Q

What can intermittent XT be associated with

A

Small hypers

A/V patterns

183
Q

What can untreated intermittent XT lead to

A

Constant XT
Reduced stereo
Amblyopia (no common unless constant in early life)

184
Q

How do you evaluation intermittent XT

A

Comprehensive history (age of onset, frequency)
CT at D and N
Control assessment
Sensory test

185
Q

What is good control of IXT

A

XT only manifest on CT

Resumes fusion rapidly

186
Q

What is fair control of IXT

A

XT on CT, fusion regained after blinking or refixating

187
Q

What is poor IXT

A

XT manifest spontaneously nad for an attended period of time

Slide 40

188
Q

How do you manage IXT

A

Correct significant error, mild myopia, moderate (greater than +4) hyperopia

Correcting mild hyperopia can make deviation WORSE
Patching for amblyopia 
VT (fusional vergence training) 
Prisms
Surgery 
Botox
189
Q

What is convergence insufficient XT

A 
XT greater at N than D 
Intermittent alternating at N
Low AC/A
Poor near fusion convergence
Receded NPC
190
Q

What are some symptoms of convergence insuffiency XT

A

Asthenopia
Diplopia
Blurred near vision

Common during reading

191
Q

What is a treatment option for convergence insufficiency XT

A

Vision therapy

BI reading glasses

192
Q

What is constant XT

A

Commonly seen in older patients with sensory XT or patients with longstanding XT that has decompensated

Enlarged VF

Surgery could be used

193
Q

What is infatnile XT

A 
Large, constant angle
Could alternate
Less common than infantile ET
Present before 6 mo of age
Likely to have neurological issues or craniofacial disorders

Poor adduction on version

194
Q

How would you treat infantile XT

A

Neuro consult
Treat refractive error
Treat amblyopia
Surgery in children

195
Q

What is sensory XT

A

Any condition that causes vision loss in one eye

196
Q

What are some symptoms of sensory XT

A

Poor VA
Poor cosmesis
Constant or unilateral
Large angle

197
Q

What should you determine in sensory XT

A

If VA can be improved since this may improve alignment with peripheral fusion

If VA is improved, surgery can be useful

If VA does not improve, misalignment could occur again after surgery

198
Q

What is constructive XT

A

Common post surgery

Months-years after surgery

Motility (5 decks)

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