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Motility > Block 12 > Flashcards

Block 12 Flashcards

1
Q

Involuntary rhythmic oscillation of 1 or both eyes

A

Nystagmus

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2
Q

Can be a sign of visual pathway lesion or an ocular control abnormality

A

Nystagmus

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3
Q

Type of waveform of nystagmus: has both quick and slow components

A

Jerk

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4
Q

Which way is the slow phase in a jerk nystagmus

A

Away from the target

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5
Q

Which way is the fast fast in jerk nystagmus

A

Back to fixation

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6
Q

How is jerk nystagmus characterized

A

Direction of fast phase

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7
Q

Type of waveform of nystagmus: to and fro movements of equal velocity in each direction

A

Pendualr

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8
Q

Type of waveform of nystagmus: doesn’t have a fast phase

A

Pendular

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9
Q

Which phase of jerk nystagmus reflects the abnormality

A

Slow

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10
Q

Slow movement to the right with a fast corrective jerk movement to the left

A

Left jerk nystagmus

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11
Q

The size/extent of the movement during nystagmus is known as the

A

Amplitude

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12
Q

From what 2 points in nystagmus is the amplitude measured

A

From the start of the drift away tot he start of the corrective movement

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13
Q

Number of oscillations per unit time in nystagmus

A

Frequency

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14
Q

Fast frequency nystagmus is how quick

A

> 2Hz

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15
Q

1 Hz equals

A

1cyc/sec

- a full rotation in 1 second

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16
Q

Frequency of a slow nystagmus is what time

A

<2Hz

- need a slit lamp to view

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17
Q

Where the intensity of the nystagmus diminishes and the VA improves
- may be associated with head position

A

Null point

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18
Q

With latent nystagmus seen with occlusion, the fast phase is towards

A

Uncovered eye

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19
Q

What does latent nystagmus usually indicated

A

A congenital condition

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20
Q

Anterior seg conditions with nystagmus (3)

A

Congenital cataract
Congenital glaucoma
Iridocorneal dysgenesis (didnt form properly)

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21
Q

Foveal condition associated with nystagmus

A

Foveal hypoplasia in albinism (flattening)

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22
Q

Optic nerve/retinal disorders associated with nystagmus

A

Coloboma of ON head (fissure doesn’t close)
ON hypoplasia
Toxoplasmosis

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23
Q

Do children with congenital nystagmus usually complain about issues

A

No

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24
Q

Nystagmus from motor coordination

A

Less VA loss (better VA)

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25
Q

Nystagmus from sensory issues

A

More VA loss (worse VA)

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26
Q

Do you allow patients to use their preferred head position when doing VAs?

A

Yes bc this will allow you to asses true functional vision

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27
Q

When doing monocular VAs, you may have to use a high plus lens to blur instead of occlude because

A

You need to allow fusion so that the jerk nystagmus intensity doesn’t increase

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28
Q

When refracting pts with nystagmus, do you use the phoropter

A

No, need to see the nystagmus

- use trial lenses or a lens bar

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29
Q

CT may be difficult in patients with nystagmus. What can you use to determine if the reflexes appear symmetrical

A

Hirschberg/krimsky

Bruckner

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30
Q

Do you use occluder in Pts with nystagmus during CT and VA

A

No, use a high plus lens (+2 - +5)

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31
Q

For IOP, what do you use in pts with nystagmus

A

NCT or tonopen

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32
Q

Slit lamp is important in detecting the presence of

A

Iris coloboma or transillumination

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33
Q

In recent/acquired nystagmus, what 2 tests should be done asap

A

CT/MRI for neuro eval

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34
Q

Sensationof the environment moving

A

Oscillopsia

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35
Q

Position of gaze where eyes are quiet

A

Null point

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36
Q
  • small amp and variable freq
  • intermittent conjugate jerk (fast in direction of gaze)
  • seen in both eyes when extreme lateral gaze is held (>30 degrees)
  • symmetrical in rt and lt gaze
A

End point nystagmus

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37
Q

Pts with which type of nystagmus may fail road side sobriety test

A

Endpoint nystagmus

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38
Q
  • jerk nystagmus due to rotation
  • related to endolymph in semicircular canals
  • slow conjugate mvmt then fast phase OPP of rotation
A

Rotational nystagmus

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39
Q

Which way is the fast phase in rotational nystagmus

A

Opposite of the rotation

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40
Q

Nystagmus type seen when putting water in semicircular canals

A

Caloric nystagmus

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41
Q

Normal response in Caloric testing

A

Cold water: fast toward opposite ear

Warm water: fast toward ipsilateral ear

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42
Q

Slow pursuit eye movement followed by fast corrective saccade bc VF moves over the retina

A

OKN (optokinetic nystagmus)

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43
Q

Is the head still or moving when testing OKN

A

Head is still

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44
Q

When is the OKN developed

A

3-5 months

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45
Q

What will a child’s OKN response be if they have congenital nystagmus

A

Reverse OKN response

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46
Q

Congenital nystagmus: which gender

A

Boys twice as often

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47
Q

Congenital nystagmus: is family hx likely

A

Yes

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48
Q

Congenital nystagmus: etiology mostly afferent or efferent

A

Efferent 60% (afferent 40%)

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49
Q

Pendular and/or jerk nystagmus

  • horizontal
  • no oscillopsia
  • active fixation may increase nystagmus
A

Congenital nystagmus

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50
Q

Congenital nystagmus: is VA good

A

At null point it is good

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51
Q

Congenital nystagmus: when converging, what happens to nystagmus

A

Decreases

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52
Q

Which etiology of Congenital nystagmus will have better vision

A

Efferent etiology

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53
Q

Possible afferent etiological of Congenital nystagmus

A

Optic atrophy, ON hypoplasia, retinal dystrophy

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54
Q

Pt with Congenital nystagmus that later envelops esotropia bc of attempts to suppress nystagmus by converging

A

Nystagmus blockage syndrome

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55
Q

May look like 6 nerve palsy, but there is an ability to abduct the eye

A

Nystagmus blockage syndrome

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56
Q

Congenital, jerk nystagmus after occlusion of one eye

A

Latent nystagmus

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57
Q

Which way is the fast phase in latent nystagmus

A

Toward uncovered eye

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58
Q

Latent nystagmus may increase with the disruption of

A

Fusion

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59
Q
  • Starts shortly after birth
  • pendular nystagmus
  • bilateral usually
  • high-frequency
  • head nodding
  • torticollis
A

Spasms nutans

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60
Q

Eye movements like those in spasmus nutans are similar to those seen in

A

Chiasmal tumors, glioma and craniopharyngioma and retinal dystrophies

Send to neuro!!

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61
Q
  • Pendular

- 1 eye elevates and intorts while the other depresses and extorts

A

See-saw nystagmus

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62
Q
  • Lesion in the suprasellar area may cause
  • craniopharyngioma
  • Joubert syndrome
A

See-saw nystagmus

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63
Q
  • vertical jerk nystagmus (fast beats down)
A

Downbeat nystagmus

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64
Q
  • vertical jerk nystagmus (fast beats up)
A

Upbeat nystagmus

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65
Q

Etiologies of downbeat nystagmus

A
  • craniocervical junction

- medications

66
Q

Etiolgies of upbeat nystagmus

A
  • brainstem abnormalities

- drugs

67
Q

Horizontal jerk with a rotary element

- inner ear or vestibular abnormalities

A

Vestibular nystagmus

68
Q

Hearing loss is common in which nystagmus type

A

Vestibular nystagmus

69
Q

What 3 things are often seen in vestibular nystagmus because of the dysfunction of vestibular system

A

Oscillopsia, nausea, vertigo

70
Q

Rhythmic convergence and retraction of eyes when attempting upgaze moment

A

Convergence-retraction syndrome

71
Q

Often seen in parinaud syndrome

A

Convergence-retraction syndrome

72
Q

Hallmark sign of periodic alternating nystagmus

A

Shifting null point

73
Q

Possible etiologies of periodic alternating nystagmus

A
  • degeneration of cerebellum

- skew deviation

74
Q

How often does direction change in periodic alternating nystagmus

A

Every 90 seconds with about 10 seconds of rest between

75
Q

How may patient adapt to periodic alternating nystagmus

A

Alternating head turns

76
Q

what kind of prisms do you use to move a patients null point

A

yoked prism

77
Q

what should be considered first to help improve the clarity of the retinal image and lessen the nystagmus

A

refractive correction

78
Q

type of add: used at near to improve VA and aid in accomodation

A

plus adds

79
Q

type of add: induce convergence since nystagmus could decrease with convergence

A

minus adds

80
Q

which direction of prism is used to induce convergence to dampen nystagmus

A

BO

81
Q

what are yoked prisms

A

base is placed in the same direction over each eye

82
Q

for anomalous head position, which way are the bases placed in yoked prisms

A

base in same direction as head turn

83
Q

images are shifted toward which part of the prims

A

apex

84
Q

which type of prism is used for large amounts of prisms but also degrades the vision

A

fresnel prisms

85
Q

when using fresnel prism, the apex is placed toward what? base?

A

apex - the null point

base - towards turn

86
Q

if a pt has a left head turn, the pt has the null point in the right gaze, which direction will the bases go over each eye to shift the image and reduce the head turn?

A

bases to the left

87
Q

when is occlusion treatment used

A

amblyopia (consider using a high plus lens instead of straight occlusion to not break fusion)

88
Q

what is the purpose of vision therapy

A

for fusion vergences or to improve motor control

89
Q

when can meds be used to help with nystagmsu

A

if it is due to a system problem (infection, metabolic or vascular issue)

90
Q

what is a common medication that helps reduce the severity of nystagmus, but there are adverse effects to it

A

gabapentin

91
Q

what is the kestenbaum technique in surgical nystagmus correction

A

shift the null point to closer to primary postion and eliminate the head turn

92
Q

what is the minimum age cutoff for surgical nystagmus correction and why

A

older than 4 bc of the risk of overcorrection in younger

93
Q

spontaneous upward movement of one or both eyes when tired, fusion is broken or inattentive

A

dissociated vertical deviation (DVD)

94
Q

what is often found with infantile strabismus

A

DVD

95
Q

is DVD usually treated

A

no

96
Q

if the eye is elevated in adduction

A

IO overaction

97
Q

this is mainly present in children with infantile strabismus

A

IO overaction

98
Q

found in 2/3 of children with congenital strab

A

IO overaction

99
Q

present when a horizontal deviation changes in magnitude between up and down gaze

A

pattern strab

100
Q

horizontal deviation is more divergent in upgaze

A

V pattern

101
Q

horizontal deviation is more divergent in downgaze

A

A pattern

102
Q

when is the V pattern clinically significant

A

difference between up and down gaze is >/= 15pd

103
Q

most common pattern deviation

A

V pattern

104
Q

which pattern deviation is seen in infantile ET

A

V pattern

105
Q

which pattern deviation is seen in SO palsies

A

V pattern

106
Q

if pt has a V pattern deviation, what head position may they have

A

chin elevation

107
Q

when is teh A pattern clinically significant

A

difference between up and downgaze in >/= 10pd

108
Q

pattern deviation seen more frequenetly with XT

A

A pattern

109
Q

head psition in pt with A patten

A

chin down

110
Q

more common in pts with infantile strab associated with craniofacial malformations, down’s

A

A pattern deviation

111
Q

When it comes to management plan, what is it important that you do with your patient

A

Communicate about their condition and the plan

- explain pros and cons

112
Q

What kind of lenses will decrease ESO (dec accom)

A

Plus lenses

113
Q

What kind of lenses with decrease EXO (inc accom)

A

Minus lenses

114
Q

You put the fresnel prims over which eye

A

Nondominant

115
Q

The eye will move toward which part of the prism

A

Base

116
Q

Short term treatment for diplopia

A

Monocular occlusion

117
Q

Treatment for acute paralytic strab due to unilateral 6th nerve palsy

A

Botox

118
Q

What does Botox do

A

Stops release of ACh at NMJ resulting in paralysis

119
Q

Which way will the eye turn in 3rd nerve palsy

A

Down and out with ptosis

120
Q

Optical tx of 3rd nerve palsy

A
  • Glasses

- fresnel prism

121
Q

Pharm Tx of 3rd nerve palsy

A
  • tx underlying condition

- immediate care if suspect aneurysm or tumor

122
Q

Possible causes of CN3 palsy

A
  • vascular
  • tumor
  • demylinating disease
123
Q

Possiblecauses of CN 4 palsy

A
  • idiopathic
  • head trauma
  • vascular
124
Q

Optical tx of CN 4 palsy

A

BI, BD prims

125
Q

What palsy’s do you consider surgery for if it doesn’t resolve

A

4 and 6

126
Q

Possible cause of CN 6 palsy

A
  • trauma
  • vascular
  • tumor
127
Q

Optical tx of cn6 palsy

A

BO prism

128
Q

Inability of one eye to attain bino vision bc of imbalance of muscles

A

Strabismus

129
Q

Primary tx of strab

A

Refractive correction

130
Q

ET due to uncorrected hyperopia

A

Refractive accommodative ET

131
Q

ET due to high AC/A

- greater at N

A

Non refractive accommodative ET

132
Q

ET due to high hyperopia and high AC/A

A

Mixed accommodative ET

133
Q

Which kind of accommodative ET may require refractive Sx

A

Refractive accommodative ET

134
Q

Onset of infantile ET

A

Birth to 6mo

135
Q

Onset of early onset non-accommodative ET

A

6mo to 2yr

136
Q

Type of ET due to vision loss in one eye

A

Sensory ET

137
Q

What should you do to a pt with divergence insufficiency ET

A

Neuro referral

138
Q

ET after XT surgery

A

Consecutive ET

139
Q

Deviation is latent at times, manifest during visual inattention, fatigue or stress

A

Intermittent XT

140
Q

Exo greater at N, low AC/A, receded NPC

A

Convergence insufficiency XT

141
Q

Optical Tx of convergence insufficiency XT

A

BI reading glasses

142
Q

Spectacle correction for someone with sensory ET or XT

A

Glasses with polycarbonate lenses

143
Q

Type 1 Duane’s

A

Can’t abduct

144
Q

Type 2 Duane’s

A

Can’t adduct

145
Q

Type 3 Duane’s

A

Can’t ab or adduct

146
Q

Optical XT for duanes

A

Prism

147
Q

Do you do Sx for duanes?

A

Yes if significant strab in primary, head posture, to improve field of bino vision

148
Q

Restricted elevation in adduction

A

Browns

149
Q

Optical Tx for brown’s syndrome

A

BU or yoked prism

150
Q

What is the primary Tx for browns

A

Sx

151
Q

Do most Brown’s pts require Tx

A

No

152
Q

Autoimmune, NM disorder; fluctuating weakness of voluntary muscle groups

A

MG

153
Q

Optical Tx for MG

A

Occlusion

154
Q

Sx for MG?

A

Not usually (spontaneous remission in 30% of pts)

155
Q

Autoimmune overprod of thyroid hormone, affecting orbital tissues an EOMs

A

Graves

156
Q

Optical Tx of Graves

A

Prism (fresnel)

157
Q

Sx for graves?

A

Yes, for significant deviations if stable for 6 mo

158
Q

Other ways to Tx Graves

A

Tx of dry eye, cold compresses, smoking cessation

159
Q

Tissue of EOMs replaced with fibrotic tissue; restricted eye movements, ptosis, chin elevation

A

Fibrosis syn

160
Q

Do you do Sx for fibrosis syn

A

Yes, if have significant strap in primary

Motility (3 decks)

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