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Motility > Block10 > Flashcards

Block10 Flashcards

1
Q

What does a left hypertrophia mean

A

Either:
- left eye elevated
Or
- right eye depressed

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2
Q

Do you use correction in CT

A

Yes

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3
Q

Purpose of CT

A

Assess the presence and magnitude of a phoria or tropia

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4
Q

What all is recorded in CT

A 
Correction?
Magnitude
Eye
P or T
Constant or intermittent 
Distance or near
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5
Q

How is an intermittent tropia recorded

A

(T)

- in parentheses

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6
Q

How is CT at N recorded

A

’

- with an apostrophe

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7
Q

Do you use correction on EOMs

A

No

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8
Q

Purpose of EOM test

A

To asses ability to perform conjugate eye movements

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9
Q

What all should be recorded in EOM test

A

Eye
Ability of muscles (full and smooth; if restricted)
Diplopia (- if not)
Pain (- if not)

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10
Q

Do you preform hirschberg with correction

A

No

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11
Q

Purpose of hirschberg

A

To determine the position of the visual axes under binocular conditions at N

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12
Q

How to perform hirschberg

A

1) look at penlight
2) look at reflex monocularly
3) look at reflex binocularly

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13
Q

Hirschberg: reflex is nasal

A
  • positive angle lamda

- exo

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14
Q

Hirschberg: reflex is temporal

A
  • negative angle lamda

- eso

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15
Q

Hirschberg: reflex is above

A

Hypo

Record as opposite eye hyper

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16
Q

Hirschberg: reflex is below

A

Hyper

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17
Q

Which eye is the prism placed over in Krimsky

A

FIXATING eye until reflex is in the same position as deviating eye

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18
Q

BO relieves

A

Eso

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19
Q

BI relieves

A

Exo

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20
Q

In krimsky, 1mm deviation is equal to how many prism diopter

A

22

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21
Q

Pertinent entrance tests if there is a possible strab (6)

A

1) CT
2) EOMs
3) saccades
4) pursuits
5) hirschberg/krimsky
6) bruckner

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22
Q

Purpose of bruckner test

A

To evaluate the symmetry of binocular fixation

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23
Q

What patients will we typically used bruckner test on

A

Infants and young preverbal kids

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24
Q

Do kids where their correction for bruckner?

A

No

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25
Q

What instrument do we use in bruckner test

A

direct ophthalmoscope

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26
Q

Procedure for bruckner test

A

1) look at o-scope light (80-100cm away)

2) compare red reflexes in eyes

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27
Q

Bruckner test: If the red reflexes are equally bright

A

Binocular fixation

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28
Q

Bruckner test: If the red reflexes are not equal

- more prominent red eye

A

Fixating eye

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29
Q

Bruckner test: If the red reflexes are not equal

- lighter/white reflex

A

Nonfixating eye

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30
Q

Bruckner test: If the red reflexes are not equal

- dimmer eye

A

Media opacity

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31
Q

Bruckner test: If the red reflexes are not equal

- brighter eye

A

Retinoblastoma

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32
Q

Bruckner test: If the red reflexes have crescents

- at head of oscope

A

Hyperopia

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33
Q

Bruckner test: If the red reflexes have crescents

- at handle of oscope

A

Myopia

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34
Q

Bruckner test: If the red reflexes has no cresecents

A

Emmetropic

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35
Q

How to record bruckner test

A
  • if eyes appear equally bright
  • if any opacities
  • presence of refractive error and if its equal in both eyes
  • which eye appears whiter and brighter
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36
Q

What movements compensate for cyclophorias

A

Cyclovergence movements

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37
Q

Purpose of double Maddox rod

A
  • detect torsional misalignment

- measures cyclodeviation but does not differentiate between P and T

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38
Q

Correction for double Maddox rod

A

Yes

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39
Q

Target for double Maddox rod

A

D - muscle light

N - penlight @ 40cm

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40
Q

Procedure for double Maddox rod test

A

1) trial frame with red Maddox lens over OD and clear Maddox lens over OS
- placed vertically (lllll)
- use vertical prism to induce separate horizontal lines if they only see 1
2) rotate the lenses until the 2 lines are parallel
- note degree of deviation

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41
Q

Double Maddox rod: the tilt of the line is ___________ the tilt of the retinal image

A

Opposite

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42
Q

Double Maddox rod: red line tilted out (left side of line is up)

A

Eye intorted

- IO underacting (wont extort)

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43
Q

Double Maddox rod: red line tilted in (left end of line pointed toward nose)

A

Eye extorted

- SO underacting (wont intort)

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44
Q

Test to identify the muscle responsible for a vertical deviation

A

Parks 3 step

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45
Q

3 steps in parks 3 step test

A

1) which eye is hyper (using alternate CT)
2) does it inc on right or left gaze (using CT)
3) does it increase on right or left head tilt (using CT)

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46
Q

Tool to figure out how to determine which muscle is underacting in parks 3 step evaluation

A
  • Draw SR, SO, IR, IO in each eye (like an H)
  • circle the underacting in each eye for each of the 3 steps
  • whichever eye is circled 3 times is the underacting/paretic muscle
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47
Q

Determines if deviation is mechanical or paretic

A

Forced duction test

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48
Q

Procedure for forced duction test

A

1) numb
2) fixate toward side of limited gaze
3) grab conj with forceps and move in direction of suspected restriction

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49
Q

(+) forced duction test

A

Resistance, meaning it is a mechanical restriction

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50
Q

(-) forced duction test

A

Eye moves, meaning its a paretic muscle

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51
Q

How to record forced duction test

A

(+) or (-)

Eye and muscle

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52
Q

Maps out patients filed of single bino fision

A

Hess-Lancaster test

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53
Q

Hess means

A

Dots

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54
Q

Lancaster means

A

Lines

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55
Q

Procedure for Hess-Lancaster test

A

Pt wears red green glasses (red over OD)

1) examiner has red light; pt has green
2) tell pt to put their light on top of your light (OD fixates, testing OS)
- any difference indicates the deviation direction and magnitude
3) switch lights and do the same thing testing the other eye (OS fixates, testing OD)

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56
Q

3 things to look at when interpreting Hess-Lancaster

A

Position
Size
Shape

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57
Q

When interpreting position on Hess-Lancaster, what you are looking at

A

Where the central point is in relation to where it should be

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58
Q

When interpreting size of Hess-Lancaster, what does the smaller field indicate

A

The affected eye

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59
Q

When interpreting size of Hess-Lancaster, what does displacement of the field interiorly mean (folding in).

A

Underaction of affected muscle

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60
Q

When interpreting size of Hess-Lancaster, what does the larger field indicate

A

Unaffected eye

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61
Q

When interpreting size of Hess-Lancaster, what does the displacement of the field exteriorly mean

A

Overaction

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62
Q

If the size of the fields of the Hess-Lancaster test are extremely different

A

Recent condition

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63
Q

If the size of the fields of the Hess-Lancaster test are similar

A

Long standing condition

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64
Q

What does comitancy mean

A

Deviation is the same in all positions of gaze

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65
Q

How would comitancy show up on a Hess-Lancaster field plot

A

Each point is deviated by the same amount in each gaze

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66
Q

Narrowing of the field in opposite directions (he’s-Lancaster)

A

Mechanical restriction

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67
Q

When interpreting the shape of Hess-Lancaster fields, look at the sloping of the outside edge

A

A/V patterns

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68
Q

In a palsy, how will the field of the eye look

A

The underacting/affected muscle may have slight overacting in the ipsilateral antagonist

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69
Q

In a mechanical restriction, how will the field of the eye look

A

Narrow in opposing directions

Ex: Top and bottom both smush in

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70
Q

NSUCO oculomotor test assesses

A

Pursuits and saccades

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71
Q

How do you preform the NSUCO oculomotor test

A

Red/white beads 40 cm from pt, and 2 cm apart

  • saccades: dont look until i tell you
  • pursuits: dont ever take your eyes off
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72
Q

How do you asses the NSUCO oculomotor test

A 
Score based on 
- ability
- accuracy 
- head movement
- body movement
(5 no movement, 1 lots of movement)
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73
Q

What is the purpose of the DEM test

A

Check vision therapy progress

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74
Q

Harmon distance

A

Elbow to middle knuckle

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75
Q

Procedure of DEM test

A

Pt calls off a series of numbers as quickly as possible WITHOUT using finger or pointer

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76
Q

What is the purpose of the pretest in DEM test and how quickly must it be preformed

A

The make sure kid knows numbers

12 seconds

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77
Q

Subtest A and B in DEM test what

A

Vertical saccades

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78
Q

What is recorded in the DEM tests

A

Times

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79
Q

Subtest C in DEM tests what

A

Horizontal saccades

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80
Q

How to record DEM test errors: substitution

A

(/)

- if immediate correction, count it as correct

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81
Q

How to record DEM test errors: transposition

A

Arrow where number was read out of sequence

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82
Q

How to record DEM test errors: omissions

A

Circle it if it is omitted

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83
Q

How to record DEM test errors: additions

A

Cross when extra number has been added or repeated

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84
Q

What is the DEM ration

A

Horizontal/Vertical adjusted time

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85
Q

Diagnosis based on DEM ratio: average performance in all subtest values

A

Type 1

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86
Q

Diagnosis based on DEM ratio: high horizontal time, normal vertical time

A

Type 2

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87
Q

Type 2 diagnosis from DEM test implies

A

Oculomotor dysfunction

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88
Q

Diagnosis based on DEM ratio: high horizontal and vertical times, but normal ratio

A

Type 3

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89
Q

Type 3 diagnosis from DEM test implies

A

Difficulty in automaticity of number naming

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90
Q

Diagnosis based on DEM ratio: horizontal time, vertical time and ratio are all abnormal

A

Type 4

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91
Q

Type 4 diagnosis of DEM test implies

A

Deficiency of oculomotor skills and in automaticity

- combo of type 2 and 3

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92
Q

Formula to find adjusted time in DEM test

A

Time X (80/(80-o+a))

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93
Q

This test is often used for concussion detection

A

King-devick test

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94
Q

Where does the patient hold the book in king-devick test

A

Harmon distance (like a book)

95
Q

Describe the process of king-devick test

A

Time how long it take to complete the card

- record number of errors and time

96
Q

What are the time cutoffs for king devick test: test card 1

A

stop if greater than 50 seconds

97
Q

What are the time cutoffs for king devick test: test card 2

A

Stop if total time of test card 1 and 2 is greater than 100 sec

98
Q

If pt is = 10 yrs old and unable to complete test card 3

A

Take the sum of test cards 1 and 2 time and errors

99
Q

Test to asses pursuits

A

Groffman tracings

100
Q

Detects reading disability and requires little cognitive ability

A

Groffman tracings

101
Q

In groffman tracings, are the letters scored together or individually

A

Individually

102
Q

In groffman tracings, if if trace to the incorrect number, what is the score

A

0

103
Q

In groffman tracings, how do you score them if they get to the correct number (trace correctly)

A

Score based on time it took

- times are added together for all of the letters and are compared to age-matched normative data

104
Q

In groffman tracing, if the pt uses their finger or keeps trying to use finger, what is their score

A

0

105
Q

Most common sign of neuromuscular problem

A

Deviation

106
Q

Abnormalities with sensory fusion can lead to

A

Disruption in motor fusion –> deviation

107
Q

Latent tendency to deviate when fusion is broken

A

Phoria

108
Q

Fusion can be disrupted due to (4)

A

Alternating cover test
Fatigue
Illness
Stress

109
Q

An manifest deviation of eye

A

Tropia (strabismus)

110
Q

Seen in unilateral cover test

A

Tropia

111
Q

What all is included in recording P or T

A
  • correction?
  • D or N?
  • amount of deviation
  • type of P or T
  • constant or intermittent?
  • unilateral or alternating?
112
Q

When pt fixates with the unaffected eye

A

Unilateral tropia

113
Q

Fusion is inadequate to keep aligned (seen all the time)

A

Constant tropia

114
Q

Fusion functions some times, but not always

A

Intermittent tropia

115
Q

CT norms: distance

A

1XP (+/- 2pd)

116
Q

CT norms: near

A

3XP (+/- 3pd)

117
Q

How do you verify an ortho alignment on CT

A

Use BI then BO to find reversal

118
Q

Neutralize Exo with

A

BI

119
Q

Neutralize Eso with

A

BO

120
Q

Neutralize hyper with

A

BD

121
Q

Neutralize hypo with

A

BU

122
Q

If both eyes have BU or BD, where they cancel, and the value isnt split, the prism with produce what

A

A version

123
Q

Why split the vertical prism

A

Deviation is treated with the resultant and net binocular effect

124
Q

When splitting vertical prisms, what are the direction

A

1 is BU and 1 is BD

125
Q

When splitting horizontal prism, what are the directions

A

Keep the same direction in both eyes

126
Q

By keeping the same direction when splitting horizontal prism, what kind of eye movement is created

A

Vergence

127
Q

If BO and BI were prescribed, what kind of eye movement is created

A

Version (BO and BI cancel - yoked prisms)

128
Q

Abnormal head posture is known as

A

Torticollis

129
Q

3 postures seen in torticollis

A

Head turn
Head tilt
Chin up/down

130
Q

Attempts to maintain binocularity, VA or use of limited VE

- compensatory response to ocular problem

A

Ocular torticollis

131
Q

Seen in patients with non-comitant strabismus

A

Ocular torticollis

132
Q

Abnormalities that can cause ocular torticollis (8)

A 
Nystagmus
Paretic strabismus
Restrictive strabismus 
A or V pattern strabismus
Monocular blindness 
Ptosis
Refractive error
VF defect
133
Q

Deviation the same (within 5pd) in all positions of gaze

A

Comitancy

134
Q

Deviation size is >5pd in different positions of gaze

A

Non-comitant

135
Q

Non-comitant can be due to

A

Innervation problems or mechanical constriction

136
Q

Abnormalities from birth to 1st 6months of life

A

Congenital

137
Q

Anything developing after 6 months of life

A

Acquired

138
Q

Aquired deviations are

A

Acute
Longstanding
Consecutive

139
Q

If uncertain of onset: congenital or aquired

A

Congenital

140
Q

If it is an obvious deviation than family is aware of: congenital or aquired

A

Acquired

141
Q

May appear comitant: congenital or aquired

A

Congenital

142
Q

Operation of yoked muscle is seen and secondary deviation is larger: congenital or aquired

A

Acquired

143
Q

Normal vertical fusional amplitude: congenital or aquired

A

Aquired

144
Q

Usually accompanied by suppression: congenital or aquired

A

Congenital

145
Q

Torsion is commonly seen: congenital or aquired

A

Aquired

146
Q

Action of muscle or group of muscles is completely eliminated

A

Paralysis

147
Q

Action of muscle of muscles is impaired

A

Paresis

148
Q

General term for paralysis or paresis

A

Palsy

149
Q

Paralysis or paresis often cause which kind of deviation

A

Noncomitant

150
Q

Deviation is seen in primary gaze: neurogenic or mechanical

A

Neurogenic

151
Q

Diplopia is same in different gazes: neurogenic or mechanical

A

Neurogenic

152
Q

Head tilt seen: neurogenic or mechanical

A

Neurogenic

153
Q

Chin up/down may be seen: neurogenic or mechanical

A

Mechanical

154
Q

Duction movement > version also movement: neurogenic or mechanical

A

Neurogenic

155
Q

Hess Lancaster fields are irregular: neurogenic or mechanical

A

Mechanical

156
Q

Hess Lancaster: field of affected eye is smaller: neurogenic or mechanical

A

Neurogenic

157
Q

Globe retracts when turned in direction opposite of restriction: neurogenic or mechanical

A

Mechanical

158
Q

Pain could be present: neurogenic or mechanical

A

Mechanical

159
Q

Forced duction: limited movement: neurogenic or mechanical

A

Mechanical

160
Q

Poor fusion can be associated with (6)

A 
Fatigue
Asthenopia
HA - frontal
Avoidance
Diplopia 
Suppression
161
Q

Why are vertical phobias likely to cause symptoms

A

Bc vertical fusional amplitudes are naturally limited

162
Q

Why may a pt have a small phoria but no symptoms

A

Bc sensorimotor system is able to cope with the deviation

163
Q

Infancy ocular instability is also known as

A

Split

164
Q

Seen in 2-3 months and resolves by 4 months

A

Split

165
Q

A latent esodeviation controlled by fusion vergences so eyes are aligned in binocular condition

A

EP

166
Q

Manifest deviation not properly controlled by fusion vergences

A

ET

167
Q

Appearance of ET when eyes are actually straight

A

PseudoET

168
Q

See in kids with wide, flat most bridges and small PD

A

PseudoET

169
Q

ET onset between birth and 6mo

A

Infantile ET

170
Q

Large, constant ET and possible family hx of ET

A

Infantile ET

171
Q

Usually kids with this type of ET have some other neurological or developmental condition

A

Infantile ET

172
Q

Both eyes look deviated

A

Cross fixation

173
Q

About 30-50% of all ET are

A

Infantile ET

174
Q

When can you use prism to correct a deviation

A

If you know that there was once binocularity used

175
Q

ET Onset between 6mo and 7yr

A

Accommodative ET

176
Q

Amblyopia is often present with large constant and unilateral angles in which kind of ET

A

Accommodative ET

177
Q

Average age of onset for accommodative ET

A

2.5 year

178
Q

3 types of accommodative ET

A

Refractive
Non refractive
Mixed

179
Q

About 50% of all ET have what component

A

Accommodative

180
Q

Type of accommodative ET due to high hyperopia

A

Refractive

181
Q

Type of accommodative ET due to high AC/A

A

Non refractive

182
Q

Type of accommodative ET due to high hyperopia and high AC/A

A

Mixed

183
Q

Type of Accommodative ET: similar deviation at D and N

A

Refractive

184
Q

Hyperopia range typically causing refractive accommodative ET

A

+3 to +6D

185
Q

Type of Accommodative ET: deviation is much greater at near (may not be a deviation in D)

A

Non refractive

186
Q

How to calculate AC/A ration

A

Add used to correct it

187
Q

Where should a bifocal sit on a kids to correct nonrefractive accommodative ET

A

Bisect the pupil

188
Q

Type of Accommodative ET: There is a deviation at both D and N, and it is a very different magnitude in each

A

Mixed

189
Q

Residual ET after treatment; may result after delayed treatment

A

Partially accommodative ET

190
Q

2 types of non accommodative ET

A

Early onset non accommodative ET

Acute acquired ET

191
Q

Similar to infantile ET, but onset is between 6mo and 2yr

A

Early onset non accommodative ET

192
Q

Type of non accommodative ET: ET same at D and N and is comitant

A

Early onset

193
Q

In early onset non accommodative ET, is there a lot of hyperopia present

A

No, insignificant amount

194
Q

Type of non accommodative ET: comitant and sudden onset between 3 and 5yr

A

Acute acquire ET

195
Q

Type of non accommodative ET: could be a result of illness, stress, aging

A

Acute acquired

196
Q

If you suspect acute acquire ET, do you need a neuro eval

A

ASAP

197
Q

Ultra small ET

A

Microtropia

198
Q

Fusional vergences are no longer able to maintain EP

A

Decompensating ET

199
Q

ET that develops due to vision loss in an eye

A

Sensory ET

200
Q

In sensory ET, what will the affected eyes VAs be

A

Poor

201
Q

Examples that could cause sensory ET

A

Congenital cataract, corneal scarring, retinal/macular disease, ptosis….

202
Q

What should the first step be in management of sensory ET

A

Eliminate the pathology if possible and do it as quickly as possible

203
Q

If you cannot eliminate the pathology, what should you do in sensory ET management

A

Polycarbonate lens for full time wear to protect the eye

204
Q

Nonaccomodative esodeviation greater at D

A

Divergence insufficiency ET

205
Q

Type of ET often seen in adults, is comitant, diplopia at D, HA

A

Divergence insufficiency ET

206
Q

What should you always do if you suspect divergence insufficiency ET

A

NEURO REFERRAL

207
Q

Is Sx a good choice for divergence insufficiency ET

A

No bc the deviation is only at D

208
Q

Esodeviation after Exo Sx

A

Consecutive ET

209
Q

A latent exodeviation controlled by fusional vergences

A

XP

210
Q

Prevalence of which deviation varies by ethnic groups

A

Exodeviation

211
Q

Proper alignment, but positive angle kappa, wide PD

A

PseudoXT

212
Q

Tx for this is needed if there is asthenopia or diplopia

A

XP

213
Q

3 types of intermittent XT

A

Divergence excess
Basic
Convergence insufficiency

214
Q

Type of intermittent XT: onset in childhood, deviation larger at D

A

Divergence excess

215
Q

Type of intermittent XT: onset in adults, deviation same at D and N

A

Basic XT

216
Q

Type of intermittent XT: onset in adults, deviation larger at N

A

Convergence insufficiency XT

217
Q

Most common XT

A

Intermittent XT

218
Q

Bright light may cause reflex closure of one eye in which kind of deviation

A

Intermittent XT

219
Q

Only shows during visual inattention, fatigue or stress

A

Intermittent XT

220
Q

Untreated intermittent XT can lead to

A

Constant XT

221
Q

XT only manifest on CT, then resumes fusion rapidly

A

Good control of intermittent XT

222
Q

XT on CT, fusion regained after blinking or refixating

A

Fair control of intermittent XT

223
Q

XT manifest spontaneously and for an extended period of time (usually there and visible)

A

Poor control of intermittent XT

224
Q

How would mild myopia correction affect intermittent XT

A

Make deviate better

225
Q

How could mild hyperopic correction affect intermittent XT

A

Make deviation worse

226
Q

When does Sx typically become considered in XT patients

A

If it gets progressively worse with decreasing stereo and control
- when deviation is > 50% of time

227
Q

BI reading glasses could be used to correct which type of XT

A

Convergence insufficiency XT

228
Q

Which is more common, infantile ET or XT

A

ET

229
Q

If a child has infantile XT, what are they likely to have

A

Neurological issues or craniofacial disorders

230
Q

Any condition that causes vision loss in one eye can lead to

A

Sensory ET or XT

231
Q

If the VA can be improved in sensory ET/XT patients, what should you do

A

Sx is useful here

232
Q

If the VA cannot be improved in sensory ET/XT patients, what should you do

A

Don’t do Sx, bc misaligned would probably occur again

233
Q

Common post Sx outcome, could occur months or years after Sx

A

Consecutive XT

Motility (3 decks)

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