case history

Question 1

signs of incom strab

Answer 1

Abnormal head posture

lid position - ptosis/ lid retraction

globe position - proptosis/ endophthalmos

pupil size - dilated in 3rd NP
* if pupil not affected in 3rd, it is vascular

unsteady gaze

nystagmus

Hx of falls

Question 2

symptoms of incom strab

Answer 2

Diplopia
-main symptom
- can be intermittent
- ask px if horizontal (3/6np) or vertical (3 OR 4th NP)
- worse at N or D
- any pain associated - think MECHANICAL

Awareness
- long standing or sudden - sign of decompensation/ longstanding/ congenital problem

Pain
- no pain in neurogenic palsies except 3rd NP with aneurysm
- mechanical more likely to give pain or discomfort

Astheopia
- px struggling to control BV, may complain of eye strain

Headaches
- can be severe sign of aneurysm
- sl h/a worse throughout the day can be associated with binocular control
- can be due to raised intra cranial pressure

Oscillopsia
- acquired nystagmus
- if in one direction think intranuclear ophthalmoplegia
- upbeat/ down beat = progressive palsy
- congenital nystagmus will not give oscillopsia

Question 3

History Qs

Answer 3

When did the symptoms begin?
General Health – detailed questioning

How is your blood pressure – hypertension/vascular disease

How is your blood glucose – could they be diabetic

How is your cholesterol – could they have high lipid levels in their blood

Do you attend other medical professionals?
- endocrinology = thyroid/graves
- maxillofacial - blow out fracture
- cardiology - vascular disease
- stroke physician - stroke/TIA

Previous Ocular History
· Did you receive ocular treatment as a child
· Squint/Amblyopia
· Diabetic screening
· Retinal problems
· Glaucoma
· Positive family history of any of the above