Cataracts and Eye Movement Disorders

Question 1

What kind of conjunctivitis is associated with pre-auricular lymphadenopathy?

Answer 1

Viral conjunctivitis!

Question 2

Cataracts are the leading cause of ___ in the entire world.

Answer 2

blindness

Question 3

What are cataracts?

Answer 3

opacity to the lens of the eye

Question 4

Are cataracts usually bilateral or unilateral?

Answer 4

bilateral

Question 5

What are four etiologies of cataracts, and which is most common?

Answer 5

1. age (most common)
2. congenital
3. traumatic
4. medication related

Question 6

What are two risk factors for cataracts?

Answer 6

smoking and sun exposure

Question 7

symptoms of cataracts

Answer 7

gradual, chronic, and painless loss of vision; patients complain of glare (especially at night)

Question 8

4 signs of cataracts

Answer 8

1. decreased visual acuity
2. decreased color vision
3. opalescent changes to lens
4. abnormal or even absent red reflex

Question 9

What are two things we might see upon ophthalmoscopic exam of a patient with matured cataracts?

Answer 9

can’t achieve a red reflex; exam of retina blurred or obscured

Question 10

When do you refer a patients with cataracts to ophthalmology?

Answer 10

when their lifestyle if affected

Question 11

What are two ways to treat or manage cataracts?

Answer 11

prescription eye glasses or cataract extraction surgery with or without intraocular lens placement

Question 12

When a dendritic pattern is noticed overlying the cornea upon fluorescin staining, what etiologic agent should we suspect?

Answer 12

HSV

Question 13

T/F. Nystagmus is a rhythmic, regular oscillation of the eyes.

Answer 13

T

Question 14

What are two types of nystagmus based on their movement character? Which is most common?

Answer 14

1. jerk

2. pendular

Question 15

jerk vs. pendular nystagmus

Answer 15

jerk = more common, consists of alternating phases of slow drift in one direction with a quick corrective jerk in the other direction
pendular = slow, sinusoidal, pendular oscillations to and fro

Question 16

T/F. Nystagmus is not variable depending on eye movements.

Answer 16

F, it is variable!

Question 17

5 etiologies for nystagmus

Answer 17

congenital, intoxication, metabolic derangements, infections, tumors

Question 18

symptoms of nystagmus

Answer 18

eye “shimmers” or shakes; possible decrease in visual acuity

Question 19

Does nystagmus affect visual acuity?

Answer 19

Yes, possibly!

Question 20

Who manages treatment for nystagmus?

Answer 20

typically a neurologist

Question 21

4 treatments for nystagmus

Answer 21

1. muscle relaxants like baclofen or gabapentin
2. Botox (botulinum) injection
3. surgery (Kestenbaum muscle surgery)
4. prism lenses

Question 22

What is the last resort step before surgery for nystagmus?

Answer 22

Prism lenses first!

Question 23

strabismum

Answer 23

anomaly in alignment of eye that is intermittent or constant

Question 24

esotropia vs. exotropia vs. hypertropia

Answer 24

esotropia = crossing, inward
exotropia = wandering, going outward
hypertropia = vertical misalignments

Question 25

What are three less common eye misalignments?

Answer 25

Brown syndrome, Duane syndrome, oblique muscle palsies

Question 26

Strabismus affects __% of the population.

Answer 26

4%

Question 27

4 risk factors for strabismus

Answer 27

1. low birth weight
2. positive FH
3. neurologic complications like cerebral palsy
4. low vision

Question 28

two complications of strabismus

Answer 28

1. disturbs binocular vision

2. increases risk for amblyopia

Question 29

What is amblyopia?

Answer 29

reduction in visual acuity of one or both eyes caused by disuse or misuse during critical period of visual development

Question 30

Visual development occurs up to the age of…

Answer 30

6-8 years

Question 31

3 types of amblyopia

Answer 31

1. strabismic
2. anisometropic or refractive
3. deprivational

Question 32

What are three causes of deprivational ambylopia?

Answer 32

congenital cataracts, blocked visual axis, ptosis

Question 33

What five exams would we perform for a patient with suspected strabismus?

Answer 33

visual acuity
EOMs
corneal light reflex
cover and uncover test
alternate cover test

Question 34

-tropia vs -phoria

Answer 34

-tropia is always deviated; -phoria is sometimes deviated

Question 35

What happens to the good eye if you cover the bad eye in a cover uncover test?

Answer 35

It won’t move!

Question 36

What is the role of pediatrician or primary care in a patient with strabismus?

Answer 36

recognize that there may be a misalignment and refer to ophthalmology promptly to avoid risk of or progression to amblyopia

Question 37

Strabismus can progress to…

Answer 37

amblyopia

Question 38

three ways to address strabismus

Answer 38

prescription glasses, therapeutic eye patches, surgery on eye muscles

Question 39

What neurologic condition is associated with intranuclear ophthalmoplegia?

Answer 39

Multiple sclerosis!