Clinical Skills

Question 1

Fundamental components of orthoptic assessments

Answer 1

-Vision
-Cover test
-Binocular status
=Suppression
=Diplopia
=Binocular Single Vision (BSV)
=Stages of BSV
-Ocular Motility

Question 2

What does the cover-uncover test detect?

Answer 2

Manifest strabismus

Question 3

Method of cover-uncover test

Answer 3

-Ask patient to fixate on a torch and record position of corneal reflections
-Ask patient to fixate on a near (33cm) and a distance target (6m)
-Cover one eye

Observe
=Movement of uncovered eye to take up fixation
=Then position and movement of the covered as the cover is removed

Question 4

What does the alternate cover test detect?

Answer 4

Latent strabismus (heterophorias)

Question 5

Method of alternate cover test

Answer 5

-Alternatively cover each eye and observe the movement of the uncovered eye while the patient is fixating on a near (33cm) and distance (6m) target

Question 6

Esophoria definition

Answer 6

Tendency of eyes to move inwards

Horizontal

Question 7

Exophoria definition

Answer 7

Tendency of eyes to move outwards

Horizontal

Question 8

Hyper/Hypophoria definition

Answer 8

Tendency of eyes to move upwards/ downwards

Vertical strabismus

Question 9

What is Tropias?

Answer 9

Manifest strabismus

Question 10

What is Phorias?

Answer 10

Latent strabismus

Question 11

Method of testing ocular motility

Answer 11

-Patient keeps their head still
-Using a pen torch at 50 cms distance from the eyes & starting from primary position, slowly move the targets from the primary position into each of the 9 cardinal positions of gaze. (return to the primary position after each excursion)
-Perform an alternate cover test in each of the positions of gaze to look for any over or under actions.* Test versions first (movement of both eyes from primary position.)* Ask the patient to report any diplopia* Also assess ductions. (Ductions are the extent to which one eye can move from the primary position.) To do this cover one eye and instruct the patient to follow the target into the 9 positions of gaze.* In neurogenic palsies, movement will improve on ductions, but no significant improvement will occur if a mechanical restriction is present.* Ocular motility is usually recorded diagrammatically

Question 12

Describe the image created by the direct ophthalmoscope

Answer 12

-Real, upright image
-Magnified x 15
-Field of view 6 degrees
=Increase the field by dilating pupils
=holding scope close to your eye
=getting close to the patient’s eye