Diplopia

Question 1

4 classes of dip.

Answer 1

1. physiological - object outside point of fixation
2. monocular - eye or glasses abnormality
3. binocular - ocular misalgnment
4. cerebral polyopia - processing problem - persists with a pinhole

Question 2

how to diff. between monocular and binocular dip.

Answer 2

if persists with one ey closed, it is monocular

Question 3

what is cause of binocular dip.

Answer 3

ocular misalignment

Question 4

causes of mono. dip (7)

Answer 4

1. astigmatism
2. lid lesion
3. dry eye
4. corneal damage
5. iridotomy
6. cataracts
7. decentered lens

Question 5

what happens in mono with pinhole

Answer 5

resolves

Question 6

2 causes of ocular misalignment

Answer 6

1. innervational

2. mechanical

Question 7

6 clues to cause of binoc. dip.

Answer 7

1. image sep.
2. head posture
3. ptosis
4. comtancy
5. light reflex
6. alternate cover test

Question 8

what does image separation tell us

Answer 8

max. separation in position of gaze where muscle is weakest

Question 9

what does head position tell us

Answer 9

in 4th nerve palsy the head tilts to the opposite shoulder

Question 10

4 mimickers of true ptosis

Answer 10

1. hypotropia
2. contralateral lid retraction (graves)
3. dermatochalsis
4. brow ptosis

Question 11

what are names of eyes pointing in various directions

Answer 11

up: hypertrophia
down: hypotrophia
in: esotrophia
out: exotrophia

Question 12

what is most common cause of ptosis

Answer 12

involutional, not neurogenic

Question 13

what happens in alternate cover test

Answer 13

when cover the good eye, the bad one comes to look at you

Question 14

what is comitant eye gaze

Answer 14

symmetric misalignment in all positions of gaze

Question 15

what does comitant vs. incomitant tell us

Answer 15

1. comitant - childhood strabismus or chronic innervational disease
2. incomitant - innervational or mechanical

Question 16

sign of CN 6 palsy and type of dip

Answer 16

eye inward - horizontal

Question 17

sign of CN4 palsy

Answer 17

affected eye higher - tilts head to opposite side of lesion

Question 18

3 step test for CN4 palsy

Answer 18

1. when look ahead the higher eye has palsy
2. on lat. gaze, the object sep. increases in direction opp. of palsy
3. on head tilt the sep. increases when tilt head towards the palsy

Question 19

signs of CN3 palsy

Answer 19

down and out and may or may not have blown pupil

Question 20

causes of CN3

Answer 20

aneuysm if pupil

ischemia, trauma

Question 21

what is worse sign, complete or partial sparing

Answer 21

partial sparing

Question 22

what is internuclear opthalmoplegia

Answer 22

lesion of the MLF causes ipsilateral loss of abbduction to side of lesion

Question 23

what happens in pituitary apoplexy

Answer 23

CN3 palsy and bitemporal hemianopsia

Question 24

2 conditions least likely to have loss of acuity and binocular diplopia

Answer 24

1. CN3 palsy

2. myasthenia gravis

Question 25

treatment for monocular

Answer 25

glasses, tears, catarct surgery

Question 26

treatment for binocla

Answer 26

prism glasses, patch, surgery

Question 27

2 options in surgery

Answer 27

1. weaken agonist muscle

2. stengthend antag.

Question 28

when to do surgery

Answer 28

after some time and have tried other options

Question 29

what must be done if dip doesnt decrease after 3-6 months

Answer 29

image

Question 30

what is dangerous dip.

Answer 30

misalignment + eyelid, pupil, optic nerve abnormality