Diplopia Flashcards
1
Q
What is the most common thyroid dysfunction
A
Graves
2
Q
What does cigarette smoking worsen
A
AMD
Graves
3
Q
Things about Graves
A
- TSH autoAB targeted EOMs-significant imflammation-fibroblast proliferation
- # 1 risk of bilateral/unilateral proptosis in middle aged patient
- BIG risk factor=cigarette smoking
- female prediclection (8:1)
- TSH autoAB may also attack thyroid gland-graves with thyroid dysfunction (hyper).
- 1% have concurrent MG
4
Q
Grading system for graves
A
NOSPECS
- No signs to symptoms
- Only signs, but no symptoms
- Soft tissue involvement
- Proptosis
- EOM involvement with resulting diplopia; the IR is most commonly affected first, followed by the medial, superior, and LR. (IMSLO)
- Corneal involvement
- Sight Loss due to ONH compression (enlarged EOMs)
5
Q
Von Graef sign
A
Upper lid lag on down gaze
6
Q
Dalrymple sign
A
Upper lid retraction, “stare appearance”
7
Q
EOM restrictions and Graves
A
IMSLO
-+ forced duction
8
Q
Greates threat to vision in graves
A
ONH compression
9
Q
Dx of graves
A
CT/MRI-enlarged EOM with sparing of tendons
Increased exophthalmometry
T3/T4/TSH blood work
10
Q
Treatment for graves
A
- stop smoking
- exposure K: aggressive lubrication
- diplopia: prism or surgery
- ON compression: steroids, orbital decompression
- concurrent hyperthyroidism: radioiodine, anti-thyroid meds, thyroidectomy
11
Q
Normal exophthalmometry
A
12-22mm for whites
12-18 for asians
12-24 for AA
12
Q
Browns syndrome
A
- abnormal SO muscle or tendon or trochlea
- unilateral hypotropia in primary gaze and limited elevation during adduction
- acquired or congenital
- chin up posture
- (+) FD
- Tx: prism or surgery
13
Q
Duanes
A
- congenital, abnornal muscles or abnormal CN3 or 6 nuclei.
- ET in primary
- type 1=cant abduct
- type 2=cant adduct
- type 3=cant adduct or abduct
- contralateral glob retraction and narrowed palpebral fissure with adduction
- (+) FD
- Tx=prism or surgery
14
Q
Ocular MG
A
- Ach receptor autoABs
- muscle weakness/fatigue
- variable ptosis and diplopia worse at end of day
- 70% have ocular findings as first presentation
- ice pack test, Cogans lid twitch,
- Dx=tensilon test
- management: 10% have a thymoma, do chest CT; 5% have graves, do thyroid testing, ACH inhibitors
15
Q
EOM entrapment
A
- orbital floor fracture
- entrapped IR/IO
- restricted upgaze with diplopia and (+) FD
- treatment: don’t blow nose for 48 hours, abx to decrease chance of infection, fresnel prism for temp diplopia, sx if persistent diplopia after 7-14 days
