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Motility Bloick 10 > Eval Of Ocular Movements > Flashcards

Eval Of Ocular Movements Flashcards

1
Q

Purpose of external observation

A

To identify gross abnormalities of the eye and adnexa

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2
Q

Procedure of external observation

A

Observe the patients eye alignment, facial features, head position, posture, gait, carriage

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3
Q

What to note during external observation

A

Note any abnormalities or asymmetries

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4
Q

Pseudoesotropia

A

People with excessive epicanthal folds will have the appearance of esotropia, but when you pinch the folds and do hirschbirg, they have normal alignment

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5
Q

Are eye turns unilateral or bilateral

A

Can be either

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6
Q

Head tilts and turns

A

Patients will do this as a default head position to compensate for a deviation

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7
Q

Purpose of cover test

A

To assess the presence and magnitude of a phoria or tropia

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8
Q

Correction during CT

A

Habitual at distance and near

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9
Q

What kind of deviations are seen in cover-uncover test

A

Tropias

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10
Q

What deviations re seen in the alternating cover test

A

Phobias

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11
Q

What CT test measures the amount of deviation with prism bars

A

Alternative cover test

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12
Q

Constancy in CT

A

Is it constant to intermittent

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13
Q

Eye preference in CT strabismus

A

Fixation may alternate between eyes or maintains fixation only with one eye

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14
Q

Recorder of strabismus in CT

A
  • correction
  • magnitude
  • eye
  • phoria or tropia
  • constant or intermittent (intermittent has paranthasis)
  • distance or near, apostrophe for near
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15
Q

Purpose of EOMs

A

To assess ability to perform conjugate eye movements

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16
Q

Correction in EOMs

A

None

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17
Q

What should you ask when doing EOMs

A

Ask patient to inform you if they experience pain or diploma

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18
Q

What to observe during EOMs

A
  • fixation
  • pursuit or eye movements
  • vertical movement of the eyes and lids
  • comitancy
  • monocular motility
  • saccadic movements
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19
Q

Recording for EOM

A

Eye
Ability of muscles
Diploma
Pain

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20
Q

Purpose of Hirshcberg

A

To determine the position of the visual axes, under binocular conditions at near

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21
Q

Correction for hirchsbirg

A

None

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22
Q

Purpose of Hirschberg

A

To determine the position of the visual axies, under binocular conditions at near

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23
Q

Correction with Hirschberg

A

None

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24
Q

Procedure of Hirschberg

A
  1. Have put look at penlight 50-100cm from the patient)
  2. Notice the corneal light reflexes in each moncularly
  3. Notice the corneal light reflex of each eye binocularly
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25
What is the angle lambda for a corneal reflex that is in the center of the pupil
0 | Ortho
26
What is the angle lambda of a corneal reflex that is nasal relative to the center of the pupil
+ | Exo
27
What is the angle lambda value of a reflex that is temporal to the center of the pupil
Negative | Eso
28
Angle lambda for a reflex above or below the center of the pupil
None. | Hypo or hyper
29
From Hirschberg results, if the corneal reflex is different monocularly vs binocularly
Strabismus
30
Krimsky p[rocedure
Place prism over FIXATING EYE until corneal reflex is in the same position as deviating eye
31
Prism used for eso
BO
32
Prism for exo
BI
33
Recording for Krimsky
Eye Magnitude Direction of deviation 22prismD LET
34
Pertinent entrance tests when suspect strabismus
- cover test - EOMs - saccades - pursuits - Hirschberg/Krimsky - Buckner
35
Purpose of Bruckner
To evaluate the symmetry of binocular fixation with an O scope
36
What does bruckner screen for
- strabismus - anisometropia - media opacities - post pole anomalies - presence of refractive error - great test for infants and young proverbial children
37
Correction used in Bruckner
None
38
What test is really good for infants and proverbial children
Bruckner
39
Procedure for Bruckner
- put look at ophthalmoscope (80-100cm from patient with light illuminating both pupils) - compare red reflexes between the two eyes looking through the peephole of ophthalmoscope
40
If reflexes are equally bright in Bruckner
Binocular fixation
41
If reflexes are not equal in Bruckner: darker red reflex
Fixating eye
42
Unequal reflex in Bruckner: bright, lighter, or white reflex
Non fixating eye in strabismus
43
Unequal reflexes in Bruckner: dimmer eye
Media opacity
44
Unequal reflex in bruckner: brighter eye
Retinoblastoma
45
How does hyperopia appear on a bruckner tests
Crescent towards head of ophthalmoscope
46
How does myopia appear on bruckner test
Crescent towards the handle of ophthalmoscope
47
How to record bruckner test
- two eyes aper equally bright - presence of media opactiies - presence of refractive error and if it's equal - which eye appears white and brighter
48
Torsional eye movements are _____ under normal viewing circumstances
Reflexive
49
Two types of torsion
Cycloversion | Cyclovergence
50
Conjugate movments: vertical meridian do of the retinas are rotated in the same direction and by the same amount
Cycloversion
51
Disconjugate movements: vertical meridian of the retinas are rotated in the opposite directions to maintain a single image
Cyuclovergence
52
Compensate for cyclophorias
Cyclovergence
53
Tendency of the vertical meridians of the retinas to deviate from the straight ahead position in binocular vision, which becomes manifest in the absence of fusion
Cyclophoria
54
Purpose of double Maddox rod
To detect a torsional misalignment | Measures cyclodeviation but does not differentiation between phoria and tropia
55
What is a double Maddox rod NOT capable of
Phoria vs tropia
56
Set up for double Maddox rod
Habitual correction Dim light Penlight at 40cm or muscle light
57
Procedure for double Maddox rod
- Patient wears a trial frame with a Maddox rod lens in each eye - lenses are vertical so put sees horizontal lines - vertical prism to induce separate lines - rotate the orientation of the Maddox rod lenses until two lines are parallel
58
In double Maddox rod, the tile of the line is what
Opposite the tilt of the retinal image, the line is perceived to be titled int he directing in which the under acting muscle would rotate the eye - tilted out if intorted, problems with inferior oblique - tilted in for extorted, SO problem
59
Lien tilted in towards nose in Maddox rod
Extortion
60
Line tilted out towards temporal in Maddox rod
Intorsion
61
Patient states that the right eye is tilted towards the nose in double Maddox rod
Right excyclodeviation | Right SO underacting
62
Recording of double Maddox rod
Eye Magnitude (from the trial frame) Direction 10 degrees right excyclodeviation
63
Purpose of using the amblyoscope
To assess - objective and subjective angle of deviation - abnormal retinal correspondence - cyclophoria - hyperphoria - horizontal and vertical vergences
64
What eye does the more detailed image go over in an amblyscope?
The more detailed image is the lion and it goes over the fixating eye
65
Purpose of the parks 3 step test
To identify the muscle responsible for a vertical deviation
66
Three steps to the Parks 3 step
1. Identify which eye is hyper in primary gaze 2. Identify whether the vertical deviation increases on right or left gaze 3. Identify whether the vertical deviation increases on right or left head tilt
67
Procedure for Parks 3 step for the first portion
Identify which eye is hyper in primary gaze - in primary gaze, determine whch eye is hyperdeviated - alternate cover test: the hyperdeviated eye is the one that moves down when uncovered - Maddox rod, red lens test: target seen by hyperdeviated eye will be lower than image seen by other eye
68
What is the procedure for the 2nd step of the park 3 step
Identify whether the vertical deviation increases on right or left gaze - compare the vertical deviation in right gaze and in left gaze - determine if the deviation is greater in right or left gaze by using the Maddox rod or red lens test. If difficult to determine, ask patient if separation is greater in right or in left gaze
69
What is the procedure for the 3rd step of Park 3 step test
Identify whether the vertical deviation increases on right or left head tilt - with the patient looking straight ahead, compare the vertical deviation when the patients head is tilted towards the right and left shoulder - determine if the deviation is greater on right or left head tilt
70
Parks 3 step eval
Using the H pattern figure for each eye, circle the underacting muscles that are affected in each step -the paretic muscle is the one that is circled 3 times
71
Full name for the Parks 3 step test
Parks-Bielschowsky three step test
72
+ Bileschowsky sign
Increase in hyperdeviation on head tilt of one side versus the other - incomitant deviation - SO paretic muscle of hyperdeviating eye
73
(-) Bielschowsky sign
Constant deviation OR incomitant deviation without SO involvement
74
When do you do the forced suction test
When restricted incomitant deviation is found | -mechanical restriction vs paretic muscle
75
Procedure for forced diction test
- instil anesthesia - patient fixates towards side of limited gaze - using forceps or Qtip, grasp the conj near limbus on the side opposite the direction you want to move the eye - move the eye int he direction of the suspected restriction
76
Resistance in a forced duction test
Mechanical restriction of the muscle | -positive forced Duction test
77
Eye moves freely in a forced duction test
Paretic muscle | -negative forced duction test
78
Recordings for forced duction test
Resistance=positive Eye moves=negative Eye and muscle testing (+) forced duction test for RLR
79
Purpose of a Hess Lancaster test
To evaluate the alignment of the eyes and their movements both individually and in tandem -provides measure of horizontal, vertical, and cyclo=deviation simultaneously
80
What is a Hess-Lancaster test useful for
Spatial awareness assessment and mapping out a patients field of single binocular vision
81
What does the Hess in Hess Lancaster test mean
Dot
82
What does the Lancaster int he Hess Lancaster test mean
Line
83
Procedure of the Hess Lancaster test
- low light at 1m - pt wears RG glasses (OD-red, OS-green) - examiner has red light wand, patient has green light wand - ask the patient to superimpose their light upon the projected light from the examiner. Any difference or deviation indicates the deviation direction and magnitude of the measure eye from the normal axis - swap light wands and test the other eye
84
What does any difference in deviation on the Hess Lancaster test tell us
Indicates the deviation direction and magnitude of the measure eye from the normal axis
85
Hess Lancaster recording sheet
Looks like a grid
86
What is the difference between each square on the Hess Lancaster test
5 degrees
87
What 3 things do we interpret on the hess Lancaster test
Position Size Shape
88
Position of ventral point on the hess Lancaster test
Deviation in primary position
89
Smaller field size on the hess Lancaster test
Affected eye, eye with limited movement
90
Displacement of the field interior lay (hess Lancaster test)
Underaction
91
Muscle with the greatest underaction (hess Lancaster)
Affected muscle
92
What is the next greatest underaction muscle in the hess Lancaster test
Contralateral antagonsit
93
Larger field in hess Lancaster
Unaffected eye
94
Displacement of the field exteriorly (Hess Lancaster)
Overaction
95
Muscle with the greatest overaction in hess Lancaster
Contralateral synergist | -next greatest overaction is the ipsilateral antagonist
96
How can you tell if the condition was a recent one or a long standing on in the hess Lancaster test
Differing size fields=recent | Similar size fields=long standing
97
What is it called when the deviation is the same all over the field in the hess Lancaster test
Comitancy - can occur over time - each plotted point is deviated by the same amount in each gaze
98
What do narrowing fields in opposing directions on the hess Lancaster test indicate
Mechanical restrictions
99
Sloping fields in hess Lancaster
A/V pattern, DOES NOT MEAN TORSION

Motility Bloick 10 (3 decks)

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