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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
Q

What is the angle lambda for a corneal reflex that is in the center of the pupil

A

0

Ortho

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26
Q

What is the angle lambda of a corneal reflex that is nasal relative to the center of the pupil

A

+

Exo

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27
Q

What is the angle lambda value of a reflex that is temporal to the center of the pupil

A

Negative

Eso

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28
Q

Angle lambda for a reflex above or below the center of the pupil

A

None.

Hypo or hyper

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29
Q

From Hirschberg results, if the corneal reflex is different monocularly vs binocularly

A

Strabismus

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30
Q

Krimsky p[rocedure

A

Place prism over FIXATING EYE until corneal reflex is in the same position as deviating eye

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31
Q

Prism used for eso

A

BO

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32
Q

Prism for exo

A

BI

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33
Q

Recording for Krimsky

A

Eye
Magnitude
Direction of deviation

22prismD LET

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34
Q

Pertinent entrance tests when suspect strabismus

A
  • cover test
  • EOMs
  • saccades
  • pursuits
  • Hirschberg/Krimsky
  • Buckner
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35
Q

Purpose of Bruckner

A

To evaluate the symmetry of binocular fixation with an O scope

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36
Q

What does bruckner screen for

A
  • strabismus
  • anisometropia
  • media opacities
  • post pole anomalies
  • presence of refractive error
  • great test for infants and young proverbial children
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37
Q

Correction used in Bruckner

A

None

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38
Q

What test is really good for infants and proverbial children

A

Bruckner

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39
Q

Procedure for Bruckner

A
  • 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
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40
Q

If reflexes are equally bright in Bruckner

A

Binocular fixation

41
Q

If reflexes are not equal in Bruckner: darker red reflex

A

Fixating eye

42
Q

Unequal reflex in Bruckner: bright, lighter, or white reflex

A

Non fixating eye in strabismus

43
Q

Unequal reflexes in Bruckner: dimmer eye

A

Media opacity

44
Q

Unequal reflex in bruckner: brighter eye

A

Retinoblastoma

45
Q

How does hyperopia appear on a bruckner tests

A

Crescent towards head of ophthalmoscope

46
Q

How does myopia appear on bruckner test

A

Crescent towards the handle of ophthalmoscope

47
Q

How to record bruckner test

A
  • 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
Q

Torsional eye movements are _____ under normal viewing circumstances

A

Reflexive

49
Q

Two types of torsion

A

Cycloversion

Cyclovergence

50
Q

Conjugate movments: vertical meridian do of the retinas are rotated in the same direction and by the same amount

A

Cycloversion

51
Q

Disconjugate movements: vertical meridian of the retinas are rotated in the opposite directions to maintain a single image

A

Cyuclovergence

52
Q

Compensate for cyclophorias

A

Cyclovergence

53
Q

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

A

Cyclophoria

54
Q

Purpose of double Maddox rod

A

To detect a torsional misalignment

Measures cyclodeviation but does not differentiation between phoria and tropia

55
Q

What is a double Maddox rod NOT capable of

A

Phoria vs tropia

56
Q

Set up for double Maddox rod

A

Habitual correction
Dim light
Penlight at 40cm or muscle light

57
Q

Procedure for double Maddox rod

A
  • 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
Q

In double Maddox rod, the tile of the line is what

A

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
Q

Lien tilted in towards nose in Maddox rod

A

Extortion

60
Q

Line tilted out towards temporal in Maddox rod

A

Intorsion

61
Q

Patient states that the right eye is tilted towards the nose in double Maddox rod

A

Right excyclodeviation

Right SO underacting

62
Q

Recording of double Maddox rod

A

Eye
Magnitude (from the trial frame)
Direction

10 degrees right excyclodeviation

63
Q

Purpose of using the amblyoscope

A

To assess

  • objective and subjective angle of deviation
  • abnormal retinal correspondence
  • cyclophoria
  • hyperphoria
  • horizontal and vertical vergences
64
Q

What eye does the more detailed image go over in an amblyscope?

A

The more detailed image is the lion and it goes over the fixating eye

65
Q

Purpose of the parks 3 step test

A

To identify the muscle responsible for a vertical deviation

66
Q

Three steps to the Parks 3 step

A
  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
Q

Procedure for Parks 3 step for the first portion

A

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
Q

What is the procedure for the 2nd step of the park 3 step

A

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
Q

What is the procedure for the 3rd step of Park 3 step test

A

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
Q

Parks 3 step eval

A

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
Q

Full name for the Parks 3 step test

A

Parks-Bielschowsky three step test

72
Q

+ Bileschowsky sign

A

Increase in hyperdeviation on head tilt of one side versus the other

  • incomitant deviation
  • SO paretic muscle of hyperdeviating eye
73
Q

(-) Bielschowsky sign

A

Constant deviation OR incomitant deviation without SO involvement

74
Q

When do you do the forced suction test

A

When restricted incomitant deviation is found

-mechanical restriction vs paretic muscle

75
Q

Procedure for forced diction test

A
  • 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
Q

Resistance in a forced duction test

A

Mechanical restriction of the muscle

-positive forced Duction test

77
Q

Eye moves freely in a forced duction test

A

Paretic muscle

-negative forced duction test

78
Q

Recordings for forced duction test

A

Resistance=positive
Eye moves=negative

Eye and muscle testing

(+) forced duction test for RLR

79
Q

Purpose of a Hess Lancaster test

A

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
Q

What is a Hess-Lancaster test useful for

A

Spatial awareness assessment and mapping out a patients field of single binocular vision

81
Q

What does the Hess in Hess Lancaster test mean

A

Dot

82
Q

What does the Lancaster int he Hess Lancaster test mean

A

Line

83
Q

Procedure of the Hess Lancaster test

A
  • 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
Q

What does any difference in deviation on the Hess Lancaster test tell us

A

Indicates the deviation direction and magnitude of the measure eye from the normal axis

85
Q

Hess Lancaster recording sheet

A

Looks like a grid

86
Q

What is the difference between each square on the Hess Lancaster test

A

5 degrees

87
Q

What 3 things do we interpret on the hess Lancaster test

A

Position
Size
Shape

88
Q

Position of ventral point on the hess Lancaster test

A

Deviation in primary position

89
Q

Smaller field size on the hess Lancaster test

A

Affected eye, eye with limited movement

90
Q

Displacement of the field interior lay (hess Lancaster test)

A

Underaction

91
Q

Muscle with the greatest underaction (hess Lancaster)

A

Affected muscle

92
Q

What is the next greatest underaction muscle in the hess Lancaster test

A

Contralateral antagonsit

93
Q

Larger field in hess Lancaster

A

Unaffected eye

94
Q

Displacement of the field exteriorly (Hess Lancaster)

A

Overaction

95
Q

Muscle with the greatest overaction in hess Lancaster

A

Contralateral synergist

-next greatest overaction is the ipsilateral antagonist

96
Q

How can you tell if the condition was a recent one or a long standing on in the hess Lancaster test

A

Differing size fields=recent

Similar size fields=long standing

97
Q

What is it called when the deviation is the same all over the field in the hess Lancaster test

A

Comitancy

  • can occur over time
  • each plotted point is deviated by the same amount in each gaze
98
Q

What do narrowing fields in opposing directions on the hess Lancaster test indicate

A

Mechanical restrictions

99
Q

Sloping fields in hess Lancaster

A

A/V pattern, DOES NOT MEAN TORSION

Motility Bloick 10 (3 decks)

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