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Motility Block 9 > Exam sequence in strabismus > Flashcards

Exam sequence in strabismus Flashcards

1
Q

This allows you to develop a hypothesis and guide the management plan

A

Case history

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2
Q

What do you need to address in case history

A 
CC
FOLDAR
Medical Hx
Birth Hx
Family Hx
Meds
Allergies
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3
Q

Attention to chiefs complaints

A
  • asthenopia
  • Poor cosmesis
  • failed screening
  • second opinion (confirm a dx)
  • family history of strabismus
  • birth defects
  • signs of asthenopia (rubbing)
  • developmental concerns
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4
Q

FOLDAR questions specific to ocular motility problems

A
  • frequency of deviation or symptom

- onset of deviation or symptom

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5
Q

Why do we need to ask about frequency or deviation or symptom for motility problems

A
  • Constant or intermittent can predict presence of amblyopia and sensory adaptations
  • worse during a time of day, AC/A problems, decompensations, when inattentive
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6
Q

What do we need to ask about onset of deviation or symptom for ocular motility problems

A
  • age of onset (infantile/congenital or acquired)

- mode of onset- sudden or gradual

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7
Q

Location and laterality during FOLDAR during case history

A

At distance or near in a particular gaze unilateral or alternating

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8
Q

Duration during FOLDAR in case history

A

Onset to first treatment

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9
Q

Associated signs and symptoms in case history for ocular motility problems

A

double vision, eye strain, trauma, illness, medication use, numbness and dizziness, no symptoms

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10
Q

Relieve in FOLDAR in case history for motility problems

A

Treatments that have helped: glasses, occlusions, vision therapy, surgery

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11
Q

Systemic history in ocular motility problems

A

Childhood diseases, medications, neurologic, problems, developmental milestones

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12
Q

Birth history

A

Birth weight, prematurity, complications, prenatal and perinatal care

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13
Q

Family history for ocular motility problem exam

A

History of strabismus, history of binocular dysfunctions or amblyopia

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14
Q

Direct observation of patietns experience in ocular motility exam

A

Head positioning, head movements, attentiveness, motor control

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15
Q

Head posture

A

Head tilt, turn or tip to avoid diplopia ( or to keep double images far apart)
-common in non-comitant deviations-face placed in the affected muscles diagnostic action field

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16
Q

Facial assymetry in ocular motility problems

A

Down syndrome
Cerebral palsy
Hydrocephaly
Craniofacial abnormalities

17
Q

Lid position

A

Ptosis
Exophthalmos (graves, Duane’s)
Lagophthalmos
Prominent epicanthal folds

18
Q

Nose bridge in ocular motility problems

A

Can make the appearance of strabismus not correct

19
Q

Wide nose bridge

A

Makes XT less obvious

20
Q

Narrow nose bridge

A

Makes ET less obvious

21
Q

Wide face

A

Makes XT less obvious

22
Q

Narrow face

A

Makes ET less obvious

23
Q

Hypertelorism

A

Eyes wide apart

24
Q

Positive angle lambda

A

Reflex nasal to pupil

Makes XT more obvious

25
Q

Negative angle lambda

A

Temporal reflex to pupil

Makes ET more obvious

26
Q

Normal hircschbirg

A

Reflex is about 0.5mm nasal to the center of the pupil (slightly exo)

27
Q

What to consider when looking at presence of deviation

A 
Constant or intermittent 
Unilateral or alternating 
Size and direction of the deviation 
Cosmesis 
Constancy
28
Q

Motor fusion tests done on ocular motility exam

A 
Pertinent entrance tests, eye and head tilt 
CT (in all gazes), ductions and versions 
Hirsh/Krimsky
Bruckner test 
Test of torsion-double Maddox 
Parks three step test 
Red glass 
Hess Lancaster, major amblyoscope
29
Q

What types of refractions are pertinent in an ocular motility exam

A

Keratometry
Dry ret
Subjective refraction
Cylcoplegic refraction

30
Q

What ocular health tests are pertinent in an ocular motility exam

A

Biomicroscopy

90D, BIO with 20D

Motility Block 9 (5 decks)

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