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Binocular Vision > Exotropia - Miriam > Flashcards

Exotropia - Miriam Flashcards

1
Q

What kind of people is XOT more prevalent in?

A

Asians

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2
Q

What is more prevalent intermittent or constant?

A

Intermittent

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3
Q

What are the three classifications of XOTs?

A

Secondary, consecutive and primary

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4
Q

What does secondary mean?

A

Pathology first and XOT follows due to visual impairment

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5
Q

What is a consecutive?

A
  • Esotropia first and exotropia follows
  • often constant
  • may be spontaneous
  • Often occurs after eso deviation (iatrogenic-post-op)—> leads to slow divergence over time
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6
Q

What are the two categories that a primary XOT cane be classified into?

A

Constant and intermittent

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7
Q

What is a primary constant XOT?

A

XOT is present at all times and is the initial problem

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8
Q

Why should a primary constant exotropia be examined properly?

A

To ensure nil pathology or neurological disease

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9
Q

What are three classifications of a primary intermittent XOTs?

A

Near, non-specific and distance

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10
Q

What in the history may indicate an intermittent near XOT?

A
  • More likely in adults than children
  • Complain of dipl
  • Complain of problems for near work such as HAs, dipl, asthenopic sx
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11
Q

What would happen in a CT for an intermittent near XOT?

A

Near XOT and distance controlled phoria

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12
Q

Does an intermittent non-specific XOT have BSV at any distance?

A

Yes

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13
Q

Can intermittent nonspecific XOT present at any age group?

A

Yes

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14
Q

LWhat does an intermittent non-specific XOT mean?

A

Sometimes your eyes are Straight and sometimes they aren’t

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15
Q

With intermittent distance XOT have near or distance BSV?

A

Near BSV

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16
Q

With a child who has a intermittent distance XOT how does the child not see double in the distance?

A

They suppress at the distance

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17
Q

What is the most common of all intermittent XOTs in children?

A

Intermittent distance XOT

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18
Q

What is a symptoms a mum may notice with a child intermittent distance XOT?

A

They may close one eye in bright light

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19
Q

What is a true distance XOT?

A

They have near BSV and distance XOT

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20
Q

What is a simulated distance XOT?

A

At distance they are XOT but at near they are managing to compensate

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21
Q

What are two ways someone may be simulating an XOT?

A
  • High AC/A ratio
  • Using fusion
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22
Q

How would you tell if a px has a high AC/A that causes a simulated distance XOT?

A

Present a +3.00DS to them which relaxes accommodation and will cause them to decompensate to a manifest constant XOT

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23
Q

How would you tell if a px’s fusion is causing a simulated distance XOT?

A

Use patching for about 30 mins and there will be a larger angle of deviation compared to before the patching

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24
Q

What key information should you ask in history when investigating an XOT?

A
  • Age of onset
  • Type/frequency (constant or intermittent)
  • Symptoms
  • POH (glasses, amb, pathology, previous surgery?)
  • GH (milestones, chronic health, neurological)
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25
Q

What type of XOT is amblyopia more prevalent in?

A

Constant and consecutive and secondary XOT from pathology

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26
Q

In what case will an intermittent XOT cause amblyopia?

A

If they decompensated and untreated in child

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27
Q

How would you investigate an XOT?

A
  • Cover test
  • Ocular motility
  • Near point of convergence
  • Investigation of BV function (simultaneous perception/sensory, fusional reserves, stereopsis)
  • Measure angle (PCT ect)
  • Measurement of suppression
  • AC/A ratio
  • Cyloplegic refraction
  • Fundus and media examination
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28
Q

What would a cover test show about an XOT?

A
  • size deviation
  • intermittent or constant
  • Near or distance
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29
Q

What should you note when doing ocular motility?

A

Versions and ductions (common for limitations with prev strab surgery)
Scars on sclera from surgery
A or V patterns

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30
Q

What would you note form near point of convergence when assessing XOT?

A

How well they are controlled at near
(distance XOT that may decompensate to a constant XOT)

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31
Q

Under what conditions should stereopsis be done for a XOT px?

A

Where they are controlled, for example if they have an intermittent distance XOT, would asses stereopsis at near

32
Q

If a px had an intermittent distance XOT, what binocular function tests would you use?

A

Lang, Randot, TNO, fusion range for near, 20^BO both eyes

33
Q

If a px had an intermittent near XOT, what BV tests would you use?

A

Synoptophore, FD2 distance stereotest, fusion range distance

34
Q

How would you measure the deviation?

A

Prism cover test - GOLD STANDARD
Prism reflection test
Krismsky
AT NEAR AND DISTANCE and maybe FAR distance

35
Q

In what instance would you use a Krismsky?

A

If they have poor vision

36
Q

In order to determine if a distance XOT is simulated or true what would you do?

A

With +3.00DS either eye at near with PCT (increased near angle simulated by accommodation) and after 45 minutes of occlusion with PCT (increased angle simulated by fusion)

37
Q

How is suppression measured?

A

Post-operative diplopia test to simulate what it would be like for after surgery

38
Q

Why is a fundus and media examination important?

A

To exclude pathology

39
Q

Why would someone do reconstructive surgery?

A

For cosmetic purposes

40
Q

Why have you got to be careful when carrying out reconstructive surgery?

A

If px is asymptomatic and they are suppressing after surgery they may get diplopia

41
Q

What are four principles you must consider for management

A
  • Correct diagnosis
  • Achieve best VAs in each eyes
  • Functional cure
  • Reconstructive cure
42
Q

What is functional cure?

A

Restoring BSV at all distances

43
Q

What is reconstructive cure?

A

Improving Cosmesis to make XOT smaller

44
Q

Is a secondary XOT more common in older or younger patients ? + is it more likely to be constant or intermittent?

A

older patients + constant unilateral (because pathology is constant)

45
Q

Should you refer children under 2 with a primary constant xot?

A

Yes

46
Q

What is the first stage management of XOT?

A
  • refractive correction
  • amblyopia treatment for under 7s
  • Fundus examination
47
Q

Should you under correct small degrees if hyperopia for px with XOT?

A

Yes

48
Q

How can you delay surgery with a px with XOT in relation to manipulation of rx?

A

Over minus

49
Q

In an adult px what prism would you give if surgery is contra indicated or delclined?

A

Base in

50
Q

Do prims treat the problem?

A

No

51
Q

What orhtoptic exercises can you give for XOT?

A
  • positive relative vergence
  • dot card
52
Q

What are six reasons to refer an XOT px to the HES?

A
  • pathology concerns
  • prevent amb
  • treat amb
  • give exercises
  • surgery
  • Botox
53
Q

Is Botox a predictable outcome?

A

No

54
Q

What are three reasons surgery would be undertaken for XOT PX ?

A
  • intermittent is decompensating
  • symptomatic
  • Poor cosmesis
55
Q

Why is a child with a decompensating intermittent distance XOT concerning ?

A

They may decompensate and get amb and lose bsv

56
Q

What is the management for secondary XOT?

A
  • give significant rx
  • refer hes for undiagnosed issue
  • treat amb
  • treat for cosmesis purposes
57
Q

What are two cosmetic treatments for px with secondary XOT?

A

Strabismus surgery + Botox for older children

58
Q

What is the management for consecutive XOT for under 8 yrs old?

A
  • give significant rx
    + refer for:
  • treat amb
  • prevent loss of bsv
59
Q

What is the management for a px with consecutive XOT for over 8s who are not happy with appearance or sx?

A
  • give significant rx
  • small XOT then under correct hyperopia

Refer to hes for :
- bi prism to give bsv
- surgery
- Botox

60
Q

What is the management for a px with constant XOT for an under 8?

A
  • Correct any rx
  • Refer for ocular or neurological associations + amb treatment + prevent bsv loss
61
Q

Why would you refer over 8s to hes with a constant XOT?

A
  • cosmesis purposes
  • symptomatic
  • older kids with RFs for further investigation
62
Q

Once referred to hes, what will they do to treat constant XOT?

A

Surgery or Botox

63
Q

What is the management for over 8s with constant XOT?

A

correct any rx and consider referral to hes

64
Q

What is the management for near XOT?

A
  • correct significant rx and under correct small hyperopic rx
  • refer if under 8
65
Q

is it liekly to have a child under 8 with an intermittent near XOT?

A

Unlikely

66
Q

What prisms would you give for a near XOT?

A

Base in

67
Q

In what cases would you suggest orthoptic exercises?

A
  • deviations less than 20^d
  • to improve BO fusion range
  • to improve convergence
68
Q

At the hes, what may they do to treat near XOT?

A

Surgery or Botox

69
Q

What is the management for non-specific XOt?

A

-correct significant rx
- refer under 8 for amb + prevent loss of bsv
- refer over 8s for cosmesis

70
Q

Does a px with non-specific XOT often have symptoms?

A

No

71
Q

What are the cosmetic treatment for a px with non-specific XOT?

A

Surgery and Botox

72
Q

What is the management for a child under 8 with intermittent distance XOT?

A
  • give significant rx
  • refer to hes
73
Q

What must you include when you are referring an intermittent distance XOT under 8 year old px?

A

They are well controlled at near

74
Q

If they are older than 8 years old why would you refer an intermittent distance XOT px?

A

Cosmesis

75
Q

Why should you no rush surgery if a px with distance XOT has good control at near?

A
  • risk of loss of bsv
  • risk of amb
  • risk of consecutive sot due to inaccurate measurements
76
Q

What is the hes job when managing intermittent distance XOT?

A
  • Ensure controlled and not deteriorating
  • potentially over minus
  • surgery
  • Botox
77
Q

What is the likely diagnosis?
Cover tests with accommodative target small XOP good recovery. Cover test are near with +3.00 r&l moderate XOT. Cover test at distance moderate XOT?

A

Intermittent distance simulated XOT

Binocular Vision (30 decks)

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