Ocular Motility/ Binocular Vision Flashcards
Deviation is greatest in which gaze for A-pattern exotropia?
Down gaze
Deviation is greater in which gaze for V-pattern exotropia?
Up gaze
Strabismus is either not present or is minimal in primary gaze, but is larger in both up-gaze and down gaze
X- pattern exotropia
Deviation is greater in which gaze for Y-pattern exotropia?
Superior gaze
* deviation absent or minimal in primary and down gaze
Patients with A-pattern exotropia or V-pattern exotropia will exhibit what head posture?
Chin tilt down
Patients with chin tilted up have what type of eye posture?
A-pattern esotropia and V-pattern esotropia
Head tilt to the right or left is typically observed in patients with?
Superior oblique palsy
DEM vertical component measures what?
Automaticity of number calling
Basic esophoria
AC/A?
NFV?
MEM?
PRA?
Eso equal at distance and near (within~5PD)
Average AC/A
decreased distance and near NFV
Decreased vergence facility (base in hard)
Lag MEM
Decreased PRA (minus)
Poor binocular accommodative facility (hard to clear minus)
* BIM : base-in & minus are hard for EP
Symptoms of basic eso
- Horizontal diplopia @ D&N
- blur
- Asthenopia, worse at end of day
Negative fusional vergence test with?
Base in
What is the most common accommodative disorder?
Accommodative insufficiency
Decreased amp of accommodation
Lag of accommodation on MEM
Poor monocular accommodative facility
Reduced PRA
Accommodative insufficiency
Hofstetter’s formula for minimum amp of accommodation
15 - 1/4(age)
Which VT techniques are used to help improve symptoms of accommodative insufficiency?
- Monocular lens clearing and sorting
- Monocular push-ups
What is always considered abnormal finding on MEM?
Any lead
*minus value
Expected values for MEM
+0.25 to +0.75 D lag
Treatment/ management for accommodative insufficiency
Rx plus-power lenses for reading to help relax accommodation (therefore decreases demand)
Ex: +1.00
Vision therapy
*monocular lens sorting
*pencil push ups
What is the initial step in managing amblyopia in children?
Full correction of refractive error with spectacles or contact lenses
you just prescribed full correction to your pediatric patient with anisometropic amblyopia, when do you wanna see them back?
4-6 weeks to re-evaluate VA before prescribing additional therapy
What is the most common type of muscular dystrophy associated with chronic progressive external ophthalmoplegia?
Myotonic dystrophy
* progressive weakening of muscles
* Christmas tree cataracts
True or false
Pupils are affected in chronic progressive external ophthalmoplegia
False
Pupils NOT affected
What is the main difference between CPEO and myasthenia gravis?
CPEO does not have diurnal variation of ptosis
** myasthenia gravis ptosis worse at end of day or after prolonged upgaze
RTC for CPEO
Monitor every 6 months
* no effective treatment, but managing symptoms is important
* topical lubricants with PF AT’s q1h and ointment qhs if exposure keratopathy
Chronic progressive external ophthalmoplegia
*slowly progressive bilateral
* affects all directions of gaze
*Kearns-sayre syndrome (mitochondrial DNA, triad of CPEO, pigmentary retinopathy and cardiac condition defects)