Ocular Motility Testing 5% Flashcards
1
Q
When checking stereo vision you must have_________
A
good vision in both eyes
Maculas projected straight ahead
Overlapping VFs
2
Q
Monoculary pts can have depth perception but can not have
A
stereo vision
3
Q
A high quality of vision that gives you 3D
A
Stereo vision
4
Q
How many extraocular eye muscles do we have
A
6
5
Q
Name the eye muscles
A
superior rectus
Inferior rectus
lateral rectus
medial rectus
superior oblique
Inferior oblique
6
Q
The superior oblique is attached under the
A
superior rectus in an oblique fasion
7
Q
Inferior oblique is attached under the
A
lateral rectus muscle in an oblique fashion
8
Q
*What is the function of the superior rectus muscle
A
move eye upward (elevates)
9
Q
*What is the function of the inferior rectus muscle
A
Move eye downward(suppresses)
10
Q
*What function does the superior oblique have
A
downward and out(tortional rotation)
11
Q
*What function does the inferior oblique have
A
elevates the eye up and out (torsional rotation)
12
Q
*What is the function of the lateral recuts
A
move eye outward(abduct)
13
Q
Superior oblique is attached to the ______
A
Troclea(you can feel it in nasal canthus area.)
14
Q
What are the 2 types of eye movements?
A
Sacaad and Pusuit
15
Q
Fast eye movements moving eye directly from one target to another, looking at stationary objects
A
Sacaad
16
Q
Slow eye movements looking at moving objects: slow smooth tracking of a moving target
A
Pursuit
17
Q
Law that state that each muscle has an opposing muscle in the same eye that does the opposite thing. When one muscle contracts the antagonist (opposite) muscle in the same eye must relax.
A
Sherrington’s Law
18
Q
In Sherrington’s Law the opposing muscle must relax when the opposing muscle is ______
A
contracting.
19
Q
The binocular law (law of Yoke Muscles) that states that each position of gaze is accomplished by contraction of one muscle in each eye and the amount of innervation to both eye muscles is determined by whichever eye is fixating.
A
Herring’s Law
20
Q
True or false:
During any conjugate eye movement, equal and simultaneous innervation flows to both yoke muscles.
A
True
21
Q
what is the function of the medial rectus
A
moves eye inward(adduct)
22
Q
*How many cranial nerves are there?
A
12
23
Q
Name the 12 cranial nerves
A
Olfactory Nerve I (1)
Optic Nerve II (2)
Oculomotor nerve III (3)
Troclear Nerve IV (4)
Trigeminal Nerve V (5)
Abducens Nerve VI (6)
Facial Nerve VII (7)
Vestibulocochlear Nerve VIII (8)
Glossopharyngeal Nerve IX (9)
Vagus Nerve X (10)
Accessory Nerve XI (11)
Hypoglossal Nerve XII (12)
24
Q
*What does SO4 LR6 III Mnemonic stand for?
A
SO4=superior oblique innervated by CN4
LR6=Lateral Rectus innervated by CN6
III=all other muscles innervated by CN3
25
Cranial nerve is a nerve that comes directly from ______as opposed to spinal cord
Brain
26
*What are the cranial nerves that apply to ophthalmology?
Optic nerve CN2(II)
Oculomotor nerve CN3(III)
Trochlear Nerve CN 4(IV)
Abducens nerve CN 6(VI)
27
Which CN transmits visual information to the brain?
Optic nerve (CN 2)
28
Which CN innervated the superior oblique, which depresses and rotates the eyes?
Troclear Nerve CN4
29
Which CN innervates the lateral rectus, which abducts the eye?
Abducens nerve (CN6)
30
Which CN innervates the levator muscle, superior rectus, medial rectus, inferior rectus, and inferior obliques? Also innervates ms the sphincter pupillary muscle and the ciliary body muscle.
Oculomotor nerve (CN3)
31
What is the 2nd CN
Optic nerve
32
What is the 3rd CN
Oculomtor nerve
33
What is the 4th CN
Trochlear nerve
34
What is the 6th CN
Abducens nerve
35
What is CN 1
Olfactory nerve
36
What is CN 5
Trigeminal
37
What is CN 7
Facial nerve
38
What is CN8
Vestibulocochlear nerve
39
What is CN 9
Glossipharyngeal nerve
40
What is CN10
Vagus nerve
41
What is CN 11
Accessory nerve
42
What is CN12
Hypoglossal nerve
43
*What is a Cranial nerve palsy?
Means that a nerve can not send an impulse properly.
(Know the difference in CN palsies that effect the eyes)
44
What causes a cranial nerve palsy?
Disease or trauma
Stroked, brain tumors, diabetes
45
What determines the deficit of a CN palsy?
which nerve is involved and where on the nerve the problem is.
46
CN palsy has very different causes depending on the pts_____
Age
47
What are the causes of CN palsies with over age 40
DM
CVA (strokes)
Basilar artery insufficiency(poor blood flow to back of brain)
GCA(giant cell arteritis)
48
What are the main causes of CN palsies Under age 40?
Congenital Defects
Cranial Artery Aneurysms
Head Trauma
MS
Secondary to increased intracranial pressure
49
Double VA with both eyes open
binocular diplopia
50
What causes binocular diplopia?
misalignment of the eyes
(Strabismus, damage to nerves controlling the EOM, myasthenia gravis, thyroid disease, trauma)
51
Double vision with one eye covered
Monocular diplopia
52
What cause monocular diplopia
an imperfection in the eye
(CAT, K irregularities, uncorrected astig, some retinal abnormalities suck as macular puckering)
53
Ductions are _______movements
monocular (movement of one eye)
54
When looking at right eye and it moves left that is called
adducting
55
When looking at right eye and it moves right it is
abducting
56
When eye looks up it is
supraduction
57
When eye looks down that is
infraduction
58
outwart movement
abduction
59
inward movement
adduction
60
upward movement
supraduction
61
downward movement
infraduction
62
torsional inward movement
incycloduction
63
tornsional outward movement
excycloduction
64
*Simultaneous movements of both eyes in the same direction
Versions
65
dextro means
right
66
cyclo means
rotation
67
*Simultaneous movements of both eyes in opposite direction
Vergences
68
Both eyes move toward one another (looking at near)
converging
69
When look from near to distance eyes ______
diverge
70
How many cardinal positions are there
6
71
What are the six cardinal positions
Up and right(RSR, LIO)
right (RLR, LMR)
down and right(LSO, RIR)
up and left(RIO, LSR)
left (RMR, LLR)
down and left(RSO, LIR)
72
True or false:
Everyone has a phoria and it’s natural
True
73
Phorias and tropias are classified by the __________________
Direction of deviation
74
Esotropia or Esophoria
Eye deviates inward
75
Exotropia or exophoria
Eye deviates outward
76
Hypertrophia or hyperphoria
Eye deviates upward
77
Vertical deviations are classified according to ______
The higher eye
78
Eye deviates down you would refer to that as a________of the fellow eye even if the fellow eye is the normal eye
Hyper
79
If there is a motility disturbance with no diplopia the deviation must be_____
Congenital or very poor vision
80
What are the common types of strabismus?
Exotropia
Esotropia
Accommodative Esotropia
Hypertropia
Nystagmus
Cranial nerve palsies
81
Both eyes open....tropia or phoria?
Tropia
82
One eye open....tropia or phoria?
Phoria
83
It the exotropia is acquired rather than congenital, it is usually because of _____________
Poor VA in one eye
84
Left eye is deviated outward
Left exotropia
85
Left eye is deviated inward
Left esotropia
86
What is the most common for of esotropia affecting 1-2% of population
congenital
87
When pt only fixates with one eye at a time and one eye always deviates out and pt can and does fixate with either eye
Alternating tropia
88
*Condition that typically causes a ptotic lid and on the side with the ptotic lid may be a mid dilated pupil typically 5-6 mm dilated. The pt will have an anisocoria and the eye with the ptotic lid will be deviated down and out.
3rd Cranial Nerve Palsy
89
3rd Cranial Nerve Palsy that typically does not have pupil involvement
DM 3rd CN palsy
90
Condition(palsy) characterized by hypertropia on primary gaze. This is caused by the superior oblique being palsied so the inferior oblique is acting (pulling up) without the counter inferior oblique working against it to balance by pulling it down.
4th CNP
91
Palsy characterized by abduction deficit and esotropia. This is caused by the lateral rectus being palsied and the opposing muscle is pulling without be counteracted causing they eye to pull in that direction.
6th CNP
92
*With cover/uncover test observe the eyes as the pt fixates on a ______, ______target
small, distant
93
*When doing cover/uncover what eye are you looking at?
The uncovered eye.
94
*Cover/uncover tests for tropia or phoria?
Tropia
95
*Explain how to perform a cover/uncover test.
1. observe eye as the pt fixates on a small, distant target.
2. Cover one eye
3. Look at the uncovered eye
4. Eye moves=Tropia
5. Repeat with other eye
6. Look only at the uncovered eye.
96
In Cover/Uncover test if you cover the left eye and the right eye moves out you have a _______
Right esotropia
97
When doing cover/uncover we are observing the eye recover from its deviation not observing the deviation itself, therefore it is recorded from ________
where it moves from
ex: cover right eye and left moves inward =left extropia
left eye cover and right eye moves outward=right esotropia
98
Which test is used to detect a phoria?
Alternate cover test (aka: cross cover test)
99
Explain how to do a cross cover test.
1. Observe eyes as the pt fixates on a small, distant target.
2. Alternately cover one eye then the other
3. Do not allow the pt to be binocular
4. Look at the covered eye as it is being uncovered
5. Uncovered eye moves=phoria
100
With cross cover test do not ever allow pt to be _______
binocular
101
Which eye are you observing in cross cover test?
The covered eye as it is being uncovered
102
When performing cross cover test you are observing the eye __________
Recover from its deviation, not the deviation itself (so it is recorded from the point it moves from)
103
In this test you are testing for a tropia, you do allow the pt to be binocular, and you are looking at the uncovered eye.
Cover/Uncover test
104
In this test you are testing for a phoria, pt is never to be binocular, and you are looking at the eye as you uncover it.
Alternate cover test (cross cover test)
105
When talking about tropias and phorias, which one is always there and which one do you have to look for.
Tropia is always there
Phoria you have to look for
106
If the pt does not have prism in their glasses you should do cover tests with glasses _______
off
107
If pt has a has prism in their glasses you can have them _______ for cover tests. If they have prism in their glasses and you want to document total deviation have pt _______
ON
take off glasses
108
Misalignment that is always there, even when both eyes are open and attempting to work together. Large angle deviations are obvious. If small angle, you can detect it with the Cover-Uncover test
Tropia
109
Misalignment that only occurs some of the time, such as when the synchronization between the eyes is broken by the covering one eye. You can "break fusion" using he Cross-Cover test
Phoria
110
Near point conversion is a ____test measured in ____
binocular
cm
111
To measure Near point conversion pt looks at ______target
small
112
with near point conversion record distance at which pt can no longer maintain ______(one eye will deviate outward)
Fusion
113
When checking near point convergence, pt must be.......
Alert and cooperative and have normal fusion (cannot be amblyopic)
114
What is the formula to determine the diopter of the lens if you know the focal length?
D=1/F
(D=Dioptric Power of Lens)
(F=Focal Lenght (in meters)
115
If focal point is 1/3 of a meter (1/.33) what is the Dioptric power
D=3
(D=1 divided by .33cm=3D)
Think $ and cents (it takes (3) 33cents to reach $1 so the answer is 3D)
116
Focal points are measured in _____
meters or parts of meters
117
What is the formula to determine focal length?
F=1/D
F=Focal length in meters
D=Dioptric power of lens
118
If Dioptric power is 4 then what is the focal length?
25cm
F=1 divided by 4 (1/4)
Think dollars and cents : it takes 4 quarters to equal $1, so it takes (4) 25cm to equal 1
119
Is measuring accommodative aplitude a monocular or binocular test?
monocular
120
Push-Up Method is also known as the ....
Proximity Method
121
Proximity method is measured in _____but express in _____
cm
D
122
*How do you convert cm to D?
Divide cm into 100 (100/cm=D)
(ex. convert 25cm into dioptors... 100/25=4D)
(D=1/F)
123
When doing Proximity Method aka "Push-Up Method", what do you do when a pt is presbyopic?
Add +2.50 over the pts distance Rx and subtract 2.5 from the measurement.
124
How do you perform Proximity Method (Push-Up Method)?
Have pt look at small print (J3) held at a comfortable arms length, gradually moved closer til print blurs (with effort). This is a salient point, it's not the first point at which it blurs, you must ask the pt to try to focus. Must stimulate their accommodation.
125
*How do you determine accommodative amplitude (expressed in D) mathematically?
Convert near point and far point form cm to D then subtract and get the difference between the 2..this will be your accommodative amplitude.
Ex:
Near point is 10cm
Far point is 50cm
10cm=.1 Meters and 50cm =.5 Meters
D=1/.1 answer=D=10 and D=1/.5 answer: D=
(think $ and cents: it take (10) 10 cents to equal 1 dollar so (10)10 cm to equal 1 Meter and (2) 50 cents to equal $1 so (2)50cm to equal 1 meter)
10-2=8D accomodative amplitude
126
Spherical lens test is used to determine what?
Accommodative Amplitude
127
Is Spherical Lens Test a monocular or binocular test?
Monocular
128
What are 3 ways to get accommodative amplitude?
Proximity Method(Push-up Method), Mathematically, and Spherical Lens Test.
129
How do you perform Spherical lens test?
Have pt put distance Rx on, have them hold reading card at a comfortable distance (40cm), have them fixate on stationary threshold size type (0.5 size), add plus sphere lenses until print is blurred, add minus sphere lenses until print blurs again, the difference in = accommodative amplitude.
130
Why must you add plus sphere first when checking accommodative amplitude?
Because if you start with minus first you have stimulated their accommodation and you can't do the test.
131
Is Fusional convergence amplitude test binocular or monocular?
binocular
132
Convergence is a ______action, therefore convergence tests are always_______
binocular
binocular
133
How is fusional convergence measured?
with prisms
134
What are we artificially stimulating with convergence amplitude tests?
Convergence disparity
135
What are we assessing with convergence amplitude testing?
the power and stability of the motor fusion and the pts capacity to compensate for phorias.
136
How do you perform Fusional Convergence Amplitude testing?
Place the prism bar in front of one eye and gradually increase horizontal or vertical prisms while pt fixates on a muscle light. Can do at 36cm and 6M. The point at which the pt reports diplopia is recorded as the break point. This is measured in prism D. What ever D prism is recorded when they reported diplopia is their break point. You then gradually reduce prism until their vision fuses, this is the recovery point recorded in prism D.
137
Prisms bend light rays towards their _____
base
138
An object viewed through a prism appears displaced toward the prism _____
apex
139
Prism corrects the _______ of the eye but does not correct the _______
sensory alignment
motor alignment
140
Prism simply moves where virtual space is in front of the ____eye
deviated
141
You point the prism in the direction of the ______
deviation
142
If pt has exo-deviation you would correct with what?
Base in prism
143
If pt has eso-deviation you would correct with
Base out prism
144
If pt has hyper-deviation you correct with
base down prism
145
If pt has hypo-deviation you correct with
Base up prism
146
Apex of the prism points in the direction of the _____
deviaiton
147
The magnitude of prism effect depends on _______
size of angle of the apex of the prism
148
1 prism diopter=prism which appears to displace an object ___cm of ___M.
1, 1, 1
149
*At 0.5 M if the object is displaced in 1 cm P=___
2
150
*What is the formula to calculate magnitude of prism effect?
P=C/D
Prism=displacement of object in cm divided by Distance from prism in meters
151
When prescribing prism we usually
split it between the 2 eyes
152
Why do we split the prism between the 2 eyes?
May be more cosmetically pleasing
Pt may feel more balanced
It may be cheaper for pt
153
How do you split vertical prism?
Split the prism oriented in opposite directions
(ex: if they need 6 prism D BUOD you would put 3 PD BU OD and 3 PD BD OS. Doesn't matter which eye gets BU or BD for vertical prism
154
How do you split horizontal prism?
The prism is always split in the same direction.
If they need 6PD BO OD we would give 3PD BO OD and 3PD BO OS.
155
*The Worth 4 DOT test uses and illumitated diamond patter that detects the presence of ____ or ____
fusion
suppression
156
Worth 4 DOT test can be performed ___or ____
near or distance
157
*What is the Worth 4 DOT test used for?
To detect the presence of fusion or suppression in one eye
158
*In Worth 4 DOT test pt wears________and reports_______
red&green glasses (red over right, green over left)
number and color of lights they see
159
Worth 4DOT test:
White light green and red or alternation
Normal Fusion
160
Worth 4 DOT test:
White light color of dominant eye's lens
One eye definitely dominant
161
*Worth 4 DOT test:
4 lights-2 green, 1 red, one pink or pale green
Single binocular vision
162
*Worth 4 DOT test:
5 Lights-3 green, 2 red
Diplopia
163
*Worth 4 DOT test:
2 red or 3 green
Suppressing (colors seen depends on which eye is suppressing)
164
With Worth 4 DOT test pt may have different responses for ________
Near and distance
165
*What does the Maddox Rod test for?
Phoria and tropia
166
Is Maddox rod a bincocular or monocular test?
Binocular
167
Should Maddox Rod be performed at near or distance?
both
Near @16" and Distance at 20'
168
Should Maddox Rod be perform vertically or horizontally?
both
169
How does the Maddox Rod work?
It converts white point of light into red line perpendicular to the position of the lines on Maddox Rod.
170
When you orient the Rod of Maddox rod horizontally you are checking for ....
a horizontal deviation
(eso or exo deviation)
171
When you orient the rod of Maddox Rod vertically you are checking for a....
vertical deviation
(hyper deviation)
172
Maddox Rod:
When rod is oriented vertically, pt will perceive line of light to be _____(and vice versa)
horizontal
173
Maddox Rod detects the ability of the eyes to focus on ___
the same object
174
In Maddox Rod:
With MR over OD holding rod horizontal, pt sees light source to left of vertical line
Right esophoria in relation to the left eye
175
In Maddox Rod:
MR is held horizontal over OD, pt sees light source to the right of the vertical line.
Right exophoria in relation to the left eye
176
In Maddox Rod:
MR held over OD horizontally, pt sees light superimposed over the vertical line.
Orthophoria (normal)
177
In Maddox Rod:
MR held over OD Vertically, pt sees light source superimposed over horizontal line.
Orthophoria (normal)
178
In Maddox Rod:
MR is over OD Vertically, pt sees light source above horizontal line
Right hyperdeviation
179
In Maddox Rod:
MR is held over OD vertically, pt see light source below horizontal line.
Left hyper deviation
180
*What is the Hirschberg Corneal Light Reflex Testing?
A preliminary test to determine the magnitude of the deviation in older children. Not sensitive enough for small deviations.
181
How do you perform Hirschberg Corneal Light Reflex Testing?
Shine a light at the pt and note where the K light reflex falls in relation to their pupil.
182
*An approximation further defined by Krimsky Test is 1 mm=
7 degrees of deviation
183
*Krimsky K light reflex testing:
7 degrees of deviation =
15 prism diopters
184
Krimsky corneal light reflex test is the same test as_______test only it also uses a prism.
Hirshberg test
185
How do you perform Krimsky Corneal Light Reflex Testing?
Hold the prism in front of the fixating eye, increase the strength of the prism until the K reflexes are centered in both eyes.
186
Krimsky:
The Strength of prism required to center K reflection in deviating eye=
amount of deviation present
187
Krimsky is a _____ measurement of the deviation, Hirschberg is an ____
definitive
approximation
188
A problem between a neuroconnection between the brain and the eye. We can't improve the vision with corrective lenses and the pt has a normal eye and a normal brain. Pt has a difference of 2 lines or more between their eyes or best corrected VA of 20/30 or worse.
Amblyopia
189
What is the treatment goal for amblyopia?
20/30 or 20/25
190
How do we treat amblyopia?
Occlude or patch the good eye or blur it with atropine
191
What is the purpose of patching or blurring the good eye when treating amblyopia?
Forces the bad eye to be used and helps the neurologic connection to happen.
192
When treating amlyopia, the older the child_______
the longer it takes to treat the condition.
193
It pt is born with ptosis or congenital cataract we call that
stimulus deprivation
194
Stimulus deprivation has to be treated in the first______. All other cause of amblyopia can be fixable up to age_____
few weeks of life
6 or 7yo
195
What are some Unilateral causes of Amblyopia?
Strabismus(Suppression)
Significant Uncorrected refractive errors of one ye (Anisometropia)
Stimulus deprivation (CAT, Ptosis, K opacities)
196
What are some Bilateral causes of Amblyopia?
Bilateral significant uncorrected refractive errors
Bilateral stimulus deprivation
197
Treatment for amblyopia depends on
the cause
198
If the eye has strabismus causing amblyopia you treat it by
correcting the muscle problem with sx then you can treat amblyopia once the eye is straight.
199
Therapy aimed at the higher centers of the brain
Convergence Training (aka Vision Therapy or Orthoptics)
200
In Convergence training the child must be...
alert and cooperative and cannot be amblyopic
201
Convergence training trains the ______ not the eye.
brain
202
What are the 3 types of Vergence training?
Sustained
Pursuit
Saccad
203
Vergence training: reading through a prism
Sustained
204
Vergence training: track a moving target in depth
Pursuit
205
Vergence training: quick changes in fixation distances(from near to distance)`
Saccad
