Paralytic Strabismus Flashcards
CN 3 Palsy
eye down and out (LR + SO work)
ptosis
dilated pupil
no accommodation
Common Causes of Pupil Sparing CN 3 Palsy
diabetes
hypertension
Causes of Non-Pupil Sparing CN 3 Palsy
aneurysm of PCA
neoplasms- neuromas and schwannomas; tumors of pituitary and sphenoid wing
trauma
CN 4 Palsy
eye up and in- SO impaired
head tilt opposite to side of palsy
Horner’s Syndrome Triad
Ptosis
Miosis
Anhydrosis
CN causing Horner’s Syndrome
4
Causes of CN 4 Palsy
Idiopathic
Trauma
diabetes, HTN
CN 6 Palsy
eye turned in- LR
esotropia
head turn toward affected eye
Most commonly affected oculomotor nerve
CN 6
Causes CN 6 Palsy
trauma
aneurysm
ischemic- HTN, diabetes
Testing Palsies
case history external observation VAs CT EOMs Hess-Lancaster
Cavernous Sinus Contents
CN 3, 4, V1, V2, 6
Causes of Cavernous Sinus Palsies
neoplasms
carotid cavernous fistula
aneurysm
Orbital Apex Syndrome
optic nerve affected
affects nerves in cavernous sinus
Causes of Orbital Apex Syndrome
neoplasms
fungal infection
inflammation
Medial Rectus Palsy
exo deviation
greater at near
Inferior Rectus Palsy
hyper and exo deviation
Superior Rectus Palsy
bilateral
V exo pattern
Inferior Oblique Palsy
A eso pattern
Double Elevator Palsy
SR and IO
no elevation in abduction or adduction
Bell’s phenomenon
Bell’s Phenomenon
lid does not close
Forced duction test in double elevator palsy
positive
mechanical- wont move
Double Depressor Palsy
IR and SO
no depression in abduction or adduction
head tilted down
Cause of CN 3 Palsy w/ pupil sparing
vascular
Cause of CN 3 Palsy w/o pupil sparing
aneurysm
Treating Ischemic Etiology
in HTN, DM, atherosclerosis, smoking
order blood tests- BP, glucose tolerance
Prognosis for Ischemic Etiology
resolves in 3 months
Prescribing Glasses
improve VAs can help control deviation induce prism (nondominant eye)
