Random Questions

Question 1

A 23-year old female is seen at your office with concerns of eye fatigue, diplopia and headaches after 30 minutes of computer use. Her subjective refraction is +0.25 D OU. Her near point of convergence is 15 centimeters. What is the most likely diagnosis based solely upon this information?

Answer 1

Convergence insufficiency

• receded NPC
• diplopia generally absent in latent hyperopia

Question 2

Convergence Insufficiency

• AC/A?
• accommodation?
• PRA/NRA?
• vergences?

Answer 2

• exophoria greater at near than distance
• low AC/A ratio
• receded NPC
• normal accommodation
• low NRA
• low BO vergence ranges

Question 3

NPC break and recovery?

Answer 3

5 cm // 7 cm

Tip: red/green glasses will make the system more fragile

Question 4

Pseudoconvergence insufficiency

Answer 4

• receded NPC

- accommodative insufficiency, not convergence problem

Question 5

How to differentiate pseudo CI vs real CI?

Answer 5

Use +2.00 lens in front of patient.

True CI will have difficulty, pseudo will not because the lens makes up for the insufficient accommodation.

Question 6

Sheard’s Criterion

Answer 6

2/3(phoria) - 1/3(compensating vergence)

Question 7

Training for… convergence insufficiency?

Answer 7

• VT

- if no improvement, prescribe BI prism based on Sheard’s

Question 8

Training for… convergence excess?

Answer 8

• plus lens at near

- VT or prism as needed

Question 9

Training for… divergence insufficiency?

Answer 9

• BO prism at distance
• then VT
• refer if neurological

Question 10

Training for… divergence excess?

Answer 10

• VT

- prism or minus lenses

Question 11

Training for… Basic Exo?

Answer 11

• BI prism, VT

Question 12

Training for… Basic Eso?

Answer 12

• BO prism, VT

Question 13

Training for… vertical imbalance?

Answer 13

• prism

Question 14

Insufficiencies have (high/low) AC/As

Answer 14

LOW!

Question 15

Excesses have (high/low) AC/As

Answer 15

HIGH!

Question 16

What can you do for antisuppresion therapy?

Answer 16

• increase illumination
• movement
• blur nonsuppressed eye
• increase contrast for suppressed eye

Question 17

What is Hering’s Law?

Answer 17

Hering’s law of equal innervation is used to explain the conjugacy of saccadic eye movement in stereoptic animals. Yoked movement.

Question 18

Eccentric Fixation

Answer 18

Monocular phenomenon where a non-foveal area is used to fixate.

Question 19

Bruckner Test

Answer 19

Use ophthalmoscope at 80-100cm to assess red reflex.

Question 20

Bruckner Test - Inferior Crescent

Answer 20

MYOPIA!

Question 21

Bruckner Test - Fixating eye reflex

Answer 21

Darker!

Question 22

CN 1

Answer 22

Olfactory

- smell

Question 23

CN 2

Answer 23

Optic nerve

- vision

Question 24

CN 3

Answer 24

Oculomotor nerve

- innervation to SR, IR, IO, MR, iris sphincter, ciliary muscle, levator

Question 25

CN 4

Answer 25

Trochlear nerve | - innervate SO

Question 26

CN 5

Answer 26

Trigeminal nerve (V1 - opthalmic, V2 - maxillary, V3 - mandibular) - corneal and facial sensation (sensory) - motor to muscle mastication

Question 27

CN 6

Answer 27

Abducens nerve | - innervates lateral rectus

Question 28

CN 7

Answer 28

Facial nerve | - facial motor function, taste to anterior 2/3 tongue, lacrimation + salivation (parasympathetic innervation)

Question 29

CN 8

Answer 29

Vestibular | - hearing and equilibrium

Question 30

CN 9

Answer 30

Glossopharyngeal - taste posterior 1/3 of tongue - sensory from carotid sinus - motor innervation pharynx

Question 31

CN 10

Answer 31

Vagus nerve - decrease heart rate - carries sensory info from esophagus, respiratory tract and abdominal viscera

Question 32

CN 11

Answer 32

Spinal accessory nerve | - motor innervation to trapezius, sternocleidomastoid and muscles swallowing

Question 33

CN 12

Answer 33

Hypoglossal | - motor to tongue

Question 34

Bilateral INO

Answer 34

Associated with multiple sclerosis

Question 35

Internuclear ophthalmoplegia (INO)

Answer 35

When gaze is made contralateral to the affected eye, limited adduction occurs. Contralateral eye will move laterally but have nystagmus. "The disorder is caused by injury or dysfunction in the medial longitudinal fasciculus (MLF), a heavily myelinated tract that allows conjugate eye movement by connecting the paramedian pontine reticular formation (PPRF)-abducens nucleus complex of the contralateral side to the oculomotor nucleus of the ipsilateral side."

Question 36

Congenital nystagmus characteristics

Answer 36

- binocular - conjugate - associated - no oscillopsia - damped by convergence - superimposed latent nystagmus - abolished in sleep - nystagmus direction same in all positions

Question 37

Conditions associated with congenital nystagmus

Answer 37

- ocular albinism - aniridia - congenital optic nerve disease - achromatopsia

Question 38

When a patient has a right head turn, diplopia is worse on (right/left) gaze?

Answer 38

Right gaze! Because with a right head turn, patient is looking left.

Question 39

A patient with a 4 prism diopter right hyperphoria has 5/3 right supravergence and 4/2 right infravergence. What is the correctinve prism needed?

Answer 39

0.5 base down over right eye. Formula: Base-down to break MINUS base-up to break / 2 (+) BD, (-) BU

Question 40

Compensating vergence for hyperphoria?

Answer 40

Infravergence. Assessed with base-up prism.

Question 41

Oculogyric crisis

Answer 41

Oculogyric crisis refers to spasms of extraocular muscles leading to tonic eye deviation (usually upward), with each spasm lasting from seconds to several hours; the entire episode may last up to several weeks or months.