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Orthoptics Year 3 > Revision > Flashcards

Revision Flashcards

1
Q

What are the typical tests in order, in an orthoptic assessment?

A

VA nr + dis (s glss/c glss), CT nr + dis (s glss/c glss) + NPC (near point convergence), PCT nr + dis (s glss/c glss), PFR nr + dis (s glss), Frisby, OM (S GLSS !!!)

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2
Q

What are the normal ranges for PFR?

A

NR PFR c gls : 35-45 BO -> 15 BI
DIS PFR c gls : 15 BO -> 8 BI
(Adults)

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3
Q

Where do the rectus muscles originate?

A

From the Annulus of Zinn, which encircles the optic foramen and the medial portion of the superior orbital fissure.

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4
Q

Where does the medial rectus originate?

A

Originates at the orbital apex from the medial portion of the Annulus of Zinnin close contact with the optic nerve.

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5
Q

Where is the medial rectus inserted?

A

5.5mm from the limbus

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6
Q

what is the width of the insertion of the medial rectus muscle?

A

10.5mm

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7
Q

What innervates the medial rectus muscle?

A

inferior division of the 3rd cranial nerve (oculomotor nerve)

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8
Q

what is the function of the medial rectus?

A

Adduction

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9
Q

where does the lateral rectus originate?

A

muscle arises by two heads from the upper and lower portions of the annulus of zinn where it bridges the superior orbital fissure.

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10
Q

Where is the insertion of lateral rectus?

A

7mm from the limbus

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11
Q

What is the width of the lateral rectus muscle insertion ?

A

9.5mm

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12
Q

What nerve innervates the lateral rectus?

A

CN 6 (VI) - abducens nerve , which enters from bulbar side

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13
Q

what is the function of the lateral rectus muscle?

A

Abduction

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14
Q

Where does the superior rectus muscle originate?

A

The muscle arises from the superior position of the Annulus of Zinn (in close contact with levator muscle)

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15
Q

Where is the insertion of the superior rectus muscle?

A

7.7mm from limbus

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16
Q

what is the width of the insertion of the superior rectus muscle?

A

11mm

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17
Q

What nerve innervates the superior rectus muscle?

A

CN3 (oculomotor nerve) superior division (enters muscle on bulbar side).

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18
Q

What are the functions of the Superior Rectus Muscle?

A

Elevation, intorsion and adduction

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19
Q

Where does the inferior rectus muscle originate?

A

The muscle arises from the inferior portion of the Annulus of Zinn

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20
Q

Where does the inferior rectus muscle insert?

A

6.5mm from the limbus

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21
Q

what is the width of the inferior rectus muscle as it inserts?

A

10mm

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22
Q

What nerve innervates the inferior rectus muscle?

A

CN3 (oculomotor nerve) inferior division (enters on bulbar side)

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23
Q

What are the functions of the inferior rectus muscle?

A

depression, extorsion and adduction

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24
Q

Where does the superior oblique originate?

A

From the orbital apex from the periosteum of the body of the sphenoid bone, medial and superior to the optic foramen.

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25
Q

Where is the Superior oblique inserted?

A

It passes beneath the superior rectus and inserts on the upper temporal quadrant of the globe ventral to the superior rectus.

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26
Q

What is the width of the insertion of the superior oblique?

A

Its insertion is fanned out in a curved line 10-12mm in length

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27
Q

What nerve innervates the superior oblique?

A

CN IV (4) - trochlear nerve , enters muscle on its upper surface

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28
Q

What are the functions of the superior oblique?

A

intorsion, depression and abduction

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29
Q

Where does the inferior oblique muscle originate?

A

Arises from the floor of the orbit from the periosteum covering the anteromedial portion of the maxilla bone.

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30
Q

Where does the inferior oblique insert?

A

It crosses the inferior rectus and curves upwards around the globe to insert under the lateral rectus just anterior to the macular area

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31
Q

What innervates the inferior rectus muscle?

A

inferior division of the 3rd CN nerve (oculomotor) enters muscle on bulbar surface

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32
Q

what are the functions of the inferior rectus?

A

extorsion, elevation and abduction

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33
Q

Herrings law

A

(equal innervation) nerve impulse sent to muslce to contract, equal nerve impulse to contralateral synergist so both eyes move along paralel axis (RLR + LMR contract & RMR + LLR relax)

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34
Q

Sherringtons Law

A

(reciprocal innervation) nerve impulse sent to muscle to contract, decreased signal sent to direct antagonist to relax equal amount (RLR + RMR)

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35
Q

agonist

A

primary muscle moving in given primary direction

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36
Q

synergist

A

muscle from same eye help move eye in same direction as agonist (RSR + RSO for dextro elevation) “yolk muscles”

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37
Q

antagonist

A

opposite direction of agonist (muscle relaxing) (RMR +RLR)

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38
Q

contralateral synergist

A

contralateral = opposite eye, muscle moving in same direction in opp eye, RLR agonist = LMR contralateral synergist to look right

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39
Q

underaction of muscle on cover test

A

eye goes up on CT to fixate on light becuase undershoot

40
Q

overaction of muscle on covertest

A

eye goes down on CT to fixate on light because overshot

41
Q

what does mechanical restriction mean?

A

not neurogenic, other muscles not compensating

42
Q

what are muscles in postions in RE

A

RSR (dextro elevation)
RLR (dextroversion)
RIR (dextro depression)
(RIO laevo elevation)
RMR (laveoversion)
RSO (laevodepression)

43
Q

what are muscle postions in LE

A

LIO (dextro elevation)
LMR (dextroversion)
LSO (dextro depression)
LSR (laevo elevation)
LLR (laveoversion)
LIR (laevodepression)

44
Q

acronym for muscles

A

S (IO) (IO) S
L M M L
I (SO) (SO) I

45
Q

Common concerns in kids with eye problems

A

-blurred vision, eye related pain/discomfort (older kids), failed V screening, turned eye (squint), difficulty with school work

46
Q

History and note taking of px

A

-age of onset of symptoms (earlier = more hard to return back to normal VA)
-frequency of symptoms
-time of occurrence of symptoms
-speed of onset of symptoms
-constancy of symptoms
-general health of px at time symptoms first noticed
-previous ocular investigations/treatment

47
Q

What are the two stages + process of developing vision?

A

Critical period (up to 18 weeks) + Sensitive period (up to 8 years old)
Emmetropisation

48
Q

Diploia questions

A

-horizontal / vertical
-when does it occur (near/dis, time of day)
-can you make it single
-mono/binoc (when you close one eye does it disappear)
-anything make it worse or better?
-kids might close one eye (not developed suppression)

49
Q

Onset of strab at birth- what two types?

A

-infantile esotropia (most likely, not likely exo) 30-50 diopters, need operation quickly, within first two years
-congenital eso/exo

50
Q

Congenital cataract

A

Earlier deprivation= more severe visual loss
-needs to be rested within first 6 weeks

51
Q

Which eye do you cover first when doing CT if they have squint

A

Straight eye to observe if squinting eye takes up fixation or weaker eye first

52
Q

What could a sudden onset mean?

A

Nerve palsy/papillodema (raised intracranial pressure)/tumour

53
Q

Why is alternating squint good?

A

Equal VA in both eyes just not working together

54
Q

Is it harder to control eso or exo?

A

Exophoria easier to control as easier to pull eyes in (converge) intermittent = only occasional squint
ESO = harder to control cause need to diverge

55
Q

Why would someone’s phoria decompensate?

A

Don’t have enough fusional reserves

56
Q

Why will a myope not develop amblyopia?

A

Stimulate all the time when looking close up (everything clear)

57
Q

What is ametropia?

A

Both eyes have refractive error

58
Q

What is amblyopia?

A

Developmental condition characterised by reduced vision in one eye
V/a acuity worse than 0.2 Logmar (6/9) NOT due to refractive error/retina problems = cortical condition not eye problem!!
-due to presence of sensory impediment to visual development e.g. strabismus or an anisometropia and astigmatism occurring in early life

59
Q

5 types of amblyopia

A

-stimulus deprivation amblyopia
-stabismic amblyopia (manifest strab)
-anisometropic amblyopia
-ametropic amblyopia (high RE uncorrected bilateral
-meridianal amblyopia (uncorrected astigmatism)

60
Q

What does the severity of amblyopia depend on?

A

-size of the imbalance between the two eyes
-the timing of the disturbance during visual development (critical worse than sensitive bc sensitive time to develop BV)

61
Q

Mechanisms of amblyopia

A

-light deprivation (no stimuli to retina)
-form deprivation (retina receives a refocused image)
-abnormal binocular interaction (non-fusable images are formed on fovea)

62
Q

What tests uses grating acuity (minutes)

A

Preferential looking cards (for infants)

63
Q

When will patching not help?

A

Hypoplasia of fovea = need to do Oct = doesn’t have enough cells in fovea

64
Q

How many prism diopters per degree of displacement on corneal reflections?

A

1 degree = 2 prism dioptres
-limbus touching nose = 45 degrees = 90 dioptres

65
Q

Manifest vs latent

A

Manifest = tropia (movement on CT cover/un cover, opp eye)
Latent = phoria (movement on CT cover/un cover same eye)
Alternate CT = maximum deviation
ALWAYS RECORD RECOVERY TOO

66
Q

Recording a manifest deviation

A

-size of the deviation (slight, moderate or marked)
-changes in the deviation at different distances (diff size in nr and dis)
-changes in deviation if accom exerted
-changes in deviation with and without glasses

67
Q

Fully accommodative esotropia

A

With glasses, eyes straight. Normal retinal correspondence and BV

68
Q

Distance L exotropia

A

Near = straight
Distance = distance L exotropia

69
Q

Alternating esotropia

A

Vision roughly equal, able to swap fixation

70
Q

Convergence excess esotropia

A

Only squints at near when accommodating.
Bifocals so have plus at near to relax accom and see in distance

71
Q

Hyperphoria vs hypophoria

A

Hyperphoria = eye will move up under cover and down when cover lifted
Hypophoria = eye will move down under cover and up when cover lifted

72
Q

Recording latent deviation

A

-direction of latent deviation
-size of deviation (slight, moderate or marked)
-the movement of eye to take up fixation (recovery) = indicates how compensated the heterophoria is = GOOD, MODERATE or SLOW
-changes in deviation at diff distances
-changes in deviation with/without glasses

73
Q

What are saccades

A

Fast small movements of eye (smooth pursuit = look between two lights)

74
Q

Vestibuloocular movements

A

Controlled by inner ear = when you move head down, eyes go up

75
Q

Optokenitic nystagmus

A

-infantile esotropia
-eye flicker on train
-black and white drum (OKN drum)

76
Q

3 stages of BV + tests

A

Sensory (worths lights, bagolini lenses, fixation disparity)
Motor (PFR, synoptopher)
Stereopsis (TNO, Frisby)

77
Q

Micro tropia

A

4 diopter PCT
-look for suppression
-moves picture 2 diopters off fovea

78
Q

Near BO bigger or smaller than near BI

A

Bigger, by x2 BO nr

79
Q

Nr BI bigger, same or less than distance BO

A

Same BI nr + BO dis

80
Q

Dis BO smaller or bigger than Dis BI

A

BO dis 2x bigger than BI dist

81
Q

What do you take off clycloplegic refraction?

A

Take off 1D

82
Q

If child is ESO, what tax do you want to give them?

A

As much + as possible to relax accom

83
Q

What is period of adaptation for glasses?

A

16 weeks

84
Q

What are cut-offs for glasseS?

A

> 2D Hypermetropia (bilateral)
1.50D myopia
0.75D Astigmatism (bilateral)
- any astigmatism + hypermetropia
1D difference in RX (anisometropia)

85
Q

When is rx undercorrected?

A

Under corrected by 1D for mild hypermetropia +2 - +5
undercorrected by 2D for high hypermetropia
If ESO then given

86
Q

How many lines expect with refractive adaptation

A

2-3 lines wearing glasses full time

87
Q

What is max time for patching?

A

4-6 hours max per day
400 hours max

88
Q

How long does atropine last

A

7-10 days , takes 45 mins to work

89
Q

What base for ESO?

A

Measuring eso = base out
Exercising
Prism fusional reserves = base in

90
Q

Sanskin va cards

A

Look at back of card

91
Q

Pass mark for Logmar and Kay’s

A

Logmar - 0.2
Kays - 0.1

92
Q

Tests for vision screening

A

-CT + npc
-20 diopter prism + fixation stick
-OM gross
-steropsis frisby
VA

93
Q

How much is each letter on Logmar

A

-0.20 every Logmar letter
Get 1 right = 0.18
Get 5 right = 0.10

94
Q

If px has eso, what PFR first?

A

Base in

95
Q

When you have phoria, how much PFR need to control?

A

Double
E.g. 10 diopter eso = 20 diopter BI to keep straight

96
Q

Before doing cover test, what do you ask?

A

Is it single or double?

97
Q

What are the sizes of deviation?

A

Minimal (>10)
small (10-20)
Moderate (20-35)
Marked (35+)

Orthoptics Year 3 (3 decks)

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