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Summer Final-VT > Strabismus > Flashcards

Strabismus Flashcards

1
Q

This occurs when the visual axes of both eyes do not intersect at fixation

A

Strabismus

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2
Q

Consequences of strabismus

A
  • risk of amblyopia in the deviated eye, reduced stereopsis, reduced fusion, suppression, and change of ARC
  • symptoms: diplopia, blur, HA, anomalous head positioning, asthenopia
  • there is also risk of injury to the better seeing/aligned eye
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3
Q

Prevalence of strabismus

A

-strabismus prevalence in the general population is 2-6%

In young children, the prevalence is about 2-3%

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4
Q

Risk factors for eso-tropia in children 6-72 months (BPEDS/MEPEDS)

A

As hyperopia goes up, so does the odds and chance of esotropia

2-3D: 6.3 odds
3-4D: 23x
4-5D: 59x
>5D: 122x

> 5D almost guarneteded to have esotropia

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5
Q

Relationship between refractive SE and adjusted prevalence of esotropia in children 6-72 months: BPEDS/MEPEDS

A

SE refractive error in less hyperopic eye from 2D on wards, has a large increase in prevelance of esotropia

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6
Q

Anisometropia >1D and esotropia

A

2x chance

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7
Q

Age in months and risk of esoptrioa

A

48-59 months old: 8x chance

60-72 months: 9x chance

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8
Q

Maternal smoking during pregnancy and odds of esotropia in kid

A

2x

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9
Q

Gestational age <33 weeks and chance of esotropia

A

4.43x chance of esotropia

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10
Q

Risk factors for exotropia in kids 6-72 months: astigmatism in eye with lower amount

A

1.50 to <2.50: 2.5x

> 2.50D: 5.88x

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11
Q

Maternal smoking during pregnancy and exotropia

A

2.88X

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12
Q

Gestational age <33 weeks and risk of exotropia

A

2.48X

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13
Q

Risk factors for exotropia: gender

A

Female: 1.62X

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14
Q

Family Hx and risk of exotropia in 6-72 months

A

Increases odds of XT if positive family Hx

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15
Q

Etiology of strabismus

A

Mechanical restrictions: abnormality of the EOMs; tumor metastasis; trauma etc

Uncorrected refractive error-esotropia (in hyperopes)

Other neuro abnormalities: innervation anmoalies resulting in paresis and paralysis

Neuro defects: brith injuries, cerebral palsy, developmental/special needs, ROP

Breainstem abnormaliteis or abnormalities along the visual pathway

Assault during gestation-smoking, alcohol

Genetics- strab of parent or sibling

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16
Q

Time of onset of strab: infantile

A

Onset at birth or during the 1st 6 months of life

Congenital is born with it

17
Q

Time of onset of strab: acquired

A

Strabismus that developed after 6 months

18
Q

Acquired strab deviations are

A
  • acute (trauma, tumor, infection, inflamamtion, vascular disease)
  • longstanding
  • consecutive
19
Q

Frequency of strab

A

Constant

Intermittent

20
Q

Laterality of strabismus

A

Right
Left
Alternating

21
Q

Direction of strab

A 
Esotropia 
Exotropia 
Hypertropia 
Hypotropia 
Cyclotropia
22
Q

Location of strab

A

Distance and near

23
Q

Magnitude of strab

A

Measured in PD at D and N

24
Q

Comitnancy of strab

A

Comitant: deviation same in all positions of gaze

Non comitant: deviation different in different positions of gaze.

Due to over action or under action of one or multiple muscles from innervation problems (paralytic) or mechanical restrictions

25
Q

Onset of strab

A

Infantile (at birth or during 1st 6monthjs of life)

Acquired

26
Q

Manifest deviation not properly controlled by fusional vergences

A

Esotropia

27
Q

Deviations from neuromuscular abnormaliteis can be from ___ in esotropia

A

Innervation, anatomical, mechanical, refractive, accommodative, or genetic problems

28
Q

Accomodative acquired

A

Refractive accommodative; non refractive accommodative; mixed accommodative

29
Q

Secondary esotropia

A

Sensory (due to mac scar)

Consecutive (because of surgery)

30
Q

Exodeviation

A
  • manifest is tropia
  • deviations are signs of neuromuscular abnormaliteis that can result from innervation, anatomical, mechanical, refractive, accommodative or genetic problems

Interestingly, prevalence varies by ethnic groups

31
Q

Types of exotropia

A

Infantile
Acquired
Secondary

32
Q

Acquired exotropia

A

Intermittent
Acute
Mechanical/non comitant

33
Q

Secondary exotropia

A

Sensory

Consecutive

34
Q

Exam overview for strab: detailed Hx

A

detailed Hx

  • eye turn: which eye, onset, nature of onset, frequency and size
  • eye Turn-presence/absence of diplopia, or associated symptoms/signs
  • med Hx-neuro, developmental, or systemic problems
  • brith Hx (prematurity and low birth Wt)
  • fam Hx of strab
  • previous treatments
  • medications
  • development and learning concerns
35
Q

Exam for strab

A
  • VA;age appropriate
  • CT- presence, frequency and mag of deviations
  • ocular motility-EOMS, saccades, pursuits
  • pupils
  • accomodation- amp and response
  • BV function (sensory status: stereopsis, W4D, fixation)
  • cycloplegic refraction
  • anterior and posterior segment evaluation
36
Q

Strab management overview

A
  • correction or refractive error
  • added lenses (bifocal, plus or minus)
  • prism: if already developed normal retinal correspondence and BV
  • occlusion: for amblyopia, suppression, or vergence ranges
  • VT-for amblyopia, suppression, or vergence ranges
  • pharm-Botox
  • surgery-especially for large angle
37
Q

Prism and retinal correspondence

A

Only for NRC

You will break it for ARC

Summer Final-VT (10 decks)

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