Tutorial MEH tutorial Flashcards
what does cgsl N sl + RET slow to take fixation c dip means?
“cgls” = glasses
N = near
SL + = slight plus
ET = esotropia
XT = exotripia
How do we correct esotropia?
Base out prisms
What base do we use on PCT?
The prism that correts the tropia
OUT = eso
IN = exo
what does “FLE”?
Fixing left eye : important to note.
Why is it important to note down Fixing eye?
Incomitancy : Because the size of deviation can change because of the fixing eye.
How do we know it is a underaction and not a restriction?
Testing versions = eyes moving together
Duction = eyes is solo
When there is a restrictions the eye will not move on ductions. With a under aciton there will be a movement.
what does No more movement on ductions mean?
Restriction problem!
What does a V eso pattern mean?
Bad news x
What is this?
-4 on lateral rectus in the right eye == we looking at prov diagnosis of a RE 6th nerve palsy
What other orthopic investgiations can we do to cofirm out diagnosis and use to monitor the px?
- Hess chart : measure the degree of restirction. 5 degrees for each sqaure.
- Measure lateral gaze incomitance
When can you not use a hess?
When the px is not binocular
What should we advise px who has sudden onset of 6th nerve at the age of 32?
He is young .. :/ this is a red flag!! so send to A and E urgently.
What would the HOS do?
Look for neuro scans to see tumours ect.
If px was a female and has had double vision before?
Look for MS. Meylination.
what does Horizontal involuntary eye movments mean?
Nystagmus
Can nystagmus be linked to ablbinism?
Yes
why do px with nystagmus get a CHP?
to get better vision. Head turns can cause pain and anxiety. we can do surgery to help this.
what is foveal hypoplasia?
The fovea has failed to develop properly
what can we offer the px with nystagmus?
- We need to help with her vision. But this is hard as it a long standing condition that cannot be solved
- Gabapentin or memantine : monitor them
- Council them on their condition: Let them know how we can help services ect.
Why is using Cl good?
Having the cl close to eye is better then wearing glasses as better.
Px has double vision when looking left and looking down, has a head turn to the left
Why do we need to do ductions?
To see underactions
This is a RE 4th palsy. IS this longstanding or acute
- You can tell with CHP. if longstanding they will have the posture without knowning
- The px cannot pinpoint when the symptoms started.
How can we manage this 4th nerve ?
- RE oblique disinsertion/ recession under general anastetics
- Toxin to the LIR
- do nothing
Why would we not give a prism?
He is not binocular? And the devaiton is huge so the prism would be clapped.
Why but toxin in the left inferior rectus, if it is a right 4th nerve?
The toxin will paralyse the muscle.
If we paralsys the left inferior rectus then the superior rectus will bring it up to level
Why do we not toxin the oblqiues?
Because they are involved with torision so it is a risky game.
