Tutorial MEH tutorial

Question 1

what does cgsl N sl + RET slow to take fixation c dip means?

Answer 1

“cgls” = glasses
N = near
SL + = slight plus
ET = esotropia
XT = exotripia

Question 2

How do we correct esotropia?

Answer 2

Base out prisms

Question 3

What base do we use on PCT?

Answer 3

The prism that correts the tropia
OUT = eso
IN = exo

Question 4

what does “FLE”?

Answer 4

Fixing left eye : important to note.

Question 5

Why is it important to note down Fixing eye?

Answer 5

Incomitancy : Because the size of deviation can change because of the fixing eye.

Question 6

How do we know it is a underaction and not a restriction?

Answer 6

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.

Question 7

what does No more movement on ductions mean?

Answer 7

Restriction problem!

Question 8

What does a V eso pattern mean?

Answer 8

Bad news x

Question 9

What is this?

Answer 9

-4 on lateral rectus in the right eye == we looking at prov diagnosis of a RE 6th nerve palsy

Question 10

What other orthopic investgiations can we do to cofirm out diagnosis and use to monitor the px?

Answer 10

1. Hess chart : measure the degree of restirction. 5 degrees for each sqaure.
2. Measure lateral gaze incomitance

Question 11

When can you not use a hess?

Answer 11

When the px is not binocular

Question 12

What should we advise px who has sudden onset of 6th nerve at the age of 32?

Answer 12

He is young .. :/ this is a red flag!! so send to A and E urgently.

Question 13

What would the HOS do?

Answer 13

Look for neuro scans to see tumours ect.

Question 14

If px was a female and has had double vision before?

Answer 14

Look for MS. Meylination.

Question 15

what does Horizontal involuntary eye movments mean?

Answer 15

Nystagmus

Question 16

Can nystagmus be linked to ablbinism?

Answer 16

Yes

Question 17

why do px with nystagmus get a CHP?

Answer 17

to get better vision. Head turns can cause pain and anxiety. we can do surgery to help this.

Question 18

what is foveal hypoplasia?

Answer 18

The fovea has failed to develop properly

Question 19

what can we offer the px with nystagmus?

Answer 19

1. We need to help with her vision. But this is hard as it a long standing condition that cannot be solved
2. Gabapentin or memantine : monitor them
3. Council them on their condition: Let them know how we can help services ect.

Question 20

Why is using Cl good?

Answer 20

Having the cl close to eye is better then wearing glasses as better.

Question 21

Px has double vision when looking left and looking down, has a head turn to the left

Answer 21

Question 22

Why do we need to do ductions?

Answer 22

To see underactions

Question 23

This is a RE 4th palsy. IS this longstanding or acute

Answer 23

1. You can tell with CHP. if longstanding they will have the posture without knowning
2. The px cannot pinpoint when the symptoms started.

Question 24

How can we manage this 4th nerve ?

Answer 24

1. RE oblique disinsertion/ recession under general anastetics
2. Toxin to the LIR
3. do nothing

Question 25

Why would we not give a prism?

Answer 25

He is not binocular? And the devaiton is huge so the prism would be clapped.

Question 26

Why but toxin in the left inferior rectus, if it is a right 4th nerve?

Answer 26

The toxin will paralyse the muscle.
If we paralsys the left inferior rectus then the superior rectus will bring it up to level

Question 27

Why do we not toxin the oblqiues?

Answer 27

Because they are involved with torision so it is a risky game.