Untitled spreadsheet - strabismus Flashcards
what axis do SR and IR insert
23
what axis do SO, IO insert
51
origin of inferior oblique
periostem of maxillary
what goes along with inferior oblique?
inferior division of CN3 with parasympathetic supply to iris constrictor, injury leads to mydriasis.
what is normal convergene and diversgene amplitudes
con (14-38), diverge (6-16). Vertical 2.5
what 2 tests can distinguish monofixation syndrome?
worth 4 dot: at near sees 4 lights (fusiion), at distance sees 2,3 lights (due to central scotoma), also 4 prism diopter base out prism, normal eyes will turn, monofixation, eye will not turn
what’s difference between primary and secondary deviation in hering’s law
primary: deviation measuring with normal eye fixing, seocndary: measured with paretic eye fixing, larger than primary
Sherring’ton’s law
innervation to ipsi antagonist decreases as innvervation to aganoist increaes
example of sherrington’s law
Duane’s
postive angle capa:
light reflex nasal, mimics XT, ROP, toxocara.
negative angle kapaa
light reflex temporal
Krimsky
use prizm (Kirm is like glass)
Hirschberg
1mm equal 7 degrees 15 PD
what is a duction?
monocular rotation of eye
definition of version?
conjugate binocular eye movemetns
Name 5 signs of congenital nystagmus.
null point, no oscipllopsia, OKN reversal, absent during sleep, dampened by convergence, horiziontal, increase amplitude with distance, decrese with near, increase velocity with slow phase
what is okn reversal?
eye moves in slow phase in opposite direction of OKN drum spinning
downbeat nystagmus
cervicomedullary (Chiari malformation)
seesaw nystagmus
parasellular craniopharyngioma
association with opsoclonus
neuroblastoma
periodic alternating nystagmus
cervicomedullary
rx for congenital nystagmus
base out prizm to force convergence, only fusional convergene helps, no accomodative convergenceminus lenses do not help, Kestanbeaum procedure for surgery
4 characteristics of latent nystagmus
fast phase to side of fixing eye, normal OKN, nulls with adduction, DVD 050%
alexander’s law
intenstiy increasesa when looking toward fast phase, decreases toward slow phase.
trio of spasmus nutans
torticollis, head bobbing, and shimmering nystagmus.
what is divergence excess?
XT greater at distance than near by at least 10 PD
how to distinguish simulated divergence excess from true
after 30 min patch, exodeviation becomes equal to distance tnd near. Due to enhanced fusional convergence at near due to accomodation. True: after 30 min patch, still has divergence excess at distance
what is convergence insufficiency?
near XT greater than distance XT
5 findings of congenital esotropia
present by 6 months, large angle, cross fixation
2 association with congenital esotropia
DVD in 70%, IOOA in 70% with V pattern, rx with IO weakening
what is nystagmus blockage syndrome
overaccomodation to dampen nystagmus results in et at near. Asymetry of monocular OKN response. Nasal to temporal smooth pursuit less developed
Describe refractive accomodative esotropia
high hyperopia, rx with full cyl refraction, normal ACA ratio
Nonrefractive accomodative esotopia
eso greater at near than distance rx: bifocals, consider miotics to lower ACA ratio
what is ACA ratio?
nl 3-5:1 PD per dioper of acommodation
what does a high ACA ratio mean?
near deviation exceed distance deivation by > 10 PD
heterophoria method for ACA
IPD+(near deviation-distance deviation)/accomodative demand)
lens gradient method
deviation with lens- deviation without lens/diopter power of lens
rx for cyclic ET
full hyperopic correction
associations with divergence paralysis
pontine tumors, head trauma
spasm of near synkinetic reflex (ciliary spasm)
HA, blurred distance VA.
rx for convergence insufifciency
pencil pushops
pattern for IOOA
V pattern
pattern for SOOA
A pattern
rx for SO palsy
<15 PD, just one muscle, greater than 15 PD, two mscles. With IO overaction, weaken ipsi IO.
define double elevator palsy
ptosis with unilateral defect in upgaze
causes of double elevator palsy
IR restriction, SR and IO weakness., can be supranuclear
rx for double elevator palsy with SR weakness
Knapp procedure (elevatgiona dn transposition of MR n dLR to side of SR).
pattern in Brown’s syndrome
V pattern divergence in upgaze
rx for brown’s
SO weaknening.
when are A and V patterns significant
A: diverge >10, V pattern converge >15
how much does transposition of horizontal muscules corect in A or V pattenrs
about 15 PD
ir IOO found, how much does IO weakening help?
15 PD
What is Duane’s syndrome
co-contraction of medial and lateral rectus.
signs of duane’s
retraction of globe with secondary narrowing of PF, leash phenomeon, both LR an MR pulling on eye
three types of Duane’s
1: abduct problem, 2: adduct problem, 3 both of them
associations with duane’s
duane’s goldenhar’s klippel-Fiel, fetal alchol
associations with CPEO
Kerns sayre, Bassen-Kornzweigh, refsum’s cardiac oconduction.
what is harada-Ito
anterior temporal displacement of ant4iro half of superior oblique tendon, used for excyclotorsion.
Kestenbaum procedure
bilateral resect/recess to damp nystagmus.
A direct ophthalmoscope is what kind I telescope?
Galilean
what is the Bruckner test
sign direct ophthalmoscope, brighter relfex indicates deviating eye
What is aicardi syndrome
females, chorioretinal lacunae, agenesis of corpus callosum, and infantile spasms
what is hutchinson’s triad
IK, sensorineurla deafness, malformed incsiors from congenital syphilis
which side will a patient with left IO palsy tilt his head
tilted toward paretic side
findings of bilateral fourth nerve palsy
hypertropia that alternate on side gaze, A V pattern esotropia
