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BOARDS2: amblyopia/strabismus > XT > Flashcards

XT Flashcards

1
Q

posterior embryotoxin

A

anteriorly displaced schwalbes line

-increased risk for glaucoma

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2
Q

how much does having a posterior embryotoxon increase someones risk for glaucoma

A

50%

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3
Q

axenfeld syndrome

A

posterior embryotoxin + glaucoma

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4
Q

Reiger’s anomaly

A

embryotoxin + glaucoma + iris atrophy

Axenfeld syndrome + iris atrophy

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5
Q

Rieger’s Syndrome

A

embryotoxin + glaucoma + iris atrophy + systemic problems

embryotoxin + glaucoma + iris atrophy + systemic

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6
Q

types of XT

A

infant
acquired
secondary
micro

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7
Q

acquired XT

A

acute

mechanical

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8
Q

secondary XT

A

sensory

mechanical

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9
Q

intermittent acquired XT

A

after age 6m
deviation present more when tired
50% have basic XT and the other 50% will have either convergence insufficiency or divergence excess

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10
Q

types of acquired XT

A

basic XT (equal D and N)
divergence excess
convergence insufficiency

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11
Q

infantile/congenital XT

A

large deviation of 30-80 that occurs prior to 6m of age. Because it is usually alternating, infantile usually does NOT lead to amblyopia, but it can result in a reduction iin stereopsis. Patient’s may have associated neurological problems, esp in cases of a constant infantile XT

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12
Q

acute acquired XT

A

occurs after 6m of age.

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13
Q

acute acquired XT

A

characterized by sudden onset, constant exodus deviation. potential etiologies include neurological issues, trauma, or a decompensated phoria

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14
Q

mechanical acquired XT

A

due to physical restriction of an EOM (type 2 Duanes, graves, etc). Patients will NOT have full versions due to the EOM restrictions

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15
Q

sensory XT

A

after age of 5; it is more common in adults with acquired vision loss in one eye, resulting in a loss of a stimulus to fuse. Treatment involves correcting the vision loss, if possible

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16
Q

consecutive XT

A

iatrogenic, secondary to over correction of an ET during strabismus surgery

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17
Q

micro XT

A

exo deviation of less than 10 PD that is usually undetectable with CT. Similar to micro ET, it is associated with small suppression scotoma that may be confirmed with a 4BO test. Very uncommon

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18
Q

treatment for intermittent, acquired XT

A

VT, BI, over-minusing the distance RX

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19
Q

prism for XT

A

BI

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20
Q

lenses for XT

A

more minus, increased accommodation, eyes turn in. Over minus best for XT
-be sure to look at AC/A

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21
Q

fusion and BV

A

3 bad in strabismus

  1. 2 clear images
  2. same size
  3. fall on corresponding retinal points
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22
Q

counteracting diplopia and confusion

A

the brain may suppress an image in the strabismic eye, or may develop ARC

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23
Q

ARC

A

a sensory adaptation that must develop before age 5. Only occurs under binocular viewing conditions. Under monocular viewing conditions, the deviated eye will use the fovea to fixate the target

the non foveal point in the deviated eye that is viewing the object becomes “linked” to the fovea of the fellow (non deviated) eye. The new ARC ensures that the object will be perceived in the same visual direction in each eye, thus eliminating diplopia and confusion

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24
Q

NRC

A

present when the fovea of each eye corresponds to the same visual direction in space. if a patient develops strabismus, the fovea of one eye will be deviated compared to the fellow eye, resulting in diplopia and condition

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25
Q

ARC and ET

A

nasal non foveal point

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26
Q

ARC and XT

A

temporal non foveal point

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27
Q

angle of anomaly

A

distance between the “new fovea” and the actual fovea

difference between the objective angle of deviation (the deviation measured by CT) and the subjective angle of deviation (the patient’s perception of the magnitude of the deviation)

28
Q

harmonious ARC

A

present when the angle of anomaly equals the objective angle of deviation. In other words, the new foveal point of the deviated eye corresponds with the fovea of the fellow eye so that the subjective angle of deviation is zero. The patient WILL NOT have symptoms of diplopia or confusion. This is the most common type of ARC
-the Fn of the deviated eye is constantly changing, depending on where the patient is looking., At any point in time, the point on the retina that is hit by the object in the deviated eye will become the Fn and will be linked to the f of the fellow eye under binocular conditions

29
Q

UHARC

A

present when the angle of anomaly is less than the objective angle of deviation. in other words, a point in between f and fn (where the object hits the retina) in the deviated eye becomes linked to f in the fellow eye. the subjective angle DOES NOT equal zero, and the patient WILL have diplopia and confusion (although less than with NRC) because there is not perfect correspondence between the two eyes

CT=10BI
Maddox=5BI

30
Q

type 1 paradoxical ARC

A

occurs when the point used to fixate the object in the deviated eye is further away from the fovea than fn (whereto object hits the retina). In other words, the subjective angle of deviation is greater than the objective angle of deviation. Both the subjective and objective angles of deviation are in the same direction (both esophaguses or both exo)

CT=10BO
Maddox=5BO

31
Q

type 2 paradoxical ARC

A

occurs when fn moves in the direction OPPOSITE to the deviation, causing the subjective and objective angles of deviation to be in opposite directions. Patients will have worse diplopia and confusion than if they had NRC

32
Q

paradoxical ARC in ET

A

when fn is TEMPORAL to f in the deviated eye

33
Q

paradoxical ARC in XT

A

when fn is NASAL to f in the deviated eye

34
Q

harmonious ARC

A

angle of anomaly=objective angle and deviation-no diplopia

35
Q

unharmonious ARC

A

angle of anomaly < objective angle of deviation-diplopia is present but less than with NRC

36
Q

type 1 paradoxical ARC

A

angle of anomaly objective angle-greater diplopia than with NRC

37
Q

type 2 paradoxical ARC

A

angle of anomaly>objective angle of deviation-greater diplopia than with NRC

38
Q

after image test

A

detects ARC. A line light image is flashed before each eye separately, with one eye receiving a horizontal image and the fellow eye receiving a vertical image. If the patient has NRC, the patient will see a plus sign (regardless of whether there is a deviation present). If the two lines are shifted horizontally, the patient has ARC

39
Q

horror fusionis

A

patients who have a tropia and cannot obtain fusion with prism correction. The patient will report the images become closer together with the addition of prism, but the images will eventually jump over each other without fusion

40
Q

what tests can detect suppression

A

W4D, 4BO, and Bagolini lenses

41
Q

bagolini lenses

A

good for ARC and suppression. they are Plano, clear, striated lenses that produce a line image 90 degrees from the orientation of the striations when the patient views a light source (similar to Maddox rod). The lenses are oriented so the right eye sees a line oriented as / (striations at 45 degrees) and the left eye sees a \ (striations at 135 degrees)

42
Q

most sensitive test for retinal correspondence

A

bagolini lenses

43
Q

bagolini: /

A

OS suppression

44
Q

bagolini: \

A

OD suppression

45
Q

Bagolini: X

A

NRC if cover test shows no tropia

HARC if cover test shows tropia

46
Q

bagolini: V

A

ET with NRC or UHARC

47
Q

bagolini: ^

A

XT with NRC or UHARC

48
Q

4BO test

A

detects a small suppression scotoma in a patient with a microstrabismus (less than 10) that cannot be detected on CT (the patient will likely have a mildly reduced VA without an apparent ocular etiology). As the patient views a distant target, a loose 4BO prism is introduced in front of one eye and the clinician observes the movement of both eyes.

49
Q

normal 4BO test

A

OS makes an outward moment and then re-fixates on the target

50
Q

4BO OS suppression

A

OD moves in and OS moves out due to Herings law. However, OS will not move back in

51
Q

4BO OD suppression

A

left eye never moves

52
Q

zero degree fusion

A

no fusion, monocular/supression

53
Q

first degree fusion

A

superimposition targets. testing uses two very different targets, patients will have diplopia as the targets are difficult to suppress used in anti-suppression therapy

54
Q

second degree fusion

A

flat fusion
testing uses identical targets with suppression checks. patients do NOT have diplopia. The image is single but is NOT in stereo. Requires motor fusion

55
Q

Third Degree fusion

A

ultimate sensory fusion characterized by stereopsis. Requires motor and sensory fusion

56
Q

visuoscopy

A

detects EF, which occurs when a patient uses a non-foveal point to fixate on object in the deviated eye under monocular conditions. The patient is asked to look in the center of a grid target in the direct ophthalmoscope under monocular conditions. The examiner views the location if the foveal light reflex in relation to the center of the grid

57
Q

visuoscopy: FLR centered

58
Q

visuoscopy: grid superior to FLR

A

superior EF

59
Q

visuoscopy: grid inferior to FLR

A

inferior EF

60
Q

visuoscopy: grid temporal to FLR

61
Q

visuoscopy: grid nasal to FLR

62
Q

tests for EF

A

VHS

  • visuoscopy
  • haidengers brushes
  • MAxwells spot
  • Monocular Hirschberg
63
Q

Bruckner

A

used to detect strabismus, anisometropia, and/ormedia opacities in infants. The examiner uses a direct Oscope 80-100cm away from the patient on the midline to view the red reflexes of the two eyes as the patient views the lights, the Brightness of the red reflexes are compared to each other

64
Q

deviated eye on bruckner

65
Q

darker eye on Bruckner

A

SOS

  • smaller refractive error eye
  • opacity
  • straight eye
66
Q

when should infantile ET be treated

A

should be corrected with surgery prior to 2 years of age in order to increase the likelihood of BV and stereopsis following correction of the deviation

67
Q

treatment guidelines for strabismus

A 
optical correction
plus or minus lenses 
VT
prism 
patching or atropine 
EOM surgery

BOARDS2: amblyopia/strabismus (3 decks)

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