1 Flashcards
(20 cards)
Why would you want to consider doing a forehead lift before you do an eyelid lift?
A forehead lift needs to be completed before an eyelid lift so that the patient will be able to close their eyelids. If an eyelid lift is completed before a forehead lift, the eyelids will be stuck with a “stare” appearance due to the skin being extremely tight.
What is one way to determine if eyelid ptosis is obstructing vision in patients with dermatochalasis?
To assess the visual loss caused specifically by the dermatochalasis you should do a taped and untaped visual field.
What is the main precaution you need to take into consideration when evaluating a cutaneous horn?
The main concern is that the base of the cutaneous horn could be a squamous cell carcinoma.
What is the most useful component of a visual field in determining insurance coverage for ptosis surgery?
Although we do not usually use the grey scale, insurance companies use the grey scale to determine if a ptosis surgery should be covered or not.
A patient presents ortho upon arrival, however after measuring unilateral VAs, you notice a small XT OD that recovers in 6 seconds. What is their score on the Holmes Control Scale?
Their score is a 2 on the Holmes scale. There is no XT until dissociation and recovered in more than 5 seconds.
What would you suspect if a patient presents with a Duane’s-like deviation post strabismus surgery and what should you do?
A slipped muscle. Refer back to surgeon ASAP
What are 3 examples of scenarios when an unsatisfactory alignment following strabismus surgery should be sent back to the surgeon?
- If patient is outside if monifixation range.
- If patient has diplopia
- If patient still has a constant strabismus
What are some things to try before referring an exotropic patient for strabismic surgery?
Monitor
Patch
Over minus glasses
Amblyopia therapy
In order to qualify for strabismus surgery, why must the patient have at least 10 prism diopters of deviation at distance or near ?
Because it still falls within panum’s circle so they have some binocularity.
Why can a patient with a congenital cataract not have an IOL implant immediately following cataract surgery and what is a great alternative treatment option?
A patient with a congenital cataract cannot have an IOL implant immediately after surgery due to complications later with the IOL, due to the eye still growing the IOL could dislocate , and not being certain of the refractive power needed. As Dr. Sanders recommended, an alternative option would be a contact lenses, specifically RGPs being more successful due to customizability, and easier insertion and removal.
What is the over-refraction goal for an aphakic baby? And why?
-3.00 Diopters because a baby’s world is up close. This way she can see her mommy’s face clearly :)
What is the most common type of esotropia?
The most common type is an accommodative esotropia.
A patient comes in with a slipped muscle, what will be observed in EOM’s and saccades? What should be done immediately after?
The EOMs and saccades will be limited in the field of that muscle’s action. This could potentially act like Duane’s syndrome. This should be immediately sent back to the surgeon.
In a case of pediatric nystagmus, what kind of lenses show more potential for correction (spectacle or contact lenses)? According to Dr. Sanders, why might this be the case?
Contact lenses because the patient will have edge awareness and will create a feedback loop to dampen the nystagmus
This is the type of surgery where a muscle is tightened by removing the anterior part of the muscle and reattaching the shortened muscle to the original insertion site?
Muscle resection
According to Dr. Sanders, which test is the best way to find out if a patient would benefit from a bifocal?
MEM
What is Soemmering’s Ring and what condition is it associated with? What are management options for this condition?
It’s the ring that is formed by the fusion of the anterior and posterior capsule of the lens. It is associated with aphakia and can be managed by the insertion of an IOL, or the use of a contact lens.
You’re performing a follow up examination after a strabismus surgery on a 10 year old patient. You notice corneal edema, uveitis, and folds in descemet’s membrane. What do you do next?
You would treat with steroids, then refer back to the surgeon because these are signs of ischemia due to anterior ciliary artery compression.
A child presents to your clinic with an accommodative esotropia. You do a wet retinoscopy and find +0.75 DS OD and +0.50-0.25x160 OS. Would you prescribe this prescription?
Yes, you would prescribe the full plus prescription since the patient has an esotropia in order to promote good fusion and relax the patient’s accommodation.
According to Dr. Cowen, what is an important ocular surface condition to consider before a patient has ptosis surgery?
Dry eye, because widening the palpebral fissure can induce or worsen dry eye symptoms.
