B12 Flashcards
1
Q
Is a nystagmus voluntary or involuntary?
A
Involuntary
2
Q
An involuntary rhythmic oscillation of one or both eyes
A
Nystagmus
3
Q
The shaking, dancing, jerking, or wobbling of the eyes
A
Nystagmus
4
Q
A type of nystagmus that has both quick corrective saccade and slow movements away from fixation
A
Jerk nystagmus
5
Q
This phase brings the eyes back to the target during a jerk nystagmus
A
Fast corrective saccade
6
Q
A type of nystagmus with to and fro movements of equal velocity in each direction
A
Pendular
7
Q
The type of nystagmus has a sinusoidal movement without a fast phase
A
Pendular
8
Q
What phase is a jerk nystagmus characterized by?
A
Fast phase
9
Q
The slow phase in a jerk nystagmus reflects what?
A
There is an abnormality/pathology
10
Q
A left jerk nystagmus has a slow movement to the ____ and a fast corrective jerk movement to the ____
A
Slow to the right and fast to the left
11
Q
What are the 4 different directions/movements of a nystagmus?
A
- Horizontal (side to side)
- vertical (up and down)
- torsional (rotary)
- combination
12
Q
size/extent of movement between the start of the drift away from fixation to the start of the corrective movement (in the opposite direction)
A
Nystagmus amplitude
13
Q
The number of oscillations per unit time
A
Frequency
14
Q
This means a waveform completes a full rotation in 1 sec
A
One hertz (cycle/sec)
15
Q
The greater the number of beats, the ___ the frequency
A
Higher
16
Q
What is considered a fast nystagmus?
A
> 2Hz
17
Q
What is considered a slow nystagmus?
A
<2 Hz
18
Q
Where the intensity of the nystagmus diminished and the VA improves
A
Null point
19
Q
If someone has a null point in L gaze, how will they move their head?
A
To the right
20
Q
For someone with a latent nystagmus (changes with occlusion), the fast phase is towards the _____ eye
A
Uncovered
21
Q
For a latent nystagmus will the amplitude and frequency increase or decrease?
A
Increase
22
Q
A latent component usually indicates a ____ condition
A
Congenital
23
Q
Amplitude may ____ with convergence
A
Decrease
24
Q
T/F: nystagmus is a sign of a problem
A
True
25
What are the 3 etiologies of nystagmus?
- genetics
- developmental abnormalities
- ocular pathology/conditions
26
What are the 3 anterior segment conditions associated with nystagmus?
- congenital cataract
- congenital glaucoma
- iridocorneal dysgenesis
27
This type of foveal condition is associated with a nystagmus
Foveal hypoplasia
28
What are the 3 optic nerve disorders associated with nystagmus?
- optic nerve hypoplasia
- optic nerve coloboma
- optic atrophy
29
What are the 3 primary sensory retinal abnormalities associated with a nystagmus?
- leber congenital amaurosis
- achromatopsia
- congenital station also night blindness
30
What are the 4 vitreoretinal abnormalities associated with a nystagmus?
- coloboma involving the macula
- familial exudate vitreoretinopathy
- retinal dysplasia
- retinoblastoma
31
What are the 3 type of foveal hypoplasia's that are associated with a nystagmus?
- albinism
- aniridia
- isolated
32
What are the 4 infectious diseases associated with a nystagmus?
- congenital toxoplasmosis
- cytomegalovirus
- rubella
- syphillis
33
What are the 4 types of physiological nystagmus'?
- endpoint
- rotational
- caloric
- optokinetic
34
Name the 9 types of pathological nystagmus'?
- congenital
- latent/manifest
- acquired
- spasmus nutans
- vestibular
- gaze paretic
- see-saw
- convergence-retraction
- downbeat
35
T/F: children with congenital nystagmus will complain about the problem
False. They seldom complain
36
What are some neurological signs or symptoms you should ask about?
- dizziness
- pain
- numbness
- poor balance
- ringing in the ears
- seizure
- weakness
37
Can a nystagmus be better in certain gazes, tilts or turns?
Yes
38
Nystagmus from motor coordination problems result in a ____ VA loss than nystagmus with sensory issues
Less
39
Decreased VA is more likely in motor or sensory?
Sensory
40
Should you do VA's mono only, bino only, or both at D and N for someone with a nystagmus?
Do mono and bino at D and N
41
Can near VA's be better than distance vision in someone with a nystagmus?
Yep
42
T/F: when testing for a nystagmus the patient should be sitting straight up with head positioned straight
False. They should be in their preferred head position at D and N to assess true functional vision
43
If there is an objection to occlusion, how should test for a nystagmus?
Assess their visual behavior
44
Do you want to assess eye movements in all 9 positions of gaze?
Yes
45
These 3 tests can be valuable to determine if the corneal reflex appears symmetrical in both eyes
- hirschberg
- krimsky
- Bruckners
46
Since cover test is difficult in someone with a latent nystagmus what can be used in place of a paddle?
A +5.00 lens
47
What type of test will allow you to determine if a patient has a phoria
Stereo
48
What test can be used for suppression testing for someone with a nystagmus?
W4D
49
If the patient has a very small nystagmus what can you do to get a better view?
Look in the slit lamp
50
If there is no cooperation with the slit lamp, what can you use to assess the nystagmus?
A 20D lens or a hand held slit lamp
51
Do you want to dilate a patient with a nystagmus?
Yes, so you can get a completely evaluation of the retina and periphery
52
What can help identify lebers or congenital retinal blindness?
ERG
53
What should you do if the MRI is normal, fundus appears normal, but there is decreased VA and nystagmus.
Order an ERG
54
When should you run a CT and MRI for someone with a nystagmus?
If it is acquired
55
If someone has a recent onset or/and nystagmus that has not been diagnosed, what should you do?
Refer to neuro
56
Sensation of the environment moving
Oscillopsia
57
A feeling of being off balance
Vertigo
58
The position of gaze where the eyes are quiet for someone with a nystagmus
Null point
59
Someone with this type of nystagmus, you should always warn them to not drink and drive
Endpoint nystagmus
60
A nystagmus with small amplitude and variable frequency that has an intermittent conjugate jerk, worse when tired, and symmetrical in R and L gaze
Endpoint nystagmus
61
Someone with an endpoint nystagmus will have a nystagmus seen in both eye when an extreme ___ gaze (greater than ___ degrees of midline) is held for a prolonged amount of time
Extreme lateral gaze and greater than 30 degrees
62
Type of nystagmus: jerk nystagmus due to head or body rotation.
Rotational nystagmus
63
A rotational nystagmus is related to ____ in the semicircular canals
Endolymph
64
In rotational nystagmus, the normal response is slow conjugate eye movement then fast phase in the _____ direction of the rotation
Opposite
65
Type of nystagmus: Conjugate, jerk nystagmus produced during the caloric testing of the vestibular system.
Caloric nystagmus
66
In a normal caloric response,
For cold water: nystagmus with fast phase towards the ____ ear
For warm water: nystagmus with fast phase towards the ____ ear
Cold: opposite
Warm: same
67
Type of nystagmus: Slow pursuit eye movement followed by a fast corrective saccade because a visual field moves over the retina (determined with a drum)
Optokinetic nystagmus
68
When will you see a fast corrective saccade in an optokinetic nystagmus
When fixating on a new stripe
69
Is the head still or moving in the OKN?
Still
70
When does an optokinetic nystagmus develop?
3-5 months of age
71
OKN can be used for what type of patients?
Malingering and uncooperative patients
72
How is someone with a congenital nystagmus going to react to an OKN?
They will show a reverse OKN response and could show a preserved vertical OKN response
73
Name the 4 physiological types of nystagmus?
Endpoint
Rotational
Caloric
Optokinetic
74
Physiological or pathological nystagmus: Dissociated movements with excessive oscillations in the presence of other ocular motor abnormalities.
Pathological
75
When will will a congenital nystagmus present? And who is more prone boys or girls?
At or shortly after birth, boys
76
Will someone with a congenital nystagmus have a strabismus?
Could be present
77
Is conjugate, horizontal, oscillopsia present in congenital nystagmus?
No
78
Is the etiology of congenital nystagmus more motor or sensory?
Motor (60%)
79
Will someone with congenital nystagmus have a horizontal or vertical nystagmus?
Horizontal
80
When will someone with congenital nystagmus have a head turn or tilt?
If the null point is not in primary
81
With congenital nystagmus, the nystagmus ___ with fixation and __ with convergences
Increases with fixation and dampens with convergence
82
Can a congenital nystagmus improve with age?
Yes
83
Is a latent nystagmus seen in someone with a congenital nystagmus?
Yeah usually when one eye is covered
84
Type of congenital etiology: inadequate image formation that results in a failure of development or normal fixation, poorer vision/bad VAs
Afferent etiology
85
Type of congenital etiology: fixation and or motor issues that has a better VA and has cosmesis concerns
Efferent
86
A patient with congenital nystagmus that later develops an ET with a head turn
Nystagmus blocking syndrome
87
Convergence usually ___ congenital nystagmus
Dampens
88
Type of nystagmus: a congenital, jerk nystagmus after occlusion of one eye
Latent nystagmus
89
Is a latent nystagmus horizontal or vertical?
Horizontal
90
In latent nystagmus the fast phase is towards the __ eye
Uncovered
91
A latent nystagmus is associated with what 2 conditions?
Strabismus and amblyopia
92
When a latent nystagmus occurs with both eyes open but one eye suppresses
Manifest latent nystagmus
93
In mono VA increased or reduced with a latent nystagmus?
Reduced
94
In bino VA better or reduced with a latent nystagmus?
Better
95
A left jerk latent nystagmus is when the __ is covered
OD
96
Type of nystagmus: starts shortly after birth, pendular, usually bilateral, ad should be sent to neuro
Spasmus nutans
97
When does spasmus nutans usually reduce by?
Age 5-8
98
Spasmus nutans can be associated with what 3 things?
Strabismus, amblyopia, and developmental delays
99
Type of nystagmus: small/fine amplitude with high frequency, head nodding and possibilities torticollis
Spasmus nutans
100
Type of nystagmus: pendular nystagmus where one eye elevates and intorts while the other depresses and extorts
See-saw nystagmus
101
Someone with a see-saw nystagmus probable has a lesion in the ___ or a ___ in children
Lesion in Supra stellar area or craniopharyngioma in children
102
See saw nystagmus is seen in what type of syndrome?
Joubert syndrome
103
Type of nystagmus: a jerk vertical nystagmus in primary, that has a fast phase that beats down
Downbeat nystagmus
104
A downbeat nystagmus is due to what type of abnormalities?
Cranio-cervical junction
Medications can also cause this
105
Type of nystagmus: a jerk vertical nystagmus, with the fast phase up
Upbeat nystagmus
106
What causes an upbeat nystagmus?
brainstem abnormalities or drugs
107
Type of nystagmus: horizontal nystagmus with a jerk with a rotary element
Vestibular nystagmus
108
This type of nystagmus is associated with an inner ear or vestibular abnormality
Vestibular nystagmus
109
What 3 symptoms can someone have with a vestibular nystagmus?
- oscillopsia
- nausea
- vertigo
110
A rhythmic convergence and retraction of the eyes when attempting upgaze movement
Convergence-retraction syndrome
111
Convergence-retraction is found in what syndrome?
Parinaud syndrome
112
Name 4 characteristics of parinaud syndrome
- dorsal minbrain syndrome
- pretectal dysfunction
- excess convergence
- paralysis of upward gaze
113
What are 4 accompanying neurological signs in parinaud syndrome?
- palsy in upgaze
- eyelid retraction
- pupillary light-near dissociation
- convergence-retraction
114
What is the hallmark sings in periodic alternating nystagmus?
Shifting null point
115
Type of nystagmus: horizontal nystagmus that changes directions every 90 seconds with rest of about 10 secs
Periodic alternating nystagmus
116
What might a patient with periodic alternating nystagmus do to adapt to the nystagmus?
Alternating head turnings
117
Type of nystagmus: a rapid with small amplitude and short duration nystagmus that is pendular and only maintained for a few secs because of fatigue
Voluntary nystagmus
118
Is a voluntary nystagmus horizontal or vertical?
Horizontal
119
What induces a voluntary nystagmus?
Convergence
120
Is oscillopsia present in voluntary nystagmus?
Yes
121
What are the 5 goals to improve nystagmus?
- VA
- Ocular motor control
- binocularity
- cosmesis
- comfort
122
What are 5 options to manage a nystagmus?
- glasses or contacts
- prism
- vision therapy
- surgery
- medication
123
Why would you give someone prism for their nystagmus?
- to improve fusion
- to induce convergence
- to reduce head turn
124
____ prism can be also used to move the null point
Yoked
125
Why would you want to give someone correction for their nystagmus?
To improve the clarity of the retinal image and to lessen the nystagmus
126
What is the first type of management you would give someone with a nystagmus?
Correction
127
When would you rx for hyperope with nystagmus?
1 to 2D
128
When would you rx for a myope with nystagmus?
0.50D or more
129
When would you rx for someone with a nystagmus?
0.50D or more
130
What 2 types of lenses could be considered for higher refractive errors for someone with a nystagmus?
- rigid-gas permeable lens
| - soft contact lenses
131
Why might you use plus adds for someone with a nystagmus?
- valuable at near for improved VA and clarity for near point demands
- aid in accommodation at near
132
Why might you use minus adds for someone with a nystagmus?
To induce convergence since nystagmus can decrease with convergence
133
What type of prism would you use to induce convergence in a nystagmus patient
Use BO prism
134
What type of prisms can be used to improve VA and slow down the nystagmus by improving abnormal head postures?
It also shifts the retinal image towards the null point
Yoked
135
How should the prism be placed for some with a nystagmus to lessen the head turn?
To be placed in the same direction as the head turn
136
If you put a BO over the OD and BI over the OS the image will shift to the ____ improving the small gift head/face turn
Left
137
This types of prism are used for large amounts of prism
Fresnel and ground
138
The apex of the prism is towards the ___ and the base is towards the ___
Apex towards the null point and base towards the turn
139
If someone has a left head turn, the patient has the null point in the right face and you use a base to the _____over each eye
Left..this will shift the image to the right and reduce the head turn
140
Why is vision therapy used in some nystagmus patients?
- fusional vergences
- improve motor control
- suppression that could lead to manifest latent nystagmus
141
When do you need to rx medication for someone with a nystagmus?
When there is a systemic problem (infection, metabolic, or vascular problem) or if they have oscillopsia and vertigo
142
What type of medication has been shown to help reduce the severity of nystagmus?
Gabapentin
143
This technique is used to shift the null point closer to the primary position and eliminates the head turn
Kestenbaum technique
144
When is the best age to do surgery on someone with a nystagmus? And why?
Oder than 4 because there is a higher change of over correction in younger children
145
A spontaneous upward movement of one or both eyes when tired, when fusion is broke, or inattentive
Dissociated vertical deviation (DVD)
146
For someone with a DVD, will they have a hypo deviation in the other eye?
No, they will have a hyper deviation in one or both eyes
147
At what age does DVD start?
2-3 years
148
Do you usually treat someone with a DVD?
No, unless its huge then you can do surgery
149
If someone has an IO overaction will they have a deviation in the primary gaze?
Probably not
150
When do you usually see a IO overaction?
In children with infantile strabismus mainly
151
In what gaze will you see an overaction of the IO?
When the eye is elevated in adduction
152
This is present when a horizontal deviation changes in magnitude between upgaze and downgaze
Pattern strabismus
153
Is a pattern strabismus comitant or non-comitant?
Non-comitant
154
Is a pattern strabismus considered horizontal or vertical?
Vertical
155
T/F: a pattern strabismus can be seen in an XT or ET
True
156
Pattern strabismus: horizontal deviation is more divergent in upgaze than in downgaze
V pattern
157
Pattern strabismus: horizontal deviation is more divergent in downgaze than in upgaze
A pattern
158
How do you determine A and V pattern strabismus?
Measure alignment in primary at distance and then about 25 degrees from primary in upgaze and downgaze
159
When is the V pattern considered significant?
When the difference in measurement between upgaze and downgaze is at least 15pd
160
What is the most common pattern deviation?
V
161
In what type of ET is a V pattern present?
Infantile
162
Will someone have a head posture with a V pattern strabismus?
Yes they may adopt a chin up compensatory head posture
163
What kind of palsy can a V pattern strabismus be seen in?
SO palsy (especially if bilateral)
164
When is an A pattern considered clinically significant?
When there is a difference in measurement between upgaze and down gaze is at least 10pd
165
This pattern is seen more frequently in patients with XT
A pattern
166
Will someone with an A pattern strabismus have a head posture?
They may adopt a chin down compensatory head posture
167
This pattern strabismus is more common in patients with infantile strabismus associated with craniofacial malformations, down’s.
A pattern
