Block10 Flashcards Preview

Motility > Block10 > Flashcards

Flashcards in Block10 Deck (233)
Loading flashcards...
1

What does a left hypertrophia mean

Either:
- left eye elevated
Or
- right eye depressed

2

Do you use correction in CT

Yes

3

Purpose of CT

Assess the presence and magnitude of a phoria or tropia

4

What all is recorded in CT

Correction?
Magnitude
Eye
P or T
Constant or intermittent
Distance or near

5

How is an intermittent tropia recorded

(T)
- in parentheses

6

How is CT at N recorded

'
- with an apostrophe

7

Do you use correction on EOMs

No

8

Purpose of EOM test

To asses ability to perform conjugate eye movements

9

What all should be recorded in EOM test

Eye
Ability of muscles (full and smooth; if restricted)
Diplopia (- if not)
Pain (- if not)

10

Do you preform hirschberg with correction

No

11

Purpose of hirschberg

To determine the position of the visual axes under binocular conditions at N

12

How to perform hirschberg

1) look at penlight
2) look at reflex monocularly
3) look at reflex binocularly

13

Hirschberg: reflex is nasal

- positive angle lamda
- exo

14

Hirschberg: reflex is temporal

- negative angle lamda
- eso

15

Hirschberg: reflex is above

Hypo
(Record as opposite eye hyper)

16

Hirschberg: reflex is below

Hyper

17

Which eye is the prism placed over in Krimsky

FIXATING eye until reflex is in the same position as deviating eye

18

BO relieves

Eso

19

BI relieves

Exo

20

In krimsky, 1mm deviation is equal to how many prism diopter

22

21

Pertinent entrance tests if there is a possible strab (6)

1) CT
2) EOMs
3) saccades
4) pursuits
5) hirschberg/krimsky
6) bruckner

22

Purpose of bruckner test

To evaluate the symmetry of binocular fixation

23

What patients will we typically used bruckner test on

Infants and young preverbal kids

24

Do kids where their correction for bruckner?

No

25

What instrument do we use in bruckner test

direct ophthalmoscope

26

Procedure for bruckner test

1) look at o-scope light (80-100cm away)
2) compare red reflexes in eyes

27

Bruckner test: If the red reflexes are equally bright

Binocular fixation

28

Bruckner test: If the red reflexes are not equal
- more prominent red eye

Fixating eye

29

Bruckner test: If the red reflexes are not equal
- lighter/white reflex

Nonfixating eye

30

Bruckner test: If the red reflexes are not equal
- dimmer eye

Media opacity

31

Bruckner test: If the red reflexes are not equal
- brighter eye

Retinoblastoma

32

Bruckner test: If the red reflexes have crescents
- at head of oscope

Hyperopia

33

Bruckner test: If the red reflexes have crescents
- at handle of oscope

Myopia

34

Bruckner test: If the red reflexes has no cresecents

Emmetropic

35

How to record bruckner test

- if eyes appear equally bright
- if any opacities
- presence of refractive error and if its equal in both eyes
- which eye appears whiter and brighter

36

What movements compensate for cyclophorias

Cyclovergence movements

37

Purpose of double Maddox rod

- detect torsional misalignment
- measures cyclodeviation but does not differentiate between P and T

38

Correction for double Maddox rod

Yes

39

Target for double Maddox rod

D - muscle light
N - penlight @ 40cm

40

Procedure for double Maddox rod test

1) trial frame with red Maddox lens over OD and clear Maddox lens over OS
- placed vertically (lllll)
- use vertical prism to induce separate horizontal lines if they only see 1
2) rotate the lenses until the 2 lines are parallel
- note degree of deviation

41

Double Maddox rod: the tilt of the line is ___________ the tilt of the retinal image

Opposite

42

Double Maddox rod: red line tilted out (left side of line is up)

Eye intorted
- IO underacting (wont extort)

43

Double Maddox rod: red line tilted in (left end of line pointed toward nose)

Eye extorted
- SO underacting (wont intort)

44

Test to identify the muscle responsible for a vertical deviation

Parks 3 step

45

3 steps in parks 3 step test

1) which eye is hyper (using alternate CT)
2) does it inc on right or left gaze (using CT)
3) does it increase on right or left head tilt (using CT)

46

Tool to figure out how to determine which muscle is underacting in parks 3 step evaluation

- Draw SR, SO, IR, IO in each eye (like an H)
- circle the underacting in each eye for each of the 3 steps
- whichever eye is circled 3 times is the underacting/paretic muscle

47

Determines if deviation is mechanical or paretic

Forced duction test

48

Procedure for forced duction test

1) numb
2) fixate toward side of limited gaze
3) grab conj with forceps and move in direction of suspected restriction

49

(+) forced duction test

Resistance, meaning it is a mechanical restriction

50

(-) forced duction test

Eye moves, meaning its a paretic muscle

51

How to record forced duction test

(+) or (-)
Eye and muscle

52

Maps out patients filed of single bino fision

Hess-Lancaster test

53

Hess means

Dots

54

Lancaster means

Lines

55

Procedure for Hess-Lancaster test

Pt wears red green glasses (red over OD)
1) examiner has red light; pt has green
2)tell pt to put their light on top of your light (OD fixates, testing OS)
- any difference indicates the deviation direction and magnitude
3) switch lights and do the same thing testing the other eye (OS fixates, testing OD)

56

3 things to look at when interpreting Hess-Lancaster

Position
Size
Shape

57

When interpreting position on Hess-Lancaster, what you are looking at

Where the central point is in relation to where it should be

58

When interpreting size of Hess-Lancaster, what does the smaller field indicate

The affected eye

59

When interpreting size of Hess-Lancaster, what does displacement of the field interiorly mean (folding in).

Underaction of affected muscle

60

When interpreting size of Hess-Lancaster, what does the larger field indicate

Unaffected eye

61

When interpreting size of Hess-Lancaster, what does the displacement of the field exteriorly mean

Overaction

62

If the size of the fields of the Hess-Lancaster test are extremely different

Recent condition

63

If the size of the fields of the Hess-Lancaster test are similar

Long standing condition

64

What does comitancy mean

Deviation is the same in all positions of gaze

65

How would comitancy show up on a Hess-Lancaster field plot

Each point is deviated by the same amount in each gaze

66

Narrowing of the field in opposite directions (he's-Lancaster)

Mechanical restriction

67

When interpreting the shape of Hess-Lancaster fields, look at the sloping of the outside edge

A/V patterns

68

In a palsy, how will the field of the eye look

The underacting/affected muscle may have slight overacting in the ipsilateral antagonist

69

In a mechanical restriction, how will the field of the eye look

Narrow in opposing directions
(Ex: Top and bottom both smush in)

70

NSUCO oculomotor test assesses

Pursuits and saccades

71

How do you preform the NSUCO oculomotor test

Red/white beads 40 cm from pt, and 2 cm apart
- saccades: dont look until i tell you
- pursuits: dont ever take your eyes off

72

How do you asses the NSUCO oculomotor test

Score based on
- ability
- accuracy
- head movement
- body movement
(5 no movement, 1 lots of movement)

73

What is the purpose of the DEM test

Check vision therapy progress

74

Harmon distance

Elbow to middle knuckle

75

Procedure of DEM test

Pt calls off a series of numbers as quickly as possible WITHOUT using finger or pointer

76

What is the purpose of the pretest in DEM test and how quickly must it be preformed

The make sure kid knows numbers
12 seconds

77

Subtest A and B in DEM test what

Vertical saccades

78

What is recorded in the DEM tests

Times

79

Subtest C in DEM tests what

Horizontal saccades

80

How to record DEM test errors: substitution

(/)
- if immediate correction, count it as correct

81

How to record DEM test errors: transposition

Arrow where number was read out of sequence

82

How to record DEM test errors: omissions

Circle it if it is omitted

83

How to record DEM test errors: additions

Cross when extra number has been added or repeated

84

What is the DEM ration

Horizontal/Vertical adjusted time

85

Diagnosis based on DEM ratio: average performance in all subtest values

Type 1

86

Diagnosis based on DEM ratio: high horizontal time, normal vertical time

Type 2

87

Type 2 diagnosis from DEM test implies

Oculomotor dysfunction

88

Diagnosis based on DEM ratio: high horizontal and vertical times, but normal ratio

Type 3

89

Type 3 diagnosis from DEM test implies

Difficulty in automaticity of number naming

90

Diagnosis based on DEM ratio: horizontal time, vertical time and ratio are all abnormal

Type 4

91

Type 4 diagnosis of DEM test implies

Deficiency of oculomotor skills and in automaticity
- combo of type 2 and 3

92

Formula to find adjusted time in DEM test

Time X (80/(80-o+a))

93

This test is often used for concussion detection

King-devick test

94

Where does the patient hold the book in king-devick test

Harmon distance (like a book)

95

Describe the process of king-devick test

Time how long it take to complete the card
- record number of errors and time

96

What are the time cutoffs for king devick test: test card 1

stop if greater than 50 seconds

97

What are the time cutoffs for king devick test: test card 2

Stop if total time of test card 1 and 2 is greater than 100 sec

98

If pt is = 10 yrs old and unable to complete test card 3

Take the sum of test cards 1 and 2 time and errors

99

Test to asses pursuits

Groffman tracings

100

Detects reading disability and requires little cognitive ability

Groffman tracings

101

In groffman tracings, are the letters scored together or individually

Individually

102

In groffman tracings, if if trace to the incorrect number, what is the score

0

103

In groffman tracings, how do you score them if they get to the correct number (trace correctly)

Score based on time it took
- times are added together for all of the letters and are compared to age-matched normative data

104

In groffman tracing, if the pt uses their finger or keeps trying to use finger, what is their score

0

105

Most common sign of neuromuscular problem

Deviation

106

Abnormalities with sensory fusion can lead to

Disruption in motor fusion --> deviation

107

Latent tendency to deviate when fusion is broken

Phoria

108

Fusion can be disrupted due to (4)

Alternating cover test
Fatigue
Illness
Stress

109

An manifest deviation of eye

Tropia (strabismus)

110

Seen in unilateral cover test

Tropia

111

What all is included in recording P or T

- correction?
- D or N?
- amount of deviation
- type of P or T
- constant or intermittent?
- unilateral or alternating?

112

When pt fixates with the unaffected eye

Unilateral tropia

113

Fusion is inadequate to keep aligned (seen all the time)

Constant tropia

114

Fusion functions some times, but not always

Intermittent tropia

115

CT norms: distance

1XP (+/- 2pd)

116

CT norms: near

3XP (+/- 3pd)

117

How do you verify an ortho alignment on CT

Use BI then BO to find reversal

118

Neutralize Exo with

BI

119

Neutralize Eso with

BO

120

Neutralize hyper with

BD

121

Neutralize hypo with

BU

122

If both eyes have BU or BD, where they cancel, and the value isnt split, the prism with produce what

A version

123

Why split the vertical prism

Deviation is treated with the resultant and net binocular effect

124

When splitting vertical prisms, what are the direction

1 is BU and 1 is BD

125

When splitting horizontal prism, what are the directions

Keep the same direction in both eyes

126

By keeping the same direction when splitting horizontal prism, what kind of eye movement is created

Vergence

127

If BO and BI were prescribed, what kind of eye movement is created

Version (BO and BI cancel - yoked prisms)

128

Abnormal head posture is known as

Torticollis

129

3 postures seen in torticollis

Head turn
Head tilt
Chin up/down

130

Attempts to maintain binocularity, VA or use of limited VE
- compensatory response to ocular problem

Ocular torticollis

131

Seen in patients with non-comitant strabismus

Ocular torticollis

132

Abnormalities that can cause ocular torticollis (8)

Nystagmus
Paretic strabismus
Restrictive strabismus
A or V pattern strabismus
Monocular blindness
Ptosis
Refractive error
VF defect

133

Deviation the same (within 5pd) in all positions of gaze

Comitancy

134

Deviation size is >5pd in different positions of gaze

Non-comitant

135

Non-comitant can be due to

Innervation problems or mechanical constriction

136

Abnormalities from birth to 1st 6months of life

Congenital

137

Anything developing after 6 months of life

Acquired

138

Aquired deviations are

Acute
Longstanding
Consecutive

139

If uncertain of onset: congenital or aquired

Congenital

140

If it is an obvious deviation than family is aware of: congenital or aquired

Acquired

141

May appear comitant: congenital or aquired

Congenital

142

Operation of yoked muscle is seen and secondary deviation is larger: congenital or aquired

Acquired

143

Normal vertical fusional amplitude: congenital or aquired

Aquired

144

Usually accompanied by suppression: congenital or aquired

Congenital

145

Torsion is commonly seen: congenital or aquired

Aquired

146

Action of muscle or group of muscles is completely eliminated

Paralysis

147

Action of muscle of muscles is impaired

Paresis

148

General term for paralysis or paresis

Palsy

149

Paralysis or paresis often cause which kind of deviation

Noncomitant

150

Deviation is seen in primary gaze: neurogenic or mechanical

Neurogenic

151

Diplopia is same in different gazes: neurogenic or mechanical

Neurogenic

152

Head tilt seen: neurogenic or mechanical

Neurogenic

153

Chin up/down may be seen: neurogenic or mechanical

Mechanical

154

Duction movement > version also movement: neurogenic or mechanical

Neurogenic

155

Hess Lancaster fields are irregular: neurogenic or mechanical

Mechanical

156

Hess Lancaster: field of affected eye is smaller: neurogenic or mechanical

Neurogenic

157

Globe retracts when turned in direction opposite of restriction: neurogenic or mechanical

Mechanical

158

Pain could be present: neurogenic or mechanical

Mechanical

159

Forced duction: limited movement: neurogenic or mechanical

Mechanical

160

Poor fusion can be associated with (6)

Fatigue
Asthenopia
HA - frontal
Avoidance
Diplopia
Suppression

161

Why are vertical phobias likely to cause symptoms

Bc vertical fusional amplitudes are naturally limited

162

Why may a pt have a small phoria but no symptoms

Bc sensorimotor system is able to cope with the deviation

163

Infancy ocular instability is also known as

Split

164

Seen in 2-3 months and resolves by 4 months

Split

165

A latent esodeviation controlled by fusion vergences so eyes are aligned in binocular condition

EP

166

Manifest deviation not properly controlled by fusion vergences

ET

167

Appearance of ET when eyes are actually straight

PseudoET

168

See in kids with wide, flat most bridges and small PD

PseudoET

169

ET onset between birth and 6mo

Infantile ET

170

Large, constant ET and possible family hx of ET

Infantile ET

171

Usually kids with this type of ET have some other neurological or developmental condition

Infantile ET

172

Both eyes look deviated

Cross fixation

173

About 30-50% of all ET are

Infantile ET

174

When can you use prism to correct a deviation

If you know that there was once binocularity used

175

ET Onset between 6mo and 7yr

Accommodative ET

176

Amblyopia is often present with large constant and unilateral angles in which kind of ET

Accommodative ET

177

Average age of onset for accommodative ET

2.5 year

178

3 types of accommodative ET

Refractive
Non refractive
Mixed

179

About 50% of all ET have what component

Accommodative

180

Type of accommodative ET due to high hyperopia

Refractive

181

Type of accommodative ET due to high AC/A

Non refractive

182

Type of accommodative ET due to high hyperopia and high AC/A

Mixed

183

Type of Accommodative ET: similar deviation at D and N

Refractive

184

Hyperopia range typically causing refractive accommodative ET

+3 to +6D

185

Type of Accommodative ET: deviation is much greater at near (may not be a deviation in D)

Non refractive

186

How to calculate AC/A ration

(Change in pd deviation)
--------------------------
Add used to correct it

187

Where should a bifocal sit on a kids to correct nonrefractive accommodative ET

Bisect the pupil

188

Type of Accommodative ET: There is a deviation at both D and N, and it is a very different magnitude in each

Mixed

189

Residual ET after treatment; may result after delayed treatment

Partially accommodative ET

190

2 types of non accommodative ET

Early onset non accommodative ET
Acute acquired ET

191

Similar to infantile ET, but onset is between 6mo and 2yr

Early onset non accommodative ET

192

Type of non accommodative ET: ET same at D and N and is comitant

Early onset

193

In early onset non accommodative ET, is there a lot of hyperopia present

No, insignificant amount

194

Type of non accommodative ET: comitant and sudden onset between 3 and 5yr

Acute acquire ET

195

Type of non accommodative ET: could be a result of illness, stress, aging

Acute acquired

196

If you suspect acute acquire ET, do you need a neuro eval

ASAP

197

Ultra small ET

Microtropia

198

Fusional vergences are no longer able to maintain EP

Decompensating ET

199

ET that develops due to vision loss in an eye

Sensory ET

200

In sensory ET, what will the affected eyes VAs be

Poor

201

Examples that could cause sensory ET

Congenital cataract, corneal scarring, retinal/macular disease, ptosis....

202

What should the first step be in management of sensory ET

Eliminate the pathology if possible and do it as quickly as possible

203

If you cannot eliminate the pathology, what should you do in sensory ET management

Polycarbonate lens for full time wear to protect the eye

204

Nonaccomodative esodeviation greater at D

Divergence insufficiency ET

205

Type of ET often seen in adults, is comitant, diplopia at D, HA

Divergence insufficiency ET

206

What should you always do if you suspect divergence insufficiency ET

NEURO REFERRAL

207

Is Sx a good choice for divergence insufficiency ET

No bc the deviation is only at D

208

Esodeviation after Exo Sx

Consecutive ET

209

A latent exodeviation controlled by fusional vergences

XP

210

Prevalence of which deviation varies by ethnic groups

Exodeviation

211

Proper alignment, but positive angle kappa, wide PD

PseudoXT

212

Tx for this is needed if there is asthenopia or diplopia

XP

213

3 types of intermittent XT

Divergence excess
Basic
Convergence insufficiency

214

Type of intermittent XT: onset in childhood, deviation larger at D

Divergence excess

215

Type of intermittent XT: onset in adults, deviation same at D and N

Basic XT

216

Type of intermittent XT: onset in adults, deviation larger at N

Convergence insufficiency XT

217

Most common XT

Intermittent XT

218

Bright light may cause reflex closure of one eye in which kind of deviation

Intermittent XT

219

Only shows during visual inattention, fatigue or stress

Intermittent XT

220

Untreated intermittent XT can lead to

Constant XT

221

XT only manifest on CT, then resumes fusion rapidly

Good control of intermittent XT

222

XT on CT, fusion regained after blinking or refixating

Fair control of intermittent XT

223

XT manifest spontaneously and for an extended period of time (usually there and visible)

Poor control of intermittent XT

224

How would mild myopia correction affect intermittent XT

Make deviate better

225

How could mild hyperopic correction affect intermittent XT

Make deviation worse

226

When does Sx typically become considered in XT patients

If it gets progressively worse with decreasing stereo and control
- when deviation is > 50% of time

227

BI reading glasses could be used to correct which type of XT

Convergence insufficiency XT

228

Which is more common, infantile ET or XT

ET

229

If a child has infantile XT, what are they likely to have

Neurological issues or craniofacial disorders

230

Any condition that causes vision loss in one eye can lead to

Sensory ET or XT

231

If the VA can be improved in sensory ET/XT patients, what should you do

Sx is useful here

232

If the VA cannot be improved in sensory ET/XT patients, what should you do

Don't do Sx, bc misaligned would probably occur again

233

Common post Sx outcome, could occur months or years after Sx

Consecutive XT