Flashcards in Block10 Deck (233)
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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
