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Ocular Disease 3 - Final > Diplopia > Flashcards

Flashcards in Diplopia Deck (50)
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1

what are the 5 categories of differential diagnoses for diplopia?

emergent, refractive, functional, neuropathological, and mechanical

2

what is the first thing you do if a patient presents with diplopia?

rule out an emergency - if its an emergency you need to refer

3

what are some signs that the diplopia is an emergency?

more than one CN is involved (3 and 4), patient is distressed/unwell, displays other neurological signs and/or they have a stroke

4

what is the next question after ruling out an emergency?

is the diplopia binocular

5

what do you do if the diplopia is not binocular (it is monocular)?

refract and check the media for any opacities

6

the diplopia is binocular - what is the next question you ask?

is it comitant

7

what do you do if the binocular diplopia is comitant (within 5PD in all gazes)?

perform a functional analysis, VT and monitor

8

what is the spread of comitancy?

if the deviation is comitant - this means that the problem has been there for awhile (maybe started incomitant in the past)

9

what do you look at after you determine the patient has binocular incomitant diplopia?

identify the paretic muscle and see if it matches CN control

10

what are the causes of diplopia if it is incomitant and does not match CN control?

think = MG, orbit or INO

11

what are the causes of diplopia if it is incomitant and does match CN control?

think = CN3, CN4, CN6

12

how do you test for comitancy?

good observer, muscle field tests or projection tests

13

what is the foster torch test?

a projection test for comitancy - the red light is seen by the right eye and the green is seen by the left eye, the patient is supposed to put the two colored lines on top of each other on a grid

14

if the diplopia is incomitant and purely horizontal with an exo deviation - which EOM is affected if the deviation is greater on left gaze?

right medial rectus

15

if the diplopia is incomitant and purely horizontal with an exo deviation - which EOM is affected if the deviation is greater on right gaze?

left medial rectus

16

if the diplopia is incomitant and purely horizontal with an eso deviation - which EOM is affected if the deviation is greater on left gaze?

left lateral rectus

17

if the diplopia is incomitant and purely horizontal with an eso deviation - which EOM is affected if the deviation is greater on right gaze?

right lateral rectus

18

what do you use if the patient has a vertical component with the incomitant diplopia?

Parks- 3 step flow chart (given on the exam)

19

what are the 3 questions you ask with Parks 3-step flow chart?

which is the hyper eye, is the deviation greater on left or right gaze and is the deviation greater on head tilt to the left or right

20

if the SO (isolated) is affected what do you think of? (CN4)

blunt head trauma, small vessel disease, congenital, and idiopathic

21

if the SO (isolated) is affected what do you look for? (CN4)

pertinent history, head tilt, risk factor (DM, HTN), large vertical fusional ranges and cyclo-deviation

22

if the LR (isolated) is affected what do you think of? (CN6)

small vessel disease, elevated ICP, and myasthenia gravis

23

if the LR (isolated) is affected what do you look for? (CN6)

risk factor (DM, HTN), papilledema/loss of SVP, worse with fatigue or repeated use

24

if the MR, IR, IO, SR, and levator are affected what do you think of? (CN3)

small vessel disease, space occupying cranial mass, brainstem stroke, cavernous sinus, orbital apex disease

25

if the MR, IR, IO, SR, and levator are affected what do you look for? (CN3)

risk factor (DM, HTN), papilledema/loss of SVP, focal brainstem signs, and other CN involvement

26

if the LR and/or SO and/or MR, IR, IO, SR, and levator are affected what do you think of?

cavernous sinus, orbital apex disease, and myasthenia gravis

27

if the LR and/or SO and/or MR, IR, IO, SR, and levator are affected what do you look for?

CN5 involvement, orbital bruit, red eye, and pulsating exophthalmos

28

if SR and levator or MR, IR, and IO are affected what do you think of?

orbital apex disease affecting superior or inferior division of CN3, myasthenia gravis

29

if SR and levator or MR, IR, and IO are affected what do you look for?

exophthalmos, resistance to retropulsion, papilledema/loss of SVP, other CN involvement

30

what condition do you use the tensilon test for?

myasthenia gravis