ET And XT Flashcards
When should you never give a partial prescription
Any ET
-they need a full Rx to make sure there is no type of accommodative issue going on
You will give the full cyclo refraction to all _____
Esotropes
Nonrefractive accommodative ET
- due to high AC/A ratio
- ET greater at N than D
- always important to eval at D and N
- may be intermittent alternating at N
- moderation hyperopia to myopia is seen (similar to general population)
Treatment for non refractive accomodative ET
- treat underlying refractive error-full RX
- bifocals based on AC/A
- segment height must bisect the pupil (executive or flat top)
- repeat cyclo yearly for any changes
- surgery is contraindicated. May be weaned off add if there is improved alignment at N
Who should get a bifocal
Non refractive accommodative ET
Mixed accommodative ET
Surgery and non refractive accommodative ET
Contraindicated
How long will the kid be in a bifocal for non refractive accommodative ET
Stay in it for a very long time, usually always
-could be weaned off about 7 years later
Mixed accommodative ET
- combination of refractive accommodative and non refractive accommodative findings
- high hyperopia and high AC/A ratio
Management of mixed accommodative ET
Full hyperopic Rx
Bifocal (based on AC/A)
Surgery is contraindicated
Surgery and mixed accomodative ET
Contraindicated
How can you suspect mixed accommodative ET
Some type of ET at D and N
Partially accommodative ET
- accommodation contribute to, but does not account for the entire deviation
- there is a reduction in the angle, but there is residual ET after treatment.
- this may result after delayed treatemtn of trule accommodative ET
- constant, unilateral
- suppression, ARC common
Early onset non accommodative ET
- onset is after about 6 months of age to before age 2
- clinically similar to infantile ET, but the onset is later
- ET same at distance and near
- there is no accommodative element
- insignificant amount of hyperopia
Management of early onset non accommodative ET
- correct error, consider prisms or bifocal
- amblyopia treatment
- VT to improve ranges
- consider surgery
- consider near cuases (even if child appears healthy)
Early onset vs infantile non accommodative ET
Looks similar but onset is later
Acute acquired ET
- comitant
- sudden onset in 3-5 years old (or older)
- unilateral and constant moderate angle (20-30PD)
- refractive error similar to general population
- could be as a s result of illness, stress, aging
Management of acute acquired ET
Neuro evaluations ASAP
Correction
Prism or surgery since patient probably had BV before the ET-sensory adaptations can still occur in some
Amblyopia treatment, if needed
Other esodeviations
- sensory ET
- divergence insuffiency ET
- consecutive ET
- microtropia-ultra small ET
- decomensating ET- FV no longer able to maintain EP
Who is a good candidate for strab surgery
Acute acquired ET
Sensory ET
- as ET that develops due to vision loss in one eye
- pathology prevents symmetrical visual stimulation OU
- poor VA in affected eye
- constant unilateral deviation, about 10-45 PD, poor cosmesis
Things that can cause sensory ET
Congenital cataract Corneal scarring Optica atrophy Prolonged blur Retinal/mac disease Anisometropia amblyopia Ptosis PHPV
Managment of sensory ET
-need to eliminate pathology (if possible) especially during the critical peieord
-polycarbonate lenses
-treat secondary amblyopia
Surgery can be for any residual deviation (or basically for cosmesis)
Divergence insufficiency ET
A non accommodative esodeviation greater at D than N
- comitant
- onset in adutls
- decreases fusional divergence at distance
- diplopia complaints at distance
- HA
Refractive error similar to normal population
No sensory adaptations since ate onset
Which deviation would you send out the door to the ER right away
Divergence insufficiency ET
