Exam sequence in strabismus Flashcards Preview

Motility Block 9 > Exam sequence in strabismus > Flashcards

Flashcards in Exam sequence in strabismus Deck (30):
1

This allows you to develop a hypothesis and guide the management plan

Case history

2

What do you need to address in case history

CC
FOLDAR
Medical Hx
Birth Hx
Family Hx
Meds
Allergies

3

Attention to chiefs complaints

-asthenopia
-Poor cosmesis
-failed screening
-second opinion (confirm a dx)
-family history of strabismus
-birth defects
-signs of asthenopia (rubbing)
-developmental concerns

4

FOLDAR questions specific to ocular motility problems

-frequency of deviation or symptom
-onset of deviation or symptom

5

Why do we need to ask about frequency or deviation or symptom for motility problems

-Constant or intermittent can predict presence of amblyopia and sensory adaptations
-worse during a time of day, AC/A problems, decompensations, when inattentive

6

What do we need to ask about onset of deviation or symptom for ocular motility problems

-age of onset (infantile/congenital or acquired)
-mode of onset- sudden or gradual

7

Location and laterality during FOLDAR during case history

At distance or near in a particular gaze unilateral or alternating

8

Duration during FOLDAR in case history

Onset to first treatment

9

Associated signs and symptoms in case history for ocular motility problems

double vision, eye strain, trauma, illness, medication use, numbness and dizziness, no symptoms

10

Relieve in FOLDAR in case history for motility problems

Treatments that have helped: glasses, occlusions, vision therapy, surgery

11

Systemic history in ocular motility problems

Childhood diseases, medications, neurologic, problems, developmental milestones

12

Birth history

Birth weight, prematurity, complications, prenatal and perinatal care

13

Family history for ocular motility problem exam

History of strabismus, history of binocular dysfunctions or amblyopia

14

Direct observation of patietns experience in ocular motility exam

Head positioning, head movements, attentiveness, motor control

15

Head posture

Head tilt, turn or tip to avoid diplopia ( or to keep double images far apart)
-common in non-comitant deviations-face placed in the affected muscles diagnostic action field

16

Facial assymetry in ocular motility problems

Down syndrome
Cerebral palsy
Hydrocephaly
Craniofacial abnormalities

17

Lid position

Ptosis
Exophthalmos (graves, Duane's)
Lagophthalmos
Prominent epicanthal folds

18

Nose bridge in ocular motility problems

Can make the appearance of strabismus not correct

19

Wide nose bridge

Makes XT less obvious

20

Narrow nose bridge

Makes ET less obvious

21

Wide face

Makes XT less obvious

22

Narrow face

Makes ET less obvious

23

Hypertelorism

Eyes wide apart

24

Positive angle lambda

Reflex nasal to pupil
Makes XT more obvious

25

Negative angle lambda

Temporal reflex to pupil
Makes ET more obvious

26

Normal hircschbirg

Reflex is about 0.5mm nasal to the center of the pupil (slightly exo)

27

What to consider when looking at presence of deviation

Constant or intermittent
Unilateral or alternating
Size and direction of the deviation
Cosmesis
Constancy

28

Motor fusion tests done on ocular motility exam

Pertinent entrance tests, eye and head tilt
CT (in all gazes), ductions and versions
Hirsh/Krimsky
Bruckner test
Test of torsion-double Maddox
Parks three step test
Red glass
Hess Lancaster, major amblyoscope

29

What types of refractions are pertinent in an ocular motility exam

Keratometry
Dry ret
Subjective refraction
Cylcoplegic refraction

30

What ocular health tests are pertinent in an ocular motility exam

Biomicroscopy
90D, BIO with 20D