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Neurology > Examination of Ocular Movement and Pupillary Function > Flashcards

Examination of Ocular Movement and Pupillary Function Flashcards

1
Q

what is convergence?

A

visual axis = not parallel
point of fiation = closer than infinity
eyes adduct –> <–

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2
Q

where do the L retus, I rectus, S rectus & M rectus converge at?

A

Annulus of Zinn

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3
Q

where do M & L rectus muscles move to?

A

M & L rectus
* Adduct/adbduct the eye
* rotation of eye around vertical axis

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4
Q

where do S & I rectus muscles move to?

A

S rectus - upward along lateral axis
I rectus = depresses eye, adduct the eye

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5
Q

where is the origin of S & I oblique?

A

S oblique = lesser wing of sphenoid bone
I oblique = medial inferior rim of bony orbit

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6
Q

What are the innervations of the EOM?

A

LASOT
Lateral rectus abducense nerve (CN VI)
Superior oblique trochlear nerve (CN IV)

the rest = CN III (oculomotor nerve)

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7
Q

what are the functions of the I oblique?

A

elevates the eye
abducts the eye
extors the eye

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8
Q

ues

is there always a light tension in the EOM whern the eye is in primary position?

A

yes

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9
Q

in times of paralysis, which direction does the eye deviate to?

A
  • toward direction of the intact muscle
  • paralysis distrupts tonic innervations => lack of tension
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10
Q

during inspection of the eye, what should be observed?

A

relation of limbus of the eye to the lid margins as the px gazes straight ahead

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11
Q

what is the hirschburg test & what is it for?

A

aka Corneal light reflex test
to check for ocular malignment

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12
Q

what should we take note when doing the hirschburg test in children/pedia px?

A

medial canthus looks diff so it might look like Strabismus

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13
Q

what is seen in ocular malalignment?

A
  • abnormal relation of corneal limbus to margin of eyelids
  • noncorrespondence of points of conreal light reflection
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14
Q

after inspecting the eyes in primary position & range of movement, what test is done?

A

Cover-uncover test

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15
Q

what is the normal presentation in normal px in doing Cover-Uncover test?

eye is covered and uncovered

A

we shouldnt see any movements of the eye from mid-position

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16
Q

what are alignment problems with vertical axis?

A
  • Esotropia = abnormal eye tends to deviate inward
  • Exotropia = abnormal eye tends to deviate outward
17
Q

what alignment problems with horizontal axis is seen in Cover-uncover test?

A
  • Hypertropia = abnormal eye tends to deviate upward
  • Hypotropia = abnormal eye tends to deviate downward
18
Q

what are the 3 muscles used in Accommodation reflex?

A

Convergence = Medial recti msucles
Pupilloconstriction = Pupilloconstrictor muscle of the iris
Lens thickening = Ciliary muscle (Smooth muscle, parasympathetic)

19
Q

what are the determinants of pupil size?

A
  • local disease of the eye
  • drugs
  • emotions
  • sleep/drowsiness
  • age
  • autonomic nervous system = parasympathetic & sympathetic
20
Q

what is the action of the eye during parasympathetic & sympathetic denervation?

A

Parasympathetic = pupillary dilation
Sympathetic = pupillary constriction

21
Q

what are the 4 abnormal findings in pupillary exmination?

A
  • Anisocoria = diff color of the eye
  • Hippus = oscillation of th eborders of the pupil
  • Keyser-Fleishcer ring = brownish to gray-green rings
  • Dilation lag = one pupil dilates slower than the other
22
Q

Dilation lags notes what?

A

there is sympathetic innervation problem of the eye

Horner’s syndrome, Adie’s tonic pupil

23
Q

what is checked in direct & consensual pipillary light reflex?

A

dilation & constriciton of pupils at the same time if one eye is only receiving the stimuli

Normal: one eye directly receives the light => other pupil should consen

24
Q

what is checked in direct & consensual pipillary light reflex?

A

dilation & constriciton of pupils at the same time if one eye is only receiving the stimuli

Normal: one eye directly receives the light => other pupil should consen

25
Q

what happens in direct & consensual light reflex?

A
  • direct light reflex = direct constrictin of the pupil stimulated by light
  • consensual light reflex = constriciton of the opposite pupil
26
Q

what eye test is done to check for problems w/ direct or consensual light reflex?

A

swinging flashlight test

27
Q

what is an important abnormality seen in swinging flashlight test?

A

Relative afferent pupillary defect OR
Marcus-Gunn pupil

Problems of the optic nerve

28
Q

what muscles are affected by Ptosis?

A
  • Superior tarsal msucles - carotid sympathetic nerve
  • Levator palpebrae muscle - CN III
29
Q

Can paralysis cause a more severe ptosis than superior tarsal msucle paralysis?

A

yes

30
Q

in what clin conditions can you see ptosis?

A

congeintal ptosis
Myasthenia gravis
Horner’s syndrome

Neurology (8 decks)

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