Lecture IX

Question 1

How long does occlusion therapy last for in children?

Answer 1

Must be continued through the patient’s first decade

Question 2

What has to be treated first, and why: strabismus or amblyopia?

Answer 2

Amblyopia, since need to have good vision to affect strabismus

Question 3

What is the advantage of atropine therapy?

Answer 3

Child can still use better seeing eye for distance, but switches at near to amblyopic eye

Question 4

When should EOM surgery be done, relative to treatment for amblyopia?

Answer 4

Treat amblyopia before EOM surgery

Question 5

What is the role of vision therapy in treating amblyopia or strabismus

Answer 5

No proven value

Question 6

What is recession type surgery for strabismus?

Answer 6

The muscle is detached from the eye, moved to a new position

Question 7

What is resection type surgery for strabismus?

Answer 7

Section of muscle is removed to shorten the muscle–this lightens the muscle’s pull on the eye

Question 8

Immediate referral , or less emergent need for referral: Poor red reflex in one or both eye

Answer 8

Immediate

Question 9

Immediate referral , or less emergent need for referral: intermittent strabismus on exam

Answer 9

Less emergent

Question 10

Immediate referral , or less emergent need for referral: concern about vision by parent or dr

Answer 10

Immediate

Question 11

Immediate referral , or less emergent need for referral: asymmetric or diminishing VA

Answer 11

Immediate

Question 12

Immediate referral , or less emergent need for referral: associated syndromes or systemic disease

Answer 12

Less emergent

Question 13

Immediate referral , or less emergent need for referral: constant or acute-onset strabismus

Answer 13

Immediate

Question 14

True or false: amblyopia does not present without strabismus

Answer 14

False

Question 15

If there is a poor red reflex, or poor vision or large eyes, what must be r/o? (3)

Answer 15

Cataracts
Retinal disease
Glaucoma

Question 16

Premature infants less than 1250-1500 g should be examined how often for vision problems?

Answer 16

4 weeks and every 3 weeks until vessels to ora serrata

Question 17

Why are ocular s/sx so relevant to neuro?

Answer 17

Large portion of the brain is utilized for vision

Question 18

What is the role of the edinger Westphal nucleus?

Answer 18

is the parasympathetic pre-ganglionic nucleus that innervates the iris sphincter muscle and the ciliary muscle.

Question 19

What is the role of the pretectal nucleus?

Answer 19

a midbrain structure composed of seven nuclei and comprises part of the subcortical visual system.

It is involved primarily in mediating behavioral responses to acute changes in ambient light such as the pupillary light reflex, the optokinetic reflex, and temporary changes to the circadian rhythm

Question 20

Lesion to CN III produces what pupillary defect?

Answer 20

Dilation

Question 21

What are the s/sx of Adie’s tonic pupil?

Answer 21

• Blurred vision
• Periocular discomfort
• Decreased depth perception

Question 22

Which gender is usually affected with Adie’s tonic pupil?

Answer 22

Women

Question 23

What is the cause of Adie’s pupil?

Answer 23

damage to the postganglionic fibers of the parasympathetic innervation of the eye, usually by a viral or bacterial infection which causes inflammation, and affects the pupil of the eye and the autonomic nervous system

Question 24

What is the ganglion that CN III synapses in?

Answer 24

Ciliary ganglion

Question 25

How do you diagnose Adie's pupil?

Answer 25

Small dose pilocarpine. Normal pupil will not constrict, but affected pupils are hypersensitive

Question 26

What are the three major causes of unilateral small pupil?

Answer 26

- Physiologic anisocoria - Horner's syndrome - Argyll Robertson pupil

Question 27

What is the role of Mueller's muscle? Innervation?

Answer 27

Part of the levator superioris muscle CN III

Question 28

CN 7 defect has what effect on the eye?

Answer 28

Keeps the eye open

Question 29

CN 3 defect has what effect on the eye?

Answer 29

Closed

Question 30

What is the SNS innervation of the eye?

Answer 30

C8 ish area

Question 31

Why do Pancoast tumors cause Horner's syndrome?

Answer 31

Pathway of SNS goes beneath the subclavian

Question 32

How do you diagnose Horner's syndrome?

Answer 32

Apraclonidine (a2 agonist) reverses anisocoria brought about by cocaine

Question 33

What causes the darkening of the eyes as children age? What is the effect of Horner's syndrome on this process?

Answer 33

Sympathetic innervation Will decrease pigment deposition

Question 34

What is the MOA of clonidine on the eye?

Answer 34

Alpha 2 agonist--causes contraction of the dilator muscle

Question 35

What is Argyll Robertson pupil?

Answer 35

- Pupils accommodate, but do not react to light | - Pupils are irregular and small

Question 36

What causes Argyll Robertson pupil?

Answer 36

- Syphilis - DM retinopathy - Alcoholism

Question 37

What is checked with EOMs? (3)

Answer 37

- Diplopia - Paresis/palsy - Nystagmus

Question 38

Onset of diplopia during heavy exercise = ?

Answer 38

Aneurysm

Question 39

Onset of diplopia when fatigued = ?

Answer 39

MG

Question 40

Onset of diplopia when looking to the right?

Answer 40

CN VI od

Question 41

Onset of diplopia associated with HA or retro orbital pain = ?

Answer 41

Aneurysm

Question 42

What are the etiologies of CN III palsies?

Answer 42

- Intracranial aneurysms - Vascular dz - Trauma - Brain tumor

Question 43

What are the eye characteristics of CN III palsies?

Answer 43

- Abduction - Horizontal and vertical diplopia - Ptosis

Question 44

Why are vascular diseases that affect CN III pupil sparing?

Answer 44

Pupillary fibers are on the outside of the fiber, which means that they are the last affected with compromised blood supply

Question 45

What are the characteristic findings of CN palsies in terms of the cardinal eye movements?

Answer 45

LR is constantly active, thus will constantly look laterally

Question 46

New onset of R ptosis, exotropia, and hypotropia = ?

Answer 46

CN 3 palsy

Question 47

A pupil involved CN III palsy is a (__) until proven otherwise

Answer 47

Aneurysm or PCA

Question 48

What are the symptoms of IV CN palsy (type of diplopia and compensation)?

Answer 48

- Vertical oblique diplopia | - Compensatory head tilt to opposite shoulder

Question 49

What are the etiologies of CN IV palsies?

Answer 49

-Microvascular disease (DM, HTN)

Question 50

What are the symptoms of CN VI palsy?

Answer 50

- Loss of abduction | - Horizontal diplopia

Question 51

What are the etiologies of CN VI palsy? (2 nonobvious)

Answer 51

- Increased ICP | - Demyelinating dz

Question 52

How do you assess for CN V palsies?

Answer 52

Checking corneal sensitivity with cotton wisp

Question 53

How do you assess for CN VII palsy?

Answer 53

Checking for weakness in patient's smile or ability to close eye

Question 54

What are the ocular s/sx of MG?

Answer 54

Ptosis/diplopia - No pupil findings - Fatigability

Question 55

How do you diagnose MG?

Answer 55

Edrophonium

Question 56

How do you name Nystagmus?

Answer 56

Named by the fast movement

Question 57

What are the different types of nystagmus?

Answer 57

- Horizontal - Vertical rotatory - Combination

Question 58

What are the three major benign causes of nystagmus?

Answer 58

- End gaze - Drug induced - Congenital (blind)

Question 59

True or false: occlusion therapy will treat strabismus

Answer 59

False

Question 60

True or false: glasses therapy will treat strabismus

Answer 60

True for some forms of strabismus

Question 61

What are the extremity findings of Adie's syndrome?

Answer 61

Absent knee and ankle jerks

Question 62

What is the prognosis for Adie's pupil?

Answer 62

Benign

Question 63

Which CN injury will cause a vertical diplopia?

Answer 63

CN IV

Question 64

Which CN injury will cause a side-by-side diplopia?

Answer 64

CN VI