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Flashcards in Lecture IX Deck (64):
1

How long does occlusion therapy last for in children?

Must be continued through the patient's first decade

2

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

Amblyopia, since need to have good vision to affect strabismus

3

What is the advantage of atropine therapy?

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

4

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

Treat amblyopia before EOM surgery

5

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

No proven value

6

What is recession type surgery for strabismus?

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

7

What is resection type surgery for strabismus?

Section of muscle is removed to shorten the muscle--this lightens the muscle's pull on the eye

8

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

Immediate

9

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

Less emergent

10

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

Immediate

11

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

Immediate

12

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

Less emergent

13

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

Immediate

14

True or false: amblyopia does not present without strabismus

False

15

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

Cataracts
Retinal disease
Glaucoma

16

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

4 weeks and every 3 weeks until vessels to ora serrata

17

Why are ocular s/sx so relevant to neuro?

Large portion of the brain is utilized for vision

18

What is the role of the edinger Westphal nucleus?

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

19

What is the role of the pretectal nucleus?

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

20

Lesion to CN III produces what pupillary defect?

Dilation

21

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

-Blurred vision
-Periocular discomfort
-Decreased depth perception

22

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

Women

23

What is the cause of Adie's pupil?

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

24

What is the ganglion that CN III synapses in?

Ciliary ganglion

25

How do you diagnose Adie's pupil?

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

26

What are the three major causes of unilateral small pupil?

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

27

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

Part of the levator superioris muscle

CN III

28

CN 7 defect has what effect on the eye?

Keeps the eye open

29

CN 3 defect has what effect on the eye?

Closed

30

What is the SNS innervation of the eye?

C8 ish area

31

Why do Pancoast tumors cause Horner's syndrome?

Pathway of SNS goes beneath the subclavian

32

How do you diagnose Horner's syndrome?

Apraclonidine (a2 agonist) reverses anisocoria brought about by cocaine

33

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

Sympathetic innervation

Will decrease pigment deposition

34

What is the MOA of clonidine on the eye?

Alpha 2 agonist--causes contraction of the dilator muscle

35

What is Argyll Robertson pupil?

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

36

What causes Argyll Robertson pupil?

-Syphilis
-DM retinopathy
-Alcoholism

37

What is checked with EOMs? (3)

-Diplopia
-Paresis/palsy
-Nystagmus

38

Onset of diplopia during heavy exercise = ?

Aneurysm

39

Onset of diplopia when fatigued = ?

MG

40

Onset of diplopia when looking to the right?

CN VI od

41

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

Aneurysm

42

What are the etiologies of CN III palsies?

-Intracranial aneurysms
-Vascular dz
-Trauma
-Brain tumor

43

What are the eye characteristics of CN III palsies?

-Abduction
-Horizontal and vertical diplopia
-Ptosis

44

Why are vascular diseases that affect CN III pupil sparing?

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

45

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

LR is constantly active, thus will constantly look laterally

46

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

CN 3 palsy

47

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

Aneurysm or PCA

48

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

-Vertical oblique diplopia
-Compensatory head tilt to opposite shoulder

49

What are the etiologies of CN IV palsies?

-Microvascular disease (DM, HTN)

50

What are the symptoms of CN VI palsy?

-Loss of abduction
-Horizontal diplopia

51

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

-Increased ICP
-Demyelinating dz

52

How do you assess for CN V palsies?

Checking corneal sensitivity with cotton wisp

53

How do you assess for CN VII palsy?

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

54

What are the ocular s/sx of MG?

Ptosis/diplopia
-No pupil findings
-Fatigability

55

How do you diagnose MG?

Edrophonium

56

How do you name Nystagmus?

Named by the fast movement

57

What are the different types of nystagmus?

-Horizontal
-Vertical rotatory
-Combination

58

What are the three major benign causes of nystagmus?

-End gaze
-Drug induced
-Congenital (blind)

59

True or false: occlusion therapy will treat strabismus

False

60

True or false: glasses therapy will treat strabismus

True for some forms of strabismus

61

What are the extremity findings of Adie's syndrome?

Absent knee and ankle jerks

62

What is the prognosis for Adie's pupil?

Benign

63

Which CN injury will cause a vertical diplopia?

CN IV

64

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

CN VI