Neuromuscular Deviations

Question 1

Split

Infancy Ocular Instability

Answer 1

variable, transient, intermittent angle strabismus
2-3 months
resolves in 4 months
only a problem if tropia persists or is large and constant

Question 2

Esophoria

Answer 2

inward latent deviation controlled by fusional vergences

Question 3

Esotropia

Answer 3

inward manifest deviation not controlled by fusional vergences

Question 4

Pseudoesotropia

Answer 4

appearance of ET when eyes are straight

norm in kids with flat nose bridges and prominent epicanthal folds and small PD

Question 5

Congenital ET

Answer 5

first 6 months
large constant esotropia
may have cross fixation
>30pd

Question 6

Other findings of Congenital ET

Answer 6

amblyopia
A/V pattern
DVD- both eyes hyper
OIO- overactive
nystagmus
head posturing

Question 7

Managing Congenital ET

Answer 7

glasses/ bifocals/ prism
patch
VT
surgery
botox

Question 8

Accommodative Esotropia

Answer 8

associated with accommodative reflex
starts intermittent but can become constant
often hereditary

Question 9

Onset of Accommodative ET

Answer 9

6 mo to 7 yrs

Question 10

Refractive Accommodative ET

Answer 10

from uncorrected high hyperopia (forces accom) and insufficient fusional vergence to diverge

Question 11

Deviation of Refractive Accommodative ET

Answer 11

20-35pd

intermittent, alternating with asthenopia

Question 12

Refractive Accommodative ET refraction

Answer 12

+3.00 to +6.00

amblyopia if greater

Question 13

Managing Refractive Accommodative ET

Answer 13

cycloplegic refraction (2 drops)
Full correction
VT

Question 14

Non-Refractive Accommodative Esotropia

Answer 14

from high AC/ A
insufficient vergence to diverge
greater at N

Question 15

AC/ A Fromula

Answer 15

Absolute change / absolute change in accommodation

Question 16

Managing Non-Refractive Accommodative Esotropia

Answer 16

bifocals- seg height bisects pupil

Question 17

Mixed Accommodative Esotropia

Answer 17

some refractive and some nonrefractive issues

high hyperope w/ high AC/A

Question 18

Managing Mixed Accommodative Esotropia

Answer 18

full hyperopic correction

only do surgery if did not start wearing glasses early enough

Question 19

Partially Accommodative Esotropia

Answer 19

accommodation contributes to but does not completely cause deviation
after delayed treatment- did not start glasses early enough
reduced angle but ET still present- constant, unilateral

Question 20

Early Onset Non-Accommodative Esotropia

Answer 20

6 mo to 2 yrs
same as congenital but starts later
no accomm or hyperopic issue

Question 21

Managing Early Onset Non-Accommodative Esotropia

Answer 21

glasses, bifocals/ prisms
VT
surgery
neuro possibilities

Question 22

Acute Acquired Esotropia

Answer 22

comitant
3-5 yrs
from illness, stress, aging

Question 23

What should be ordered in an acute acquired esotropia?

Answer 23

neuro evaluation

Question 24

Sensory Esotropia

Answer 24

from vision loss in one eye from pathology
constant unilateral
10-45pd

Question 25

Managing Sensory Esotropia

Answer 25

eliminate pathology poly lenses treat secondary amblyopia

Question 26

Divergence Insufficiency Esotropia

Answer 26

non-accommodative greater at distance than near adults diplopia

Question 27

Managing Divergence Insufficiency Esotropia

Answer 27

Neuro referral

Question 28

Consecutive ET

Answer 28

Esodeviation after exo corrective surgery

Question 29

Exophoria

Answer 29

outward deviation controlled by fusional vergences

Question 30

Exotropia

Answer 30

outward manifest deviation

Question 31

Pseudoexotropia

Answer 31

eyes are straight but appears XT | from wide PD

Question 32

Divergence Excess Exotropia

Answer 32

larger in distance | kids

Question 33

Basic XT

Answer 33

same at distance and near | in adults

Question 34

Convergence Insufficiency XT

Answer 34

larger at near | in adults

Question 35

Intermittent Exotropia

Answer 35

sometimes latent and sometimes manifest before 5 yrs occurs later in day or with fatigue

Question 36

Bright Light and Intermittent Exotropia

Answer 36

reflex closure of one eye

Question 37

Good Control of Intermittent XT

Answer 37

only manifests on CT, resumes frequency quickly | will have good steropsis and normal retinal correspondence

Question 38

Fair Control of Intermittent XT

Answer 38

trope on CT, fusion regained after blinking or refixating

Question 39

Poor Control of Intermittent XT

Answer 39

XT manifests spontaneously and for extended period of time

Question 40

Managing Intermittent XT

Answer 40

glasses for large refractive issues mild myopic can make deviation better (converge) mild hyperopic can make deviation worse (diverge) patching/ VT surgery

Question 41

Convergence Insufficiency Exotropia

Answer 41

greater at near | low AC/A

Question 42

Symptoms of Convergence Insufficiency XT

Answer 42

asthenopia, diplopia, blurred near vision

Question 43

Managing Convergence Insufficiency XT

Answer 43

VT | BI reading glasses

Question 44

Constant XT

Answer 44

in older patients w/ sensory XT or with longstanding XT

Question 45

Managing Constant XT

Answer 45

surgery

Question 46

Congenital XT

Answer 46

large, constant angle (30- 80pd) likely to have neurological issues or craniofacial disorders poor adduction

Question 47

Managing Congenital XT

Answer 47

surgery

Question 48

Sensory Exotropia

Answer 48

any condition that causes vision loss in one eye poor VA constant and unilateral

Question 49

Consecutive Exotropia

Answer 49

post surgery | can occur after months or years of surgery