Peds

Question 1

The average axial length of the human eye in a newborn is __-__ mm. The majority of growth of the axial length occurs in the first year of life; it increases by __ mm in the first 6 months, and an additional 2 mm during the subsequent 6 months. Final axial length is reached between __ and __ years.

Answer 1

The average axial length of the human eye in a newborn is 14.5-15.5 mm. The majority of growth of the axial length occurs in the first year of life; it increases by 4 mm in the first 6 months, and an additional 2 mm during the subsequent 6 months. Final axial length is reached between 13 and 16 years.

Question 2

Chalazia are caused by blockage of the meibomian glands. Hordeola arise form from blocked ___ or ___ glands.

Answer 2

Chalazia are caused by blockage of the meibomian glands. Hordeola arise form from blocked eccrine or apocrine glands.

Question 3

Tenderness over the area of the ___ in the superonasal orbit may be seen in patients with acquired Brown syndrome, and symptoms are often worst when the globe is ___ and ___ on the affected side.

Answer 3

Tenderness over the area of the trochlea in the superonasal orbit may be seen in patients with acquired Brown syndrome, and symptoms are often worst when the globe is elevated and adducted on the affected side.

Question 4

What imaging tests should be obtained in a patient with morning glory disc anomaly? (2) What conditions are you screening for? (3)

Answer 4

MRI/MRA brain to rule out basal encephalocele, midface anomalies, Moyamoya disease

Question 5

What does PHACE stand for? What ocular condition is it associated with?

Answer 5

Posterior fossa abnormalities
Hemangioma
Arterial lesions
Cardiac abnormalities
Eye abnormalities

Morning glory disc anomaly

Question 6

Most common cause of glaucoma-like optic nerve cupping in preterm infants?

Answer 6

Periventricular leukomalacia (associated with premature birth).

The optic nerve cupping is a result of transsynaptic degeneration from bilateral lesions in the optic radiations. It presents as a large cup within a normal-sized optic disc, described as an unusual form of optic nerve hypoplasia.

Question 7

Exotropic Duane syndrome results from the abnormal development of the ___ nerve/nucleus. The result is anomalous innervation of the ___ rectus muscle by aberrant branches of ___ nuclei.

Answer 7

Exotropic Duane syndrome results from the abnormal development of the abducens nerve/nucleus. The result is anomalous innervation of the lateral rectus muscle by aberrant branches of oculomotor nuclei.

Much less common than esotropic (Type I) Duane syndrome

Question 8

Surgical treatment options for exotropic Duane syndrome include ___ rectus muscle ___ in one or both eyes. However, ___ rectus muscle ___ should be avoided because this procedure often worsens globe retraction.

Answer 8

Surgical treatment options include lateral rectus muscle recession in one or both eyes. However, medial rectus muscle resection should be avoided because this procedure often worsens globe retraction.

Question 9

The Congenital Esotropia Observational Study showed that when patients present with constant esotropia of at least __Δ after __ weeks of age, the deviations are unlikely to resolve spontaneously.

Answer 9

The Congenital Esotropia Observational Study showed that when patients present with constant esotropia of at least 40Δ after 10 weeks of age, the deviations are unlikely to resolve spontaneously.

Question 10

Hyperopia or astigmatism greater than ___ diopters suggests a refractive strabismus.

Answer 10

Hyperopia or astigmatism greater than +2.50 diopters suggests a refractive strabismus.

Question 11

An apparent abduction deficit may result from cross-fixation. The infant’s ability to abduct can be elicited by the ___ ___ ___ spinning the infant to stimulate the vestibulo-ocular reflex, or by ___ with either eye patched.

Answer 11

An apparent abduction deficit may result from cross-fixation. The infant’s ability to abduct can be elicited by the doll’s head maneuver, spinning the infant to stimulate the vestibulo-ocular reflex, or by observation with either eye patched.

Question 12

Causes of ophthalmia neonatorum and time of onset (4)

Answer 12

Chemical - first 24 hours
Gonorrhea - first 3-4 days
Chlamydia - first week
HSV - second week

Question 13

Genetic disorder most commonly associated with congenital iris ectropion

Answer 13

NF1

Question 14

Fusional convergence eliminates ___ retinal disparity and controls an ___. Fusional divergence eliminates ___ retinal disparity and controls an ___.

Answer 14

Fusional convergence eliminates bitemporal retinal disparity and controls an exophoria. Fusional divergence eliminates binasal retinal disparity and controls an esophoria.

Vertical fusional vergences are used to correct a hyperphoria.

Question 15

What is a useful clinical finding often seen with disc drusen versus true papilledema?

Answer 15

Anomalous branching of the large retinal vessels over the disc

Question 16

For acquired esotropia, the maximal angle of strabismus and fusional potential can be assessed by what test?

Answer 16

Prism adaptation: patient fitted with prisms to induce orthophoria and reexamined every 1-2 weeks, and the prism correction is increased until a stable amount of prism to achieve orthophoria is found.

Question 17

How can lymphatic malformations of the orbit present? When do exacerbations tend to occur? How are they managed?

Answer 17

Lymphatic malformations of the orbit may present with sudden proptosis caused by spontaneous intralesional hemorrhage. Exacerbations tend to occur during upper respiratory tract infections and can be managed with a short course of systemic corticosteroids. Surgical intervention is deferred unless vision is affected.

Question 18

Interpupillary distance, if large, can result in ___.

Answer 18

Interpupillary distance, if large, can result in pseudoexotropia.

Question 19

Most common retinal finding in patient with morning glory disc anomaly?

Answer 19

Retinal detachment (up to 30%!)

Question 20

Neurofibromatosis (1 and 2) shows ___ ___ inheritance. However, about __% of patients do not have a family history of the disease, reflecting the high rate of new mutations in the responsible gene.

Answer 20

Neurofibromatosis (1 and 2) shows autosomal dominant inheritance. However, about 50% of patients do not have a family history of the disease, reflecting the high rate of new mutations in the responsible gene.

Question 21

3 conditions with findings of intraocular cartilage

Answer 21

Patau syndrome (trisomy 13), medulloepitheliomas, PFV

Question 22

Surgical approaches to DVD if small-moderate, large, and in association with IOOA (3)

Answer 22

Large superior rectus muscle recessions

If residual, inferior rectus muscle resection or plication

If also IOOA, inferior oblique muscle anterior transposition/anteriorization

Question 23

Surgical treatment of IOOA without DVD

Answer 23

Inferior oblique myectomy

Question 24

The nerves to the rectus muscles and the superior oblique muscle enter the muscles approximately ___ of the distance from the origin to the insertion (or trochlea). An instrument thrust more than __ mm posterior to a rectus muscle’s insertion may cause injury to the nerve.

Answer 24

The nerves to the rectus muscles and the superior oblique muscle enter the muscles approximately one-third of the distance from the origin to the insertion (or trochlea). An instrument thrust more than 25 mm posterior to a rectus muscle’s insertion may cause injury to the nerve.

Question 25

Searching nystagmus suggests that the child has worse than ___ vision. Pendular nystagmus typically occurs in patients with visual acuity better than ___ in at least 1 eye. Jerk nystagmus often is associated with visual acuity between ___ and ___.

Answer 25

Searching nystagmus suggests that the child has worse than 20/200 vision. Pendular nystagmus typically occurs in patients with visual acuity better than 20/200 in at least 1 eye. Jerk nystagmus often is associated with visual acuity between 20/60 and 20/100.

Question 26

What test can be used to determine potential for postoperative single binocular vision?

Answer 26

Amblyoscope Tests fusional potential, retinal correspondence, detect suppression, measure primary/secondary deviations and suppression scotomas

Question 27

What is the earliest sign of anterior segment ischemia following strabismus surgery?

Answer 27

AC cell and flare Can also see corneal edema, irregular pupil

Question 28

How does postoperative steroid treatment in pediatric cataract surgery patients with IOL placement compare to treatment in those without IOL placement?

Answer 28

Patients with an IOL require more aggressive steroid treatment postoperatively compared to patients without an IOL

Question 29

How might leukemia present in advanced stages? (orbital manifestation)

Answer 29

Unilateral or bilateral proptosis Chloroma (also known as granulocytic sarcoma or myeloid sarcoma) is a rare extramedullary variant of myelogenous leukemia that can develop as the sole manifestation of relapse after apparently successful treatment of AML

Question 30

What are 3 causes of acquired Brown syndrome, and what work-up should be considered?

Answer 30

Local trauma to the region of the trochlea, systemic inflammatory conditions, sinusitis CT scan should be considered

Question 31

Positive angle kappa occurs when the fovea is usually slightly ___ to the pupillary axis, making the corneal light reflection slightly ___ to the center of the cornea.

Answer 31

Positive angle kappa occurs when the fovea is usually slightly temporal to the pupillary axis, making the corneal light reflection slightly nasal to the center of the cornea. This causes a pseudoexotropia, e.g. foveal dragging in ROP.

Question 32

Congenital stationary night blindness is a group of hereditary conditions (___ most common form) causing ___ dysfunction.

Answer 32

Congenital stationary night blindness is a group of hereditary conditions (X-linked most common form) causing rod dysfunction, resulting in night blindness and electronegative dark-adapted ERG (large a-wave with reduced b-wave).

Question 33

How do patients with CSNB typically present? How might those with the X-linked form differ?

Answer 33

Patients typically present in infancy with nystagmus and a normal appearing fundus. The X-linked form is the most common, and presents with myopic tilt and temporal pallor.

Question 34

Compare and contrast iris stromal cysts from cysts of the iris pigment epithelium (pathogenesis and presentation)

Answer 34

Iris stromal cysts: enlarging congenital lesions caused by sequestration of epithelial tissues during embryogenesis. May cause visual obstruction, glaucoma, and corneal decompensation. Cysts of the iris pigment epithelium: caused by separation of the 2 layers of the iris pigment epithelium, not by sequestration of tissue. They typically are stable and do not usually cause clinical complications.

Question 35

What does CHARGE syndrome stand for, and what ocular finding is it associated with?

Answer 35

C – Coloboma of the eye (iris and CB colobomas), CNS anomalies H – Heart defects A – Atresia of the choanae R – Retardation of growth and/or development G – GU defects E – Ear anomalies (bowl-shaped and concave ears, known as "lop ears")

Question 36

What are the steps of the 3-step test? What is this test used for?

Answer 36

(1) hypertropic eye with distance fixation (2) misalignment worse in left or right gaze (3) misalignment worse in left or right head tilt Used to identify which paralytic muscle is causing cyclovertical strabismus

Question 37

The 3-step test does not work with patients who have had ___ ___ surgery, have a ___ disease, or have ___ syndrome.

Answer 37

The 3-step test does not work with patients who have had previous strabismus surgery, have a restrictive disease (such as thyroid eye disease), or have Brown syndrome.

Question 38

___ ___, disconjugate eye movements, and ___ ___ deviation of both eyes can be noted in healthy newborns but should not persist beyond __ months of age.

Answer 38

Skew deviation, disconjugate eye movements, and tonic downward deviation of both eyes (sunsetting) can be noted in healthy newborns but should not persist beyond 4 months of age.

Question 39

Signs of poor visual development include ___ eye movements, lack of response to ___ ___, ___, and forceful rubbing or poking of the eyes.

Answer 39

Signs of poor visual development include searching eye movements, lack of response to familiar faces/objects, nystagmus, and forceful rubbing or poking of the eyes (oculodigital reflex).

Question 40

What distinguishes type 1 Duane from 6th nerve palsy?

Answer 40

Limited adduction of affected eye

Question 41

The ___ ___ is the primary anatomical site affected in the development of amblyopia.

Answer 41

The visual cortex is the primary anatomical site affected in the development of amblyopia.

Question 42

___ ___ or ___ ___ would be associated with the sensation of a soft stop while probing.

Answer 42

Lacrimal tumor or canalicular obstruction would be associated with the sensation of a soft stop while probing.

Question 43

Paradoxical pupils, a pupillary constriction in response to darkness, are most commonly associated with ___ ___, although they can occur with ___ ___.

Answer 43

Paradoxical pupils, a pupillary constriction in response to darkness, are most commonly associated with retinal dystrophies, although they can occur with optic neuropathies.

Question 44

Delayed visual maturation is the condition wherein normal visual ___ and ___ do not develop in an infant within the first __ months of life.

Answer 44

Delayed visual maturation is the condition wherein normal visual fixation and tracking do not develop in an infant within the first 3 months of life.

Question 45

Cortical or cerebral visual impairment is a condition in which visual deficits result from pathology posterior to the ___ ___ ___.

Answer 45

Cortical or cerebral visual impairment is a condition in which visual deficits result from pathology posterior to the lateral geniculate nucleus.

Question 46

What is the inheritance pattern for most patients with primary congenital glaucoma?

Answer 46

Sporadic

Question 47

Craniosynostosis characterized by clover leaf skull

Answer 47

Pfeiffer syndrome

Question 48

Clinical findings of the 3 types of Duane syndrome

Answer 48

Type 1: most common form, poor abduction and esotropia, narrowing of palpebral fissure on attempted adduction Type 2: limited adduction and exotropia Type 3: poor abduction and adduction; either esotropia or exotropia may result

Question 49

The 2 strongest risk factors for ROP are ___ ___ and ___ ___.

Answer 49

The 2 strongest risk factors for ROP are gestational age and birth weight.

Question 50

Optic neuritis in children, in contrast with that in adults, is more frequently ___ and associated with ___ ___.

Answer 50

Optic neuritis in children, in contrast with that in adults, is more frequently bilateral and associated with disc edema.

Question 51

Congenital anomalies: Agenesis is a developmental ___ Hypoplasia is a developmental ___ Hyperplasia is developmental ___ Dysraphia is a failure to ___

Answer 51

Agenesis is a developmental failure (anophthalmos). Hypoplasia is a developmental arrest (optic nerve hypoplasia). Hyperplasia is developmental excess (distichiasis) Dysraphia is a failure to fuse (choroidal coloboma). Others: Failure to divide or canalize: congenital NLDO Persistence of vestigial structures: PFV

Question 52

___, ___, and ___ constitute the classical clinical triad of primary congenital glaucoma.

Answer 52

Epiphora, photophobia, and blepharospasm constitute the classical clinical triad of primary congenital glaucoma.

Question 53

What is the basic pathologic defect of congenital glaucoma?

Answer 53

Increased re­sis­tance to aqueous outflow through the trabecular meshwork due to abnormal development of neural crest–­derived tissue of the anterior chamber ­angle

Question 54

What are the secondary diagnostic positions?

Answer 54

Straight up, straight down, right gaze, left gaze

Question 55

What are the tertiary diagnostic positions?

Answer 55

Up and right, up and left, down and right, down and left, right and left head-tilt

Question 56

What feature of morning glory disc anomaly differentiates it from optic disc coloboma?

Answer 56

Increased number of blood vessels coming off the disc

Question 57

Y pattern strabismus (pseudo-overaction of the inferior obliques) results from aberrant innervation of the ___ ___ muscles in ___.

Answer 57

Y pattern strabismus (pseudo-overaction of the inferior obliques) results from aberrant innervation of the lateral rectus muscles in upgaze. (There is no fundus torsion, no difference in vertical deviation on head tilt, and no superior oblique underaction.)

Question 58

X patterns are usually associated with ___ and ___ in ___.

Answer 58

X patterns are usually associated with overelevation and overdepression in adduction.

Question 59

What is Panum's area?

Answer 59

Space within which objects that fall on disparate retinal points are seen singly

Question 60

What are conditions associated with these nystagmus syndromes? - Fusional maldevelopment nystagmus - Congenital vertical nystagmus - Periodic alternating nystagmus (2) - See-saw nystagmus

Answer 60

Fusion maldevelopment nystagmus (latent): infantile esotropia Congenital vertical nystagmus: inherited retinal dystrophies Periodic alternating nystagmus: albinism and Arnold-Chiari malformation See-saw nystagmus: rostral midbrain lesion such as a craniopharyngioma

Question 61

When is an A pattern considered clinically significant? V pattern?

Answer 61

A pattern: difference in measurement between upgaze and downgaze is at least 10 prism diopters V pattern: difference at least 15 prism diopters

Question 62

What structures do Leber congenital amaurosis affect? What ancillary testing would you obtain, and what do you expect it to show?

Answer 62

Leber congenital amaurosis is a group of hereditary retinal dystrophies that affect both the rod and cone photoreceptors. An ERG typically shows extinguished waveforms.

Question 63

Wedge-shaped cortical cataract is ___ or associated with occult ___ ___ ___, previous ___ ___, or retinal ___.

Answer 63

Wedge-shaped cortical cataract is idiopathic or associated with occult posterior segment tumor, previous blunt trauma, or retinal coloboma.

Question 64

Ocular findings in Goldenhar syndrome can include ___ ___, ___, upper eyelid coloboma, iris abnormalities, and corneal ___.

Answer 64

Ocular findings in Goldenhar syndrome can include Duane syndrome, microphthalmia, upper eyelid coloboma, iris abnormalities, and corneal hypoesthesia.

Question 65

Indications for NLD probing in congenital NLDO (3)

Answer 65

(1) NLDO that fails to resolve with age and conservative treatment (2) Dacryocystocele in the newborn that is unresponsive to massage (3) Previously failed NLD probing procedure

Question 66

Ocular motor recordings in patients with: - Infantile nystagmus syndrome - Latent nystagmus

Answer 66

Infantile nystagmus syndrome: accelerating slow phase (diagnostic) Latent nystagmus: 2 types of slow phases, linear and decelerating

Question 67

3 major classification categories of visual dysfunction in infants and children

Answer 67

(1) Delayed visual maturation (2) Pregeniculate visual impairment (pathology anterior to LGN) (3) Retrogeniculate visual impairment (pathology posterior to LGN), aka cerebral visual impairment

Question 68

Most frequent cause of childhood visual impairment in developed countries

Answer 68

Retrogeniculate visual impairment (amblyopia considered a cause of this)

Question 69

Origins of: - Superior oblique - Inferior oblique - Remaining extraocular muscles

Answer 69

Superior oblique: structural origin is orbital apex above the annulus of Zinn. Functional origin is the trochlea Inferior oblique: orbital rim Remaining extraocular muscles: annulus of Zinn

Question 70

What is the difference between hypertelorism and exorbitism?

Answer 70

Hypertelorism is the excessive distance between the medial orbital walls and is detected radiographically. Exorbitism is prominent eyes due to shallow orbits or an increased angle of divergence of the orbital walls.

Question 71

In ___, the skull is long in anterior-posterior axis and narrow bitemporally, usually from premature closure of the ___ suture.

Answer 71

In scaphocephaly, the skull is long in anterior-posterior axis and narrow bitemporally, usually from premature closure of the sagittal suture.

Question 72

Patients with infantile esotropia have asymmetric smooth pursuit, which is better in the ___-to-___ direction.

Answer 72

Patients with infantile esotropia have asymmetric smooth pursuit, which is better in the temporal-to-nasal direction.

Question 73

What distinguishes congenital fibrosis syndrome from CPEO?

Answer 73

Progressive loss of EOM over time with CPEO

Question 74

Distinguish clinical optic nerve appearances of: - Dominant optic atrophy - Leber hereditary optic neuropathy - Optic nerve hypoplasia

Answer 74

Dominant optic atrophy: temporal pallor with an area of triangular excavation LHON: peripapillary telangiectasia ONH: yellow peripapillary halo with a ring of pigmentation

Question 75

If restriction persists after the repair of the orbital floor and release of the entrapped muscle, ___ of the restricted muscle is the next step.

Answer 75

If restriction persists after the repair of the orbital floor and release of the entrapped muscle, recession of the restricted muscle is the next step.

Question 76

DVD should be treated if it manifests frequently during the day and is noticeable (__ to __ prism diopters).

Answer 76

DVD should be treated if it manifests frequently during the day and is noticeable (6 to 8 prism diopters).

Question 77

``` Demographic and epidemiologic characteristics of pediatric uveitis: slight ___ (male/female) preponderance, mostly ___ (unilateral/bilateral), age __-__ at diagnosis, ___ (yes/no) family history ```

Answer 77

Slight female preponderance, mostly bilateral, age 8–9 at diagnosis, no family history

Question 78

Patients with pseudoxanthoma elasticum have a higher incidence of what optic nerve abnormality?

Answer 78

Disc drusen

Question 79

___ of the lateral rectus muscle is the preferred surgical therapeutic option for upshoots and downshoots in patients with Duane syndrome.

Answer 79

Y-splitting of the lateral rectus muscle is the preferred surgical therapeutic option for upshoots and downshoots in patients with Duane syndrome.

Question 80

Latent nystagmus is a ___, ___ jerk nystagmus that reverses direction with change in fixation. A ___ jerk nystagmus occurs with when the right eye is covered, and a ___ jerk occurs when the left is covered.

Answer 80

Latent nystagmus is a conjugate, horizontal jerk nystagmus that reverses direction with change in fixation. A left jerk nystagmus occurs with when the right eye is covered, and a right jerk occurs when the left is covered.

Question 81

Extorsion of __ degrees or more in downgaze, or more than __ degrees of extorsion in primary position is highly suggestive of bilateral superior oblique palsies.

Answer 81

Extorsion of 10° or more in downgaze, or more than 15° of extorsion in primary position is highly suggestive of bilateral superior oblique palsies.

Question 82

Ocular abnormalities in fetal alcohol syndrome (6)

Answer 82

``` Short palpebral fissures Telecanthus Strabismus (esotropia) Ptosis Optic nerve hypoplasia (uni- or bilateral) Retinal vascular tortuosity ```

Question 83

Searching eye movements and variable visual attentiveness with normal exam suggest ___ ___ ___.

Answer 83

Searching eye movements and variable visual attentiveness with normal exam suggest cerebral visual impairment.

Question 84

Inheritance of ectopia lentis et pupillae

Answer 84

Autosomal recessive

Question 85

Surgical approach for infantile esotropia (V-pattern esotropia and dissociated vertical deviation)

Answer 85

Bilateral medial rectus recessions and inferior oblique recessions

Question 86

Inheritance of oculocutaneous albinism? Ocular albinism?

Answer 86

Autosomal recessive; X-linked recessive

Question 87

Surgical approach for right superior oblique palsy

Answer 87

Right inferior oblique recession (lessens right hypertropia most effectively because worse in left gaze) Right inferior rectus resection can be considered, but not as effective because deviation is worst in gaze up and left

Question 88

Weakening procedures for superior oblique muscle

Answer 88

Tenotomy, tenectomy, split-tendon lengthening, spacer, recession

Question 89

To test for horizontal deviation using the Maddox rod, what direction should cylinders be oriented in front of right eye? What does the patient see, and what are the possible findings?

Answer 89

Horizontally (180 degrees) Patient sees vertical line with right eye, point source of light with left eye If point is right of line, exodeviation If point is left of line, esodeviation

Question 90

Most common strabismus associated with craniosynostosis

Answer 90

V-pattern exotropia

Question 91

Most common inheritance pattern for isolated congenital cataracts

Answer 91

Autosomal dominant

Question 92

What is the course and prognosis of juvenile xanthogranuloma?

Answer 92

Self-limited; resolves spontaneously by the age of 5 years old

Question 93

What muscles are supplied by the medial muscular branch of the ophthalmic artery?

Answer 93

Medial rectus, inferior rectus, inferior oblique

Question 94

What muscles are supplied by the lateral muscular branch of the ophthalmic artery?

Answer 94

Lateral rectus, superior rectus, superior oblique, levator palpebrae superioris

Question 95

At what age should an infant maintain fixation and react with facial expressions?

Answer 95

6-8 weeks

Question 96

What family of disorder is Bardet-Biedl syndrome?

Answer 96

Ciliopathy (retinal degeneration, renal disease, cerebral anomalies)

Question 97

Most common age for onset of accommodative esotropia

Answer 97

1-3 years

Question 98

What material are extraocular muscle pulleys primarily made of?

Answer 98

Elastin

Question 99

What feature characterises central fusion disruption?

Answer 99

Misalignment of visual axes and intractable diplopia

Question 100

What eye movement abnormality can occur in healthy infants in the first months of life?

Answer 100

Intermittent esotropia

Question 101

Prevalence of amblyopia in the North American population

Answer 101

2-4%

Question 102

Following congenital cataract surgery, what finding predisposes a child to glaucoma?

Answer 102

Small corneal diameter (micro cornea, persistent fetal vasculature)

Question 103

Clinical findings of Brown syndrome (4)

Answer 103

Limited elevation in adduction that improves in abduction but not completely, adduction causes widening of the palpebral fissure and downshoot of the involved eye, hypotropia of the involved eye in primary, V pattern due to divergence on upgaze from tight superior obliques

Question 104

Work-up and management of Brown syndrome

Answer 104

Positive forced duction testing confirms diagnosis May be congenital or acquired, constant or intermittent. Work up acquired cases with CT scan. Management can be medical and/or surgical. May also spontaneously resolve.

Question 105

Most common finding in patients with congenital rubella? Visual prognosis?

Answer 105

Bilateral pigmentary retinopathy Good if no cataract, microphthalmia, or glaucoma

Question 106

Weakening procedure for inferior oblique

Answer 106

Anterior transposition or anteriorization

Question 107

How can you preserve the torsional action of the superior oblique when doing a weakening procedure?

Answer 107

Tenotomy of only the posterior 75%–80% of the tendon to preserve torsion, which is controlled by the most anterior tendon fibers

Question 108

Lymphocytic choriomeningitis virus can cause severe ___ infections, and is transmitted via exposure to ___. Ocular findings include ___ and ___ ___ scarring.

Answer 108

Lymphocytic choriomeningitis virus can cause severe congenital infections, and is transmitted via exposure to rodents. Ocular findings include macular and chorioretinal peripheral scarring (similar in morphology and distribution to that of congenital toxoplasmosis).

Question 109

What is the primary purpose of the 4-diopter base-out prism test?

Answer 109

To document a facultative scotoma in a patient with no manifest deviation

Question 110

What is anomalous retinal correspondence? How is this an adaptation?

Answer 110

Anomalous retinal correspondence is a condition where the fovea of the fixating eye has acquired an anomalous common visual direction with a peripheral retinal element in the deviating eye. It is an adaptation that restores some degree of binocular cooperation despite manifest strabismus.