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Orthoptics Year 3 > Revision > Flashcards

Revision Flashcards

(97 cards)

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1
Q

What are the typical tests in order, in an orthoptic assessment?

A

VA nr + dis (s glss/c glss), CT nr + dis (s glss/c glss) + NPC (near point convergence), PCT nr + dis (s glss/c glss), PFR nr + dis (s glss), Frisby, OM (S GLSS !!!)

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2
Q

What are the normal ranges for PFR?

A

NR PFR c gls : 35-45 BO -> 15 BI
DIS PFR c gls : 15 BO -> 8 BI
(Adults)

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3
Q

Where do the rectus muscles originate?

A

From the Annulus of Zinn, which encircles the optic foramen and the medial portion of the superior orbital fissure.

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4
Q

Where does the medial rectus originate?

A

Originates at the orbital apex from the medial portion of the Annulus of Zinnin close contact with the optic nerve.

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5
Q

Where is the medial rectus inserted?

A

5.5mm from the limbus

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6
Q

what is the width of the insertion of the medial rectus muscle?

A

10.5mm

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7
Q

What innervates the medial rectus muscle?

A

inferior division of the 3rd cranial nerve (oculomotor nerve)

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8
Q

what is the function of the medial rectus?

A

Adduction

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9
Q

where does the lateral rectus originate?

A

muscle arises by two heads from the upper and lower portions of the annulus of zinn where it bridges the superior orbital fissure.

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10
Q

Where is the insertion of lateral rectus?

A

7mm from the limbus

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11
Q

What is the width of the lateral rectus muscle insertion ?

A

9.5mm

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12
Q

What nerve innervates the lateral rectus?

A

CN 6 (VI) - abducens nerve , which enters from bulbar side

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13
Q

what is the function of the lateral rectus muscle?

A

Abduction

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14
Q

Where does the superior rectus muscle originate?

A

The muscle arises from the superior position of the Annulus of Zinn (in close contact with levator muscle)

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15
Q

Where is the insertion of the superior rectus muscle?

A

7.7mm from limbus

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16
Q

what is the width of the insertion of the superior rectus muscle?

A

11mm

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17
Q

What nerve innervates the superior rectus muscle?

A

CN3 (oculomotor nerve) superior division (enters muscle on bulbar side).

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18
Q

What are the functions of the Superior Rectus Muscle?

A

Elevation, intorsion and adduction

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19
Q

Where does the inferior rectus muscle originate?

A

The muscle arises from the inferior portion of the Annulus of Zinn

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20
Q

Where does the inferior rectus muscle insert?

A

6.5mm from the limbus

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21
Q

what is the width of the inferior rectus muscle as it inserts?

A

10mm

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22
Q

What nerve innervates the inferior rectus muscle?

A

CN3 (oculomotor nerve) inferior division (enters on bulbar side)

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23
Q

What are the functions of the inferior rectus muscle?

A

depression, extorsion and adduction

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24
Q

Where does the superior oblique originate?

A

From the orbital apex from the periosteum of the body of the sphenoid bone, medial and superior to the optic foramen.

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25
Where is the Superior oblique inserted?
It passes beneath the superior rectus and inserts on the upper temporal quadrant of the globe ventral to the superior rectus.
26
What is the width of the insertion of the superior oblique?
Its insertion is fanned out in a curved line 10-12mm in length
27
What nerve innervates the superior oblique?
CN IV (4) - trochlear nerve , enters muscle on its upper surface
28
What are the functions of the superior oblique?
intorsion, depression and abduction
29
Where does the inferior oblique muscle originate?
Arises from the floor of the orbit from the periosteum covering the anteromedial portion of the maxilla bone.
30
Where does the inferior oblique insert?
It crosses the inferior rectus and curves upwards around the globe to insert under the lateral rectus just anterior to the macular area
31
What innervates the inferior rectus muscle?
inferior division of the 3rd CN nerve (oculomotor) enters muscle on bulbar surface
32
what are the functions of the inferior rectus?
extorsion, elevation and abduction
33
Herrings law
(equal innervation) nerve impulse sent to muslce to contract, equal nerve impulse to contralateral synergist so both eyes move along paralel axis (RLR + LMR contract & RMR + LLR relax)
34
Sherringtons Law
(reciprocal innervation) nerve impulse sent to muscle to contract, decreased signal sent to direct antagonist to relax equal amount (RLR + RMR)
35
agonist
primary muscle moving in given primary direction
36
synergist
muscle from same eye help move eye in same direction as agonist (RSR + RSO for dextro elevation) "yolk muscles"
37
antagonist
opposite direction of agonist (muscle relaxing) (RMR +RLR)
38
contralateral synergist
contralateral = opposite eye, muscle moving in same direction in opp eye, RLR agonist = LMR contralateral synergist to look right
39
underaction of muscle on cover test
eye goes up on CT to fixate on light becuase undershoot
40
overaction of muscle on covertest
eye goes down on CT to fixate on light because overshot
41
what does mechanical restriction mean?
not neurogenic, other muscles not compensating
42
what are muscles in postions in RE
RSR (dextro elevation) RLR (dextroversion) RIR (dextro depression) (RIO laevo elevation) RMR (laveoversion) RSO (laevodepression)
43
what are muscle postions in LE
LIO (dextro elevation) LMR (dextroversion) LSO (dextro depression) LSR (laevo elevation) LLR (laveoversion) LIR (laevodepression)
44
acronym for muscles
S (IO) (IO) S L M M L I (SO) (SO) I
45
Common concerns in kids with eye problems
-blurred vision, eye related pain/discomfort (older kids), failed V screening, turned eye (squint), difficulty with school work
46
History and note taking of px
-age of onset of symptoms (earlier = more hard to return back to normal VA) -frequency of symptoms -time of occurrence of symptoms -speed of onset of symptoms -constancy of symptoms -general health of px at time symptoms first noticed -previous ocular investigations/treatment
47
What are the two stages + process of developing vision?
Critical period (up to 18 weeks) + Sensitive period (up to 8 years old) Emmetropisation
48
Diploia questions
-horizontal / vertical -when does it occur (near/dis, time of day) -can you make it single -mono/binoc (when you close one eye does it disappear) -anything make it worse or better? -kids might close one eye (not developed suppression)
49
Onset of strab at birth- what two types?
-infantile esotropia (most likely, not likely exo) 30-50 diopters, need operation quickly, within first two years -congenital eso/exo
50
Congenital cataract
Earlier deprivation= more severe visual loss -needs to be rested within first 6 weeks
51
Which eye do you cover first when doing CT if they have squint
Straight eye to observe if squinting eye takes up fixation or weaker eye first
52
What could a sudden onset mean?
Nerve palsy/papillodema (raised intracranial pressure)/tumour
53
Why is alternating squint good?
Equal VA in both eyes just not working together
54
Is it harder to control eso or exo?
Exophoria easier to control as easier to pull eyes in (converge) intermittent = only occasional squint ESO = harder to control cause need to diverge
55
Why would someone’s phoria decompensate?
Don’t have enough fusional reserves
56
Why will a myope not develop amblyopia?
Stimulate all the time when looking close up (everything clear)
57
What is ametropia?
Both eyes have refractive error
58
What is amblyopia?
Developmental condition characterised by reduced vision in one eye V/a acuity worse than 0.2 Logmar (6/9) NOT due to refractive error/retina problems = cortical condition not eye problem!! -due to presence of sensory impediment to visual development e.g. strabismus or an anisometropia and astigmatism occurring in early life
59
5 types of amblyopia
-stimulus deprivation amblyopia -stabismic amblyopia (manifest strab) -anisometropic amblyopia -ametropic amblyopia (high RE uncorrected bilateral -meridianal amblyopia (uncorrected astigmatism)
60
What does the severity of amblyopia depend on?
-size of the imbalance between the two eyes -the timing of the disturbance during visual development (critical worse than sensitive bc sensitive time to develop BV)
61
Mechanisms of amblyopia
-light deprivation (no stimuli to retina) -form deprivation (retina receives a refocused image) -abnormal binocular interaction (non-fusable images are formed on fovea)
62
What tests uses grating acuity (minutes)
Preferential looking cards (for infants)
63
When will patching not help?
Hypoplasia of fovea = need to do Oct = doesn’t have enough cells in fovea
64
How many prism diopters per degree of displacement on corneal reflections?
1 degree = 2 prism dioptres -limbus touching nose = 45 degrees = 90 dioptres
65
Manifest vs latent
Manifest = tropia (movement on CT cover/un cover, opp eye) Latent = phoria (movement on CT cover/un cover same eye) Alternate CT = maximum deviation ALWAYS RECORD RECOVERY TOO
66
Recording a manifest deviation
-size of the deviation (slight, moderate or marked) -changes in the deviation at different distances (diff size in nr and dis) -changes in deviation if accom exerted -changes in deviation with and without glasses
67
Fully accommodative esotropia
With glasses, eyes straight. Normal retinal correspondence and BV
68
Distance L exotropia
Near = straight Distance = distance L exotropia
69
Alternating esotropia
Vision roughly equal, able to swap fixation
70
Convergence excess esotropia
Only squints at near when accommodating. Bifocals so have plus at near to relax accom and see in distance
71
Hyperphoria vs hypophoria
Hyperphoria = eye will move up under cover and down when cover lifted Hypophoria = eye will move down under cover and up when cover lifted
72
Recording latent deviation
-direction of latent deviation -size of deviation (slight, moderate or marked) -the movement of eye to take up fixation (recovery) = indicates how compensated the heterophoria is = GOOD, MODERATE or SLOW -changes in deviation at diff distances -changes in deviation with/without glasses
73
What are saccades
Fast small movements of eye (smooth pursuit = look between two lights)
74
Vestibuloocular movements
Controlled by inner ear = when you move head down, eyes go up
75
Optokenitic nystagmus
-infantile esotropia -eye flicker on train -black and white drum (OKN drum)
76
3 stages of BV + tests
Sensory (worths lights, bagolini lenses, fixation disparity) Motor (PFR, synoptopher) Stereopsis (TNO, Frisby)
77
Micro tropia
4 diopter PCT -look for suppression -moves picture 2 diopters off fovea
78
Near BO bigger or smaller than near BI
Bigger, by x2 BO nr
79
Nr BI bigger, same or less than distance BO
Same BI nr + BO dis
80
Dis BO smaller or bigger than Dis BI
BO dis 2x bigger than BI dist
81
What do you take off clycloplegic refraction?
Take off 1D
82
If child is ESO, what tax do you want to give them?
As much + as possible to relax accom
83
What is period of adaptation for glasses?
16 weeks
84
What are cut-offs for glasseS?
> 2D Hypermetropia (bilateral) > 1.50D myopia > 0.75D Astigmatism (bilateral) - any astigmatism + hypermetropia > 1D difference in RX (anisometropia)
85
When is rx undercorrected?
Under corrected by 1D for mild hypermetropia +2 - +5 undercorrected by 2D for high hypermetropia If ESO then given
86
How many lines expect with refractive adaptation
2-3 lines wearing glasses full time
87
What is max time for patching?
4-6 hours max per day 400 hours max
88
How long does atropine last
7-10 days , takes 45 mins to work
89
What base for ESO?
Measuring eso = base out Exercising Prism fusional reserves = base in
90
Sanskin va cards
Look at back of card
91
Pass mark for Logmar and Kay’s
Logmar - 0.2 Kays - 0.1
92
Tests for vision screening
-CT + npc -20 diopter prism + fixation stick -OM gross -steropsis frisby VA
93
How much is each letter on Logmar
-0.20 every Logmar letter Get 1 right = 0.18 Get 5 right = 0.10
94
If px has eso, what PFR first?
Base in
95
When you have phoria, how much PFR need to control?
Double E.g. 10 diopter eso = 20 diopter BI to keep straight
96
Before doing cover test, what do you ask?
Is it single or double?
97
What are the sizes of deviation?
Minimal (>10) small (10-20) Moderate (20-35) Marked (35+)

Orthoptics Year 3 (3 decks)

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