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strabismus and paediatrics Flashcards

1
Q

which muscle has the closest and furthest insertion to the limbus and their distance

A

medial rectus closest 5.5

superior rectus furthest 7.7

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2
Q

movement of superior rectus

A

intorsion and adduction

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3
Q

movement of inferior rectus

A

depression

extorsion and adduction

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4
Q

movement of superior oblique

A

intorsion

abduction and depression

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5
Q

movement of inferior oblique

A

extorsion

abduction and elevation

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6
Q

what is hering’s law

A

yolk muscles involved in a particular direction of gaze receive equal and simultaneous flow of innervations.

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7
Q

sherrington’s law

A

increase in innervation of a muscle is accompanied by a decrease in innervation of its antagonist.

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8
Q

define ambylopia

A

characterized by a reduction in VA in the early years of life (<8 years of age) due to a developmental failure of the visual pathway between the eye and the visual cortex in the occipital lobe

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9
Q

aeitologies of ambylopia

A

Strabismus

refractive error

stimulus deprivation (e.g. cataract).

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10
Q

Mx of ambylopia

A

1) Treat underlying cause.
2) Occlusion therapy: The good eye is patched to allow visual connections between the amblyopic eye and the brain to develop properly.
3) Pharmacologic penalisation of the good eye using atropine. (Note: Atropine may cause photophobia and reverse amblyopia.)

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11
Q

characterisitcs of binocular single vision

A

simultaneous perception

fusion

stereopsis

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12
Q

define simultaneous perception

A

An image formed simultaneously on each retina.

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13
Q

define sensory fusion

A

ability to unite the two images from each retina to form a single image.

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14
Q

define motor fusion

A

The ability to align the eyes to maintain sensory fusion.

Motor fusion occurs via version (conjugate movements) and vergence (disconjugate movements) in order to achieve binocular vision.

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15
Q

define steropsis

A

perception of depth

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16
Q

tests for simultaneous perception and fusion

A

Worth 4-dot test, Bagolini glasses and synoptophore.

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17
Q

tests for motor fusion

A

Base-out or base-in prism bar or Risley prism tests. Applying a base-out prism moves the image to the temporal retina so the eye has to converge to achieve binocular single vision. The opposite is true for a base-in prism.

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18
Q

tests for stereopsis

A

Titmus, Lang, TNO, Frisby and synoptophore.

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19
Q

what is heterophoria

A

Deviation of the eye that is hidden by fusion and revealed when fusion is broken, for example, with an alternating cover test.

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20
Q

define esophoria

A

inward deviation of the eye

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21
Q

define exophoria

A

outward deviation of the eye

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22
Q

what is heterotropia

diagnosis

A

Abnormal alignment of the eye, also known as a manifest squint.

Can be tested using the cover test.

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23
Q

what is the normal accommodative convergence to accommodation

A

In the normal eye, one diopter of accommodation is accompanied by 3–5 PD of accommodative convergence.

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24
Q

the most common form of childhood squint

A

esotropia

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25
possible causes of esotropia
nerve palsies, thyroid eye disease, trauma
26
what is fully accommodative esotropia
esotropia that resolves with correction of hypermetropia. Normal AC/A ratio.
27
Mx of fully accommodative esotropia
full cycloplegic hypermetropic correction
28
what is partially accommodative esotropia
partially resolves with correction of hypermetropia but needs treatment of ambylopia. Normal AC/A
29
Mx of partially accomoodative esotropia
fully cycloplegic hypermtropic correction and treatment of ambylopia
30
what is convergence excess esotropia
Esotropia for near vision only due to high convergence. High AC/A ratio.
31
Mx of convergence excess esotropia
bifocal glasses or surgery (e.g. bilateral MR recession).
32
when does infantile esotropia develop
within the first 6 months of life
33
what is infantile esotropia
- Large-angle (>30PD) deviation - Cross-fixation (carries low risk of amblyopia) - Latent horizontal nystagmus normally develops in first 6 months
34
what is near versus distance esotropia
Distance: Esophoria for near vision and esotropia for distance Near: Esotropia for near only but with normal AC/A ratio
35
most common type of exotropia
intermittent exotropia
36
Mx for intermittent exotropia
myopic correction, orthoptic exercises or surgery (e.g. unilateral or bilateral LR recession).
37
what is distance exotropiia | classification
TRUE - exotropia made worse looking at a distance with normal AC/A ratio. SIMULATED - there is a larger exotropia for distance with high AC/A ratio; however, the near exotropia is increased when looking through a +3D lens or after occlusion of the normal eye.
38
what is near exotropia
Defined as a worse exotropia for near vision, it is common in young myopic adults or teenagers.
39
what is constant exotropia
A constant large-angle exotropia, typically occurring within the first 6 months of life. It is usually associated with neurological anomalies
40
Mx of constant exotropia
surgical with bilateral LR recession and MR resection.
41
what is microtropia
A small angle squint <10PD (5°), most commonly an esotropia associated with anisometropia. Patients have subnormal binocular single vision with sensory and motor fusion and reduced stereopsis
42
what is microtropia w identity
no manifest deviation on cover test but deviation can occur on 4PD test
43
what is microtropia wo identity
manifest deviation on cover test
44
what is duane retraction syndrome
innervation of the LR muscle by CN3 rather than CN6 with associated CN6 nucleus hypoplasia.
45
characteristics of duane retraction syndrome
retraction of the globe on aDDuction. Associated with deafness or Goldenhar syndrome. Three types exist ``` I (most common) II III Esotropia with limited abduction Exotropia with limited adduction Esotropia with limited abduction and adduction ```
46
what is brown syndrome and causes
This unilateral syndrome is caused by mechanical restriction of the SO tendon at the trochlea. It can be congenital or arise post-trauma/surgery
47
characteristics of brown syndrome
limited elevation in adduction or on upgaze with an - associated click sensation. - pts can't look up and in
48
what is resection
process of shortening the muscle (strengthening procedure).
49
what is recession
process of loosening the muscle by moving it away from its insertion (weakening procedure).
50
what surgery would be done in constant exotropia
bilateral LR recession (loosening) and MR resection (strengthening) corrects the eye misalignment.
51
what is tucking procedure
augment the SO muscle. Indication is for congenital fourth nerve palsy.
52
what is advancement procedure
bringing the muscle closer to the limbus. This is done to a previously recessed EOM.
53
strengthening procedures
resection tucking advancement
54
what is disinsertion
primarily used for a highly active Inferior Oblique. It separates the tendon at its insertion, making it weaker.
55
innervation primary function secondary function superior rectus
CNIII Elevation intorsion & ADduction
56
innervation primary function secondary function inferior rectus
CN3 depression extorsion and ADDuction
57
innervation primary function secondary function superior oblique
CN6 intorsion abduction & depression
58
innervation primary function secondary function inferior oblique
CN3 extorsion ABduction & elevation
59
antagonist-agonist muscles
muscles in same eye that move the eye in different directions
60
synergist muscles
muscles in the same eye direction (right IR & right SO)
61
Newborn baby VA test
fix and follow
62
infants upto 3 years (pre verbal) VA test
Cardiff acuity test/ cardiff cards
63
18m - 4 years (verbal) VA test
kay picture tests
64
4-5 years test VA
Keeler crowded LogMAR test
65
what is leucoria
white pupil - urgent referral to opthamology
66
what is retinoblastoma
malignant tumour of the retina - most common intraocular tumor of childhood and most sinister cause autosomal dominant (bilateral usually) or sporadic (usually unilateral) loss of function of retinoblastoma tumour suppressor gene on chromosome 13 Mx - radioactive plaque or enucleation + adjuvant chemo
67
what is congenital cataract features Mx
leukocoria, dull red reflex, squint or nystagmus commonly idiopathic but alos hereditary linked w rubella Mx surgery - lensectomy --- contact lens, aphakic glasses or lens implant
68
what is retinopathy of prematurity
screen pre term babies (<30 weeks) + low birth weight (<1.5Kg) retinal periphery is only fully vascularised close to term incomplete retinal vascularisation causes hypoxia leukocoria seen in advanced cases due to a retinal detachment Mx- ablation of avascular retina + laser
69
what is coloboma
- keyhole pupil - present at birth - failure of choroidal fissure to close during embryological development - mutation of PAX2 gene + also linked with fetal alcohol syndrome - degree of visual impairment ranges from asymptomatic to significant visual loss - white retinal reflex + severe amblyopia
70
what is ptosis Mx
- more likely t have weak LPS - more pronounced when tired or unwell Mx - require urgent frontalis suspension surgery (within 2-4 weeks) - take part of fascia lata and insert it onto tarsal plate and frontalise muscle
71
what is congenital glaucoma/ buphthalmos
buphthalmos is an enlargement of the eye acd in children is a feature of the congenital glaucoma - consanguity - corneal diameter >12mm before 1 year - cloudy cornea - excessive tearing - photophobia mX - > Medical: drops - > surgical: goniotomy
72
Pathogens of chlamydial conjunctivitis Sx Ix Mx
chlamydia trachomatis unilateral red eye white follicules periauricular lympahdenopathy mucopurulent/'stringy' discharge Ix - giemsa stain Mx erythromycin drops
73
Pathogens Sx Ix Mx
Gram -ve diplococci Neiserriae Gonnorhoea - severe infection can cause corneal ulceration and perforation - severe discharge - early presentation - may co-exist with chlamydia Ix - swab gram stain Mx - IM/IV ceftriaxone
74
what is capillary haemangioma
swelling commonly superonasally from borth which increases in size for 6 months - benign tumour - risk of refractive error - can causes mechanical ptosis which risks ambylopia if the lid covers the visual acis Mx - oral beta blockers
75
what is limbal dermoid
benign congenital tumour often ass w eyelid coloboma or goldenhar's syndrome
76
what is dermoid cyst
smooth round non-tneder immobile lump on orbital rim | - gradually grows with risk of rupture

DEP (20 decks)

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