Week 2 - Revision/general clinical strat Flashcards Preview

(1) Concomitant Strabismus and Visual Development > Week 2 - Revision/general clinical strat > Flashcards

Flashcards in Week 2 - Revision/general clinical strat Deck (17)
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1
Q

What are some common concerns from patients?

A

• Blurred vision
• Eye related pain/discomfort
• Failed vision screening test
• Turned eye
• Eyes do not look healthy/normal
• Difficulty with school work
• None

2
Q

What questions need to be asked during the H&S?

A

• age of onset of symptoms (if any)
• frequency of symptoms time of occurrence of symptoms
• speed of onset of symptoms
• constancy of symptoms
• general health of the patient at the time symptoms first noticed
• any previous ocular investigations and/or treatment

3
Q

What are the symptoms?

A

• Diplopia
• Awareness
• Pain
• Blurred vision
• Headaches
• Asthenopia

4
Q

Why is age of onset important?

A

CRITICAL PERIOD:

• restoration of binocular vision
- Onset of strabismus at birth
- poor prognosis for development of binocularity
- treatment must be within the first two years

• Restoration of visual acuity
- the earlier the deprivation the more severe the visual loss
- susceptibility to the development of amblyopia up to 8-9 years
- earlier the treatment the better the prognosis

5
Q

Caterogies of Age of onset?

A

• Infantile
• >2 years

6
Q

What are the different modes of onset?

A

• Sudden
• Constant
• Intermittent
• Gradual

7
Q

What questions should be asked during H&S regarding the strabismus?

A

• Who noticed?
• Why happened?
• Time?
• Which eye?
• Direction?
• Position of head?
• any other defects/symptoms?

8
Q

What is important about frequency of symptoms?

A

• establish severity of condition
- do symptoms disrupt the patients daily life
• severe and annoying usually suggest recent onset
• Paired with incomitancy - rule out systemic conditions

• decompensating heterophoria important to consider previous treatment, general illness, fatigue stress or an increase in workload
• Usually exophoria

9
Q

What is important about of distance symptoms?

A

• in young children symptoms often occur after close work - pay particular attention to near response
• divergence excess look out for intermittent asthenopia and photophobia for distance fixation (tv, driving)
• viewing distance may be required at full 6m or more

10
Q

Whats important about speed of onset of symptoms?

A

• diplopia with sudden and recent onset more sinister
• symptoms should always be evaluated with other signs
- raised ICP can also cause sudden strabismus and is often associated with vision loss - history of headache/nausea

11
Q

Whats important about constancy of symptoms?

A

• constant strabismus rarely gives rise to symptoms if it has been present for some time
• intermittent binocular problems more difficult may not be present at examination, ask patient to return repetitive testing to reduce fatigue?

12
Q

whats important to know about general health of Px at time symptoms first noticed?

A

General health includes:

• General development
• Birth History
- Difficult forceps delivery, prematurity, drug use during pregnancy
• Attributed cause
- Trauma, illnesses
• Family History
- 1% if non family, 15% if one family member, 20% if two or more

13
Q

Whats important about previous ocular history?

A

• Optical
- Age, worn well, cycloplegic done, change in Rx, good fit, any prisms

• Orthoptic
- occlusions, exercises, orthoptists/optoms

• Surgical
- When, why, which eye, procedure, progress/complications

14
Q

How is a manifest deviation recorded?

A

• Squint eye in direction of deviation
• the size of the deviation (slight,moderate or marked)
• changes in the deviation at different distances
• changes in the deviation if accommodation is exerted
• changes in the deviation with and without glasses

15
Q

How is latent deviation recorded?

A

• the direction of the deviation
• the size of the deviation (slight, moderate or marked)
• the movement of the eye to take up fixation is known as the recovery movement
- This indicates how well compensated the heterophoria is
• recovery is usually referred to as rapid or good moderate, slow or delayed
• changes in the deviation at different distances
• changes in the deviation with and without glasses

16
Q

What does alternate cover test reveal?

A

• Maximum deviation present in both heterotropia and heterphoria

17
Q

So what does a cover test show?

A

• detects all manifest and latent strabismus
• indicates size and variation in deviation with distance and the effect of any refractive error
• gives an indication of the level of visual acuity in either eye - fixation
• indicates if a latent deviation is controlled (well compensated) - rate of recovery