Week 2 - Revision/general clinical strat Flashcards
What are some common concerns from patients?
• Blurred vision
• Eye related pain/discomfort
• Failed vision screening test
• Turned eye
• Eyes do not look healthy/normal
• Difficulty with school work
• None
What questions need to be asked during the H&S?
• 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
What are the symptoms?
• Diplopia
• Awareness
• Pain
• Blurred vision
• Headaches
• Asthenopia
Why is age of onset important?
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
Caterogies of Age of onset?
• Infantile
• >2 years
What are the different modes of onset?
• Sudden
• Constant
• Intermittent
• Gradual
What questions should be asked during H&S regarding the strabismus?
• Who noticed?
• Why happened?
• Time?
• Which eye?
• Direction?
• Position of head?
• any other defects/symptoms?
What is important about frequency of symptoms?
• 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
What is important about of distance symptoms?
• 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
Whats important about speed of onset of symptoms?
• 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
Whats important about constancy of symptoms?
• 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?
whats important to know about general health of Px at time symptoms first noticed?
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
Whats important about previous ocular history?
• 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
How is a manifest deviation recorded?
• 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
How is latent deviation recorded?
• 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
