1
Q
a vision condition in which a person can not align both eyes simultaneously under normal conditions
A
Strabismus
2
Q
When one or both of the eyes may turn in, out, up, or down
A
Strabismus
3
Q
T/F: an eye turn can be constant or intermittent
A
True
4
Q
What are the 4 causes of strabismus
A
- congenital
- accommodative ET
- abnormal visual development
- neurological
5
Q
What are the 4 types of neurological strabismus
A
- cranial nerve palsies
- neurological disease
- posterior fossa tumors or malformations
- raised ICP
6
Q
What are some symptoms someone with a strabismus may have
A
- double vision
- blurry vision
- reduced peripheral vision
- headaches
- dizziness
7
Q
CN3 innervates what? (EOMs, other muscles, etc.)
A
EOMs (SR, MR, IR, IO)
Superior palpebral levator muscle
Edinger-Westphal Nucleus
8
Q
If someone has a CN3 palsy how will their eye be positioned or not be able to move?
A
Down and out
9
Q
If someone has a CN3 palsy what will be some characteristics you will see?
A
- the eye will be positioned down and out, or cant move down and out
- there will be ptosis (due to SPL muscle not working)
- dilated pupil and non-accommodative response (if EW nucleus isnt working)
10
Q
What are the 4 etiologies in children with a CN3 palsy?
A
- congenital
- vascular
- primary tumor
- metastatic tumor
11
Q
What are the 3 etiologies in young adults with a CN3 palsy?
A
- demyelination
- vascular
- tumor
12
Q
What are the 2 etiologies in older adults with a CN3 palsy?
A
- vascular
- tumor
13
Q
What are the 3 conditions related to an ischemic or vascular problem in a CN3 palsy?
A
- diabetes
- hypertension
- pupil sparing
14
Q
What the most common vascular related cause in adults with a CN3 palsy?
A
Diabetes
15
Q
If the pupils arent affected in a CN3 palsy then its mostly what kind of problem?
A
Vascular
16
Q
If there is something that is compressing on the nerve (more peripheral) then its probably a __ or an ___. If the cause is from these the patients eye will still be down and out but the pupils will be dilated with no accommodative response
A
Tumor or an aneurysm
17
Q
What is the most common intracranial aneurysm in a CN3 palsy?
A
Posterior communicating artery
18
Q
What are 2 types of non-pupil sparing etiologies for a CN3 palsy?
A
- intracraninal aneurysm
- neoplasm
19
Q
What are two other arteries that can be involved in an intracranial aneurysm? (CN3 palsy)
A
Internal carotid artery or basilar artery
20
Q
What is an acute risk of an aneurysm rupturing in a CN3 palsy?
A
Subarachnoid hemorrhage (pain)
21
Q
What are 2 types of neoplasms in a CN3 palsy?
A
Neuromas or schwannomas
22
Q
What are 2 types of tumors that could be adjacent to the CN3 nerve?
A
Pituitary or sphenoid wing meningioma
23
Q
What are 7 etiologies of a CN3 palsy?
A
- Vascular
- intracranial aneurysm
- neoplasm (tumor)
- trauma
- migraine
- inflammatory
- infectious
24
Q
What type of trauma could cause a CN3 palsy?
A
Severe blows to the head with skull fracture and/or loss of consciousness
25
What is a type of inflammatory condition that can cause a CN3 palsy?
MS
26
What are 2 types of infections that can cause a CN3 palsy?
- meningitis
| - viral
27
What are some tests you would want to do to evaluate a CN3 palsy?
- case history
- external observation
- VA
- cover test (would see exo, hypo)
- EOMs
- pupil testing
- NPC
- accommodation testing due to EWN
- Hess Lancaster test
28
What muscle does CN4 innervate?
SO
29
If someone has a CN4 palsy what position will the eye be in or wont be able to move?
Eye up and in
30
People with a CN4 palsy usually has a head tilt to the ____ side of the palsy
Opposite
31
Someone with a CN4 palsy with a right head tilt will have an affected ____ SO palsy
Left SO palsy
32
What is the longest intracranial pathway?
CN4
33
Describe the CN4 pathway
Crosses in back of the brain stem-->partially encircling the midbrain-->decussates after midbrain
34
CN 4 nucleus is near ___ fibers
Descending sympathetic fibers
35
If there is a CN4 palsy it can lead to what kind of syndrome?
Ipsilateral pre-ganglionic horners syndrome
36
What is the horners syndrome triad?
miosis, ptosis, anhidrosis
37
What are the 8 etiologies of a CN4 palsy?
- congenital
- idiopathic
- head trauma
- microvasculopathy
- tumor
- aneurysm
- MS
- iatrogenic injury
38
What are the 2 ways someone can have a congenital CN4 palsy?
- abnormal development of CN4 nucleus
| - abnormal development of peripheral nerve or tendon
39
What is the most common cause of acquired isolated CN4 palsy?
2nd?
First: idiopathic
Second: head trauma (with a loss of consciousness)
40
What are some tests you do to evaluate a CN4 palsy?
- case history
- external observations
- cover test
- EOMs
- pupils
- P3S
- NPC
- Hess Lancaster
41
What EOM does CN6 innervate?
Lateral Rectus
42
If the LR is not working what will the eye look like?
The eye will be turned in (esotropia)
43
If someone has a CN6 palsy they will probably have a head turn towards the ____ eye
Affected eye
44
If someone has a CN6 palsy with a left head turn what muscle is affected?
LLR
45
CN6 is susceptible to what 5 things?
- injury
- increased ICP
- mastoid infection
- skull fracture
- tumors
46
If someone has a lesion to CN6 nerve, root, or nucleus what are some presentations you may see?
- ipsilateral paresis of LR
- convergence strabismus increasing in temporal gaze
- lateral diplopia
47
If someone has a ipsilateral paresis or paralysis of facial muscles for Nuclear lesions what type of palsy would you think?
CN6
| - this is due to CN7 root encircles CN6 nucleus
48
If someone has lateral diplopia what palsy do you think this could be?
CN6
49
What is the most commonly affected oculomotor nerve in adults?
-CN6
50
What is the most common affected oculomotor nerve in children?
CN4
51
What is the second most commonly affected oculomotor nerve in children?
CN6
52
The how many anterior ciliary arteries supplies the LR?
1, all other EOMS are supplied by 2
53
The LR is more affected by ____ than other EOMs. And why?
Ischemia, because only 1 ACA is supplying it
54
What are the 8 etiologies of a CN6 palsy?
- Trauma
- Aneurysm
- Ischemic (HTN, diabetes)
- Idiopathic
- Demyelination
- Neoplasm
- Inflammatory
- Meningitis
55
What are some tests you would use to evaluate CN6 palsy?
- case history
- external observations
- VA
- cover test (eso)
- EOMs (limited towards temporal gaze)
- Hess Lancaster
56
What are 2 types of multiple cranial nerve palsies?
- cavernous sinus
| - orbital apex syndrome
57
What nerves are located in the cavernous sinus? What syndrome is related?
CN 3, 4, 5, (V1 and V2), 6
Horners
58
If the cavernous sinus is affected is the optic nerve affected?
Nope
59
What is the #1 cause of a cavernous sinus palsy?
Neoplasm
60
What are some other causes of a cavernous sinus palsy?
- carotid cavernous fistula
- aneurysm
- Fungal infection
- inflammatory
- tolosa-Hunt
61
What nerves are affected in orbital apex syndrome?
What is a syndrome that can result from this?
CN 3, 4, 5 (V1), 6
| Syndrome: horners
62
Is the optic nerve affected in an orbital apex syndrome?
Yes
63
What is the #1 cause of an orbital apex syndrome?
Neoplasm
64
What are some other causes of an orbital apex syndrome?
- fungal infection
| - inflammation
65
If someone has medial rectus problem what will they present with?
-exo deviation, greater at near
66
If someone has inferior rectus problem what will they present with?
Hyper and exo deviation
67
If someone has superior rectus problem what will they present with?
Bilateral, in V exo pattern
68
If someone has an inferior oblique problem what will they present with?
An eso pattern
69
What is affected in a double elevator palsy?
SR and IO of the same eye are affected
So they will have no elevation in abduction or adduction
70
What is usually present in a double elevator palsy?
Bells phenomenon
71
What are the two etiologies of a double elevator palsy?
- congenital
| - Supra nuclear defect
72
What is bells phenomenon?
When you ask someone to close their eye but they cant and the eye just moves up
73
What are 5 differential diagnoses of a double elevator palsy?
will they have a positive off negative forced duction test?
- blowout fracture
- thyroid eye disease
- browns
- congenital fibrosis of the IR
- general fibrosis syndrome
they will have a positive forced duction
74
What is another name for a double depressor palsy?
Monocular depression deficiency
75
In a double depressor palsy what two muscles are affected?
IR and SO (so there will be no depression in abduction or adduction)
76
If someone has a double depressor palsy how will their head be tilted?
Down (chin depressed) to compensate of hypertropic eye
77
What are the 4 types of neurogenic palsies?
- supranuclear (cortical control, BG, SC, thalamus, VA, cerebellum)
- internuclear
- nuclear (brainstem, ocular motor cranial nerve nuclei)
- infranuclear (ocular motor nerves and EOMs)
78
What are the 8 etiologies of a neurogenic palsy?
- congenital
- traumatic
- inflammatory
- neoplastic
- ischemic
- toxic
- demyelination
- idiopathic
79
What are 7 supranuclear palsy classifications?
- Lesions above the level of Ocular Motor Nerve Nuclei
- Gaze palsies
- Tonic gaze deviation
- Saccadic and smooth pursuit disorders
- Vergence abnormalities
- Nystagmus
- Ocular oscillations
80
An internuclear palsy can be caused by a lesion of what?
Medial longitudinal fasciculus
81
Internuclear palsies are caused by?
- MS in younger patients
| - vascular origin in elderly patients
82
If someone has a internuclear palsy can they converge?
Yes since the CN3 isnt affected
83
What are 5 presentations of a nuclear palsy?
- Unilateral CN III with bilateral ptosis
- Unilateral CN III with contralateral superior rectus underaction
- Isolated extraocular muscle palsy of inferior rectus, inferior oblique, or medial rectus
- Brown’s Syndrome
- Bilateral CN III with spared levator function
84
What nerves are affected if someone has a infra-nuclear palsy?
CN 3, 4, 6
85
In a CN3 palsy, if the pupil is spared its most likely cause is?
Vascular
86
In a CN3 palsy, if the pupil is not spared its most likely cause is?
Aneurysm
87
If someone had a head trauma what is the most common CN palsy they will have?
CN4
88
If someone has diplopia in lateral gaze, what kind of palsy would you think this is?
CN6 palsy
89
If someone has diplopia in vertical gaze, what kind of palsy would you think this is?
CN3 or CN4
90
If you suspect an aneurysm or a neoplasm what should you do?
Seek immediate care
91
If you suspect an aneurysm what tests should you order?
Angiography or MRA
92
If you suspect someone as a neoplasm what tests should you order?
MRI or CT scan
93
When does an ischemia usually occur?
>40 yoa
94
If someone had an ischemia will this be sudden or slow occurring?
Sudden
95
How long does it take an ischemia to resolve on its own?
3 months
96
What are some ways to manage a strabismus?
- glasses
- occlusion
- Botox
- surgery
97
What is the first step in managing strabismic symptoms?
Glasses
98
A prism used for short-term treatment of diplopia, but can also be used long term
Fresnel prism
99
Which eye do you place fresnel prism over?
Non-dominant eye
100
A common treatment for acute paralytic strabismus due to unilateral CN6 palsy
Botox
101
Neurotoxic protein that prevents the release of neurotransmitter acetylcholine from axon endings at the neuromuscular junction, resulting in paralysis
Botox
102
What are some temporary side effects of Botox?
- Soreness at injection site
- Weakness in the muscles that were injected
- Muscle soreness that affects your whole body
- Difficulty swallowing
- A red rash that lasts several days after the injections
103
What is a treatment for long term fixing of a strabismus?
Surgery
104
A treatment meant to weaken, strengthen, or change the vector of force for a given muscle, based on the strabismus
Surgery
105
What are some risks of surgery on someone with a strabismus?
- Mild discomfort after
- Continued strabismus
- Endophthalmitis (infection)
- Ocular ischemia
106
EOM is tethered or a systemic disease reduces the elasticity of one or more muscles
Mechanically restrictive
107
Are mechanical restrictive deviations incomitant or comitant?
Incomitant
108
Can mechanical restrictions be congenital, acquired, or both
They can be acquired or congenital
109
In mechanically restrictive deviations you will have gross limitations of ocular movement in___
One or more directions of gaze
110
What type of deviation is usually present in mechanically restrictive deviations?
-small deviations or orthophoria in primary gaze
111
In mechanically restrictive deviations, will you have a negative or positive forced duction test?
Positive
112
What tests may be beneficial to measure mechanically restrictive deviations?
- Maddox rod
| - prism bar over the affected eye
113
What tests are beneficial to measure if both eyes are mechanically restricted?
- hirschberg
| - krimskey
114
What is the overall problem for someone with Duanes syndrome?
Not able to adduct, abduct, or both
115
What are 3 congenital mechanical restriction conditions?
- Duanes syndrome
- browns syndrome
- fibrosis syndrome
116
What is the type in Duanes syndrome where the patient has limited ADDuction?
Type 2
117
What is the type in Duanes syndrome where the patient has limited ABDuction?
Type 1
118
What is the most common type of Duane syndrome?
Type 1
119
T/F: patient with limited abduction in the absence of a significant strabismus in primary position should be considered Duane syndrome until proven otherwise
True
120
What is the type in Duanes syndrome where the patient has limited ABDuction and ADDuction?
Type 3
121
Will someone with Duane syndrome have a significant strabismus in primary gaze?
No
122
Is Duane syndrome bilateral or unilateral?
Unilateral
123
In Duane syndrome, the size of the deviation increases towards the _____ side
Affected
124
If someone has Duane syndrome will they have an A or V pattern?
Possibly
125
What are 2 characteristics of Duane syndrome regarding the globe and fissure?
- the globe retracts (enophthalmos)
| - eyelid fissure narrows on adduction
126
What is the most common onset of Duane syndrome?
Sporadic, often presents during infancy
127
What is the etiology of Duane syndrome?
-mechanical, anatomical, and innervation disorder
128
What 2 muscles are inserted too far posteriorly in Duane syndrome?
-fibrotic LR or MR
129
What type of innervation does Duane syndrome have?
Anomalous innervation
130
Do people with Duane syndrome have binocularity?
Yes
131
Will someone with Duane syndrome have amblyopia or diplopia?
It is very rare
132
Do people with Duane syndrome have a head posture?
It depends on the amount of deviation in primary position but if they have type 1, they turn their head toward the affected side and type 2 they turn it towards the opposite side
133
You may see an up/downshoot often affected eye during ____ in Duane syndrome. This mimics overaction of the ____ and/or ___
ADDuction
| Overaction of the IO and/or SO
134
What is a differential diagnosis of Duanes?
CN 6 Palsy
135
Name 4 characteristics of a CN6 palsy (what makes it different than Duane)
- negative FDT
- absence of retraction with adduction
- esotropic angle is larger (deviation in primary position)
- rarely have vertical anomalous movements
136
What are 2 treatments of Duane syndrome?
- surgical
| - prism
137
If someone has a left Duane syndrome Type 1 what type of prism would you give this patient?
- OS BO
| - OD BI
138
Does surgery improve adduction/abduction?
What about bino vision?
-it rarely improves the deviation but improves the field of bino vision
139
What is the overall problem for someone with Browns syndrome?
They have restricted elevation in adducted eye around the mid horizontal plane
140
Is browns syndrome unilateral or bilateral?
Usually unilateral
141
Which eye is more likely affected in browns syndrome?
OD
142
What is the etiology of browns syndrome?
the trochlear to the SO tendon insertion distance cannot be increased because of mechanical causes
Commonly due to a thickening of the SO tendon--> cant move through the trochlea effectively
143
Can browns be acquired?
Yes (trauma, inflammatory disease processes, iatrogenic)
144
T/F: browns doesn't improve with time
False. It does improve
145
Will someone with browns syndrome have a vertical deviation in the primary gaze?
Probably not, if so it is minimal
146
Someone with browns will have a ___FDT with marked resistance to forcible elevation of the eye in ____ only
- positive FDT
| - adduction only
147
You may hear an audible click with elevation with this syndrome
Browns syndrome
148
What syndrome will you have a V-pattern exo deviation in up-gaze
Browns syndrome
149
Will someone have a head posture with browns syndrome?
Chin elevation and pointing toward the opposite shoulder
150
In browns syndrome, the patient will have a mild downshoot of the affected eye in?
Adduction
151
In browns, there will be ___ of the palpebral fissure in adduction
Widening
152
Will there be an absence of overaction of the ipsilateral SO in browns?
Yes
153
T/F: there will be normal elevation in abduction for the affected eye in browns
True
154
In browns there will be restricted elevation in ____
Adduction
155
Does someone with browns have bino vision?
Yes, when the eyes are in primary position or downgaze
156
T/F: someone with browns will probably be orthophoric in primary position
True
157
Do people with browns have amblyopia?
Nope
158
Do people with browns have diplopia?
No
159
What is a differential diagnosis of browns?
IO paresis
160
Name 4 characteristics of IO paresis
- hypertropia in primary position
- head tilt to the affected side along with possible head turn and chin elevation
- A pattern: exotropia greater in downgaze
- able to fulfill P3S
161
Do most browns patients require treatment?
No
162
When is treatment recommended for brown syndrome patients?
When they have significant hypotropia in primary position or compensatory head posture that is cosmetically displeasing
163
What is the primary treatment for someone with browns?
Surgery
164
What is the secondary treatment for someone with browns?
Prism (you want to move the image down so they dont have to move the eye up as much)
165
Does VT usually work with patients with browns?
Not really
166
What is the onset of Duanes?
Congenital
167
What is the onset of browns?
Congenital or browns
168
In someone with type 1 Duanes, what will be their head posture?
Turns head towards the affected side
169
For someone with type 2 Duanes, what will be their head posture?
Turns head away from affected side
170
For someone with browns, what will be their head posture?
Chin elevation
171
What are the lid changes for duanes syndrome?
Narrowing of the fissure
172
An autoimmune, neuromuscular disorder characterized by the fatiguability of voluntary striated muscle
Myasthenia Gravis
173
This disease occurs secondary to the loss of ACh receptors at the NM junction which results in the failure to release/produce ACh
MG
174
MG commonly affects women ____ and men ____
Women under 40 and men over 60
175
T/F: MG can occur at any age
True
176
T/F: MG can be neonatal or congenital
True
177
When do people experience initial symptoms with MG?
During emotional upset
178
Is MG hereditary?
No. Its sporadic
179
What causes muscle weakness in MG?
the immune system releases antibodies that block and destroy ACh receptor sites along with tyrosine kinase--> fewer receptor sites-->less nerves signals-->muscle weakness
180
What type of gland may trigger antibody production in MG?
Thymus gland
181
T/F: the thymus is smaller in MG patients
False. It is larger
182
What is the hallmark in MG?
Muscle weakness that worsens after periods of activity and improves after periods of rest
183
What are the 2 forms of MG?
- generalized
| - ocular
184
What are the signs and symptoms of generalized MG?
- weakness of arm and leg muscles
| - difficulties with speech, chewing, swallowing, and breathing
185
T/F: Ocular MG may present before generalized MG
True
186
What are the 3 signs and symptoms of ocular MG?
- ptosis
- diplopia
- nystagmus movements
187
What is the most common feature of ocular MG?
Ptosis
188
Ptosis is MG is often due to what?
A palsy of the levator muscle
189
Is ptosis in MG bilateral or unilateral?
Unilateral
190
Ptosis in ocular MG will get ___ later in the day
Worse
191
Will people with Ocular MG have horizontal or vertical diplopia?
They could have either, there is no definite pattern
192
A disease of the skeletal muscle that can mimic many other ocular musculature paresis
MG
193
What muscles will someone with MG have difficulty with?
And what will each of these present with?
- orbicularis oculi: unable to resist a forced eye opening
- masseter muscle: unable to open jaw
- sternocleidomastoid: present with head droop
- tounge: undulate to push sides of mouth, poor gag response
- diaphragm: ventillary depression--> DEATH
194
Wen the muscles are too weak to control breathing can lead to what?
Mysthenia Crisis
195
What are 4 associations with MG?
- thymomas (tumor of the thymus gland)
- thymus hyperplasia (enlargement)
- thyroid disease
- autoimmune disorders
196
What are some of the ocular diagnoses of MG?
- use old photos
| - fatigue during ocular movement
197
What 2 ocular tests are used on patient with potential MG?
- Cogan's Lid Twitch
| - Ice Test
198
For someone with MG how will they react to cogans lid twitch?
While in downgaze, the upper eyelid twitches as a patient looks up
199
T/F: ptosis will get worse in time with looking up in MG patients
True
200
What will be the result of the ice test be for someone with MG?
At least 2mm of eyelid elevation after 2 minutes of application
201
Will you see improvement during an ice test in someone with MG?
Yes
202
What should you suspect if there is a presence of an inconsistent deviation along with ptosis and restricted ocular motility
MG
203
Name future tests you should do on someone with MG (7)
- electromyography
- sleep test
- systemic anticholinesterase agents
- physical/neuro exam
- blood test
- diagnostic testing (MRI/CT)
- pulmonary function
204
What is the most sensitive test for MG?
electromyography
205
Blocks ACh breakdown, should temporarily improve ptosis and eliminate motility restriction.
Name the 2 agents
Systemic Anticholinesterase agents
2 names:
- edrophonium chloride
- neostigmine
206
Why would you want to do a blood test on someone with MG?
To detect increased ACh receptor antibodies
207
Would you want to give someone with MG prism?
No due to variability throughout the day
208
What are two ocular treatments you would potentially do for a MG patient?
- occlusion
| - surgery (not often)
209
Name 4 systemic treatments for MG
- anticholinesterase agents
- immunosuppressive drugs
- thymectomy
- plasmapheresis and IV immunoglobulin
210
Is there a cure for MG?
No
211
T/F: patients with MG have a relatively high quality of life and a normal life expectancy
True
212
An autoimmune disorder that results in the overproduction of the thyroid hormone
Graves' disease
213
What is the common cause of graves?
Hyperthyroidism
214
What are the 2 subtypes of Graves' disease?
- graves dermopathy
| - graves ophthalmopathy
215
What are the common signs of graves?
- goiter
- weight loss
- heat intolerance (sweating)
- change in menstrual cycle
- fatigue
- thick, red skin
- rapid, irregular heartbeat
- bulging eyes
- erectile dysfunction
216
An autoimmune, inflammatory condition that involves mostly the orbital tissues and muscles
Graves ophthalmopathy
217
Graves ophthalmopathy results from the overproduction of what?
Thyroid hormone
218
This is believed to be the most common cause of spontaneous diplopia in middle aged people
Graves ophthalmopathy
219
Describe the histology of graves ophthalmopathy
Autoantibodies bing to thyrotropin receptors onto stimulate excess production on thyroid hormone--> build up of carbs in muscles and tissues behind the eye-->changes in the lymphocytic infiltration and fibrosis of muscles which impair their elasticity->enlargement of EOMs--> incomitant deviation
220
Is graves ophthalmopathy unilateral or bilateral?
Bilateral
221
Is graves ophthalmopathy more common in men or women?
Women
222
At what age do people usually get graves ophthalmopathy ?
<40
223
Is graves ophthalmopathy hereditary?
Could be
224
What are some risk factors of graves ophthalmopathy?
- emotional/physical stress
- pregnancy
- autoimmune conditions
- smoking
225
Name the ocular signs of graves ophthalmopathy
- periorbital congestion/chemosis
- proptosis (lid retraction considered primary effect)
- lid lag (von graefes sign)
- exophthalmos (can cause SPK)
- optic neuropathy
- impaired ocular motility
226
What are some symptoms a patients with graves ophthalmopathy may have
- dry/gritty ocular sensation
- photophobia
- excessive tearing
- double vision
- pressure behind eyes
- vision loss
227
If someone has a graves ophthalmopathy will they have a + or - FDT?
+ FDT
228
What muscles is most involved in graves ophthalmopathy
IR
229
What muscle is the least involved in graves ophthalmopathy
LR
230
When someone has limited elevation in abduction and adduction with both versions and duction
SR paresis
231
Fibrous union between the __ and ___ may lead to a restriction in upgaze and hypotropia of the affected eye and in severe cases the eye will be tethered down
IR and IO
232
What time of day will diplopia be worse for a graves ophthalmopathy patient?
In the morning
233
T/F: patients with GO may develop compensating head posture (chin elevation) to maintain fusion and avoid diplopia
True
234
The affected eye in GO patients often demonstrates what to things regarding eye alignment?
- restriction of elevation and abduction
| - hypotropia in primary position
235
What are some tests that would help with your diagnosis of GO?
- tonometry
- herself exophthalmometer
- slit lamp (exposure keratopathy)
- ON evaluation
- CT of orbits
- Thyroid function tests
236
Will someone with GO have improvement or reversal over time?
Yep
237
Improvement in ocular motility in GO may occur with ___ or ___
- resolution
| - orbital edema
238
What are some treatment options for GO patients
- prism
- surgery (for big deviations)
- artificial tears
- cold compresses (for edema)
- stop smoking
239
What are 4 systemic treatments you can use for GO?
- radioactive iodine therapy
- corticosteroids
- anti-thyroid drugs
- thyroidectomy
240
Will Ocular symptoms improve with GO treatment?
Not always, they could worsen for 3-6 months
241
If someone has a -2 action of the RLR what does this mean?
There is an underaction
242
When the eye is deviated in and the light hits the nasal retina and projects temporally
Uncrossed diplopia in ESO
243
When the eye is deviated out and the light hits the temporal retina and projects nasally, across and beyond the visual axis of the fixating eye
Crossed diplopia in EXO
244
How would you treat an uncrossed diplopia in ESO?
BO prism
245
How would you treat a crossed diplopia in EXO?
BI prism
246
For worth 4 if the patient sees 2 red dots what does this mean?
They are suppressing the OS
247
For worth 4 if the patient sees 3 green dots what does this mean?
The patient is suppressing their OD
248
If the patient sees 5 dots with the red dots to their left and green dots to their right what does this mean?
Crossed diplopia (exo deviation)
249
If the patient sees 5 dots with the green dots to their left and green dots to their right what does this mean?
Uncrossed diplopia (eso deviation)
250
For W4D if the person see the red dots below the green dots why type of deviation is this?
Right hyper deviation
251
For Maddox rod, if the patient sees the red line through the light what does this mean?
Ortho
252
For Maddox rod, if the patient sees the red line to the right of the light what does this mean?
Uncrossed diplopia (eso)
253
For Maddox rod, if the patient sees the red line to the left of the light what does this mean?
Crossed diplopia (exo)
254
For Maddox rod, if the patient sees the red line below the light what does this mean?
Right hyper
255
For Maddox rod, if the patient sees the red line above the light what does this mean?
Left hyper
256
When the tissues of the EOMs are abnormal and replaced with fibrotic tissue?
Congential fibrosis of EOMs
257
How would you treat someone with congenital fibrosis of EOMs?
- amblyopia therapy
| - surgery (only would do this for cosmetic reasons or comfort/abnormal head posture)
258
Will someone with CFEOM have a + or - FDT?
+FDT
259
Name the 5 main features/observation of someone with CFEOM
- severely restricted eye movement
- fibrosis in all or just one muscle
- usually in both eyes
- ptosis
- chin elevation is common (because they are trying to look under ptosis)
Motility
flashcards
Decks in class (6)
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