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64 Cards in this Set
- Front
- Back
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T/F ET is more common than XT
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T
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T/F In school age children, Intermitten ET is more commo than cosntant ET
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FALSE
cosntant is more common |
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When does esotropia usually occur?
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typically etween 1 and 3 years of age.
are almost always stable and constant usually are unilateral due to these facts, amblyopia is likely |
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Almost 50% off esotropes have a associated ____ deviation
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vertical
due to an over-action of inferior oblique |
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Esotropia often larger at ____ due to accomodative and proximal convergence
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near
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Infantile ET refers to ET that has an onset of approximately what age?
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6 months
Congential esotropia means you were BORN with it. IT IS NOT THE SAME THIGN |
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Prevelence of infantile esotropia in the general propulation and of all esotropias?
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1% in general pop
28-54% of all ET |
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What is the etiology of infantile esotropia?
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excessive tonic convergence. Child does ot have copenstory negative fusiona l verence to overcome the tonic convergence
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Clinical characteristics of infanitle ET=
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LARGE constant angle of ET=40-60 pd. You CANNOT miss this
it is SAME at D and N often alternating ET with a NORMAL AC/A ratio (no acocmoative component) Tends to have hyeropia (greater than 2D). Pt needs surgery ASAP |
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Associated conitions with infantile esotropia?
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1.dissociated vertical deviation (50-90%)
bilateral hyper deviation usually latent, seen only on occlusion of either eye Eye moves UP uder the paddle 2. Overactio nof inferior oblique (78%). 3. Latent nystagmus 4. Rotary nystagmus |
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Treatment of infanilte ET=
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poor porgnoisis for functional cure since its during critical period, so no stereo develops. BUT good prognosis for cosmetic cure.
Treat RE Treat Ambylopia- use alterante occlusion between each eye per day because you do not want deprivation amblyopia. Refer to surgery before 18 months of age. Surgery will ONLY fix appearance. |
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Best surgery outcome for infanilte ET occurs if it happens before what age?
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18 months
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What does Surgery for infantile ET consist of?
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bilateral MR recession. MR is cut and moved back so eye cant pull the eye as hard.
Goal is an ET of 10 pd or less. can result in microtropia and monofixaatio syndrome |
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50% of all ET have n ______ component
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accomodative (hyperopia or AC/A)
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Typical age of onset for accomodative ET is typically
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between 6 months and 8 years with an average of 2.5 yrs
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Accomodative ET is usally due to
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hyperopia and/or high AC/C ratio
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3 types of fully accomodative ET
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a. refractive accomodative ET (due to hyperopia only)
b. Non-refractive accomodative ET (due to high AC/A only) c. Mixed refractive accomodaive ET (high hyoperia and high AC/A) |
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Symptoms of accomodative ET:
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INTERMITTENT eye turn. Diplopia is common
rubbing, or closing 2 eye when performing near tasks poor cosmeis |
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Size of deviation for refractivee accomodative ET at D and N
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are usally the same at both and within 10pd.
MAY be larger at N due to AC/A ratio or poor divergence skills However, AC/A is typically normal |
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Etiology of refractive accomodative ET
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due to Hyperopia, usually 2-6D
if higher than 6D, isometropic amblyopia occurs more frequently than ET LOW NFV |
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REfractive Accomdoative ET is what kind of ET
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usually intermittent and alternating --> AC very unlikely, due to instability of deviation and intermittent deviation.
AC, if presnet, will go away as accomdative ET is treated |
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Treatment of refractive accomodative ET
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Rx full hyperopia error from cycloplegic value (subtract .50D)
BIFOCAL is NOT necessary followup in 4-6 weeks for full binocular eval and then every 6 months consider VT if I vergence is low SURGERY IS CONTRAINDICATED |
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___________ET is similar to CE
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nonrefractive accomodative
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Symptoms on NONrefractive accomodative ET
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intermittent eye turn at NEAR only
rub or close eye when performing N tasks poor cosmesis |
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Size of deviation of nonrefractive accomodative ET
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orth to mild ET at D
10 pd of eT or MORE at N |
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etiology of nonrefractive accomodative ET
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AC/A ratio
typically above 6/1 |
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Is AC likely in a pt with nonrefractive accomodative ET?
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NO
if present it is lightly embedded and will go away as treated |
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T/F Amblyopia is unlikely in pts with nonrefractive accomodative ET
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T
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Treatment of non-refractive accomodative ET
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correct ametropia
prescribe BIFOCAL (depends on AC/A amount, deviation size, Harmon's diance... max is 3D) Must give Flat top until adolescent FU in 6 weeks conisder VT if compensatinve NFV is low Surgery is CONTRAINDICATED |
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When is the trope noticed in Mixed accomodative Esotropia
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deviation is present at D and N but LARGER at NEAR
moderate to high hyperopia PLUS high AC/A ratio |
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Treatment of mixed accomdoative esotropia
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correct hyeropia based off of cycl -.50D
PRESCRIBE BIFOCAL depending on AC/A, flat top fu in 6 weeks consider VT if NFV is low SURGERY IS CONTRAINDICATED |
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________________esotropia=esotropia that is not affected by correction of the RE or by RX of a bifocal. Angle is the same at distance and near.
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non-accomodative esotropia
aka basic eso |
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Early onset non-accomodative ET occurs at what age?
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occurs before 2 years of age (6month to 1 year usually)
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Acute aquired comitant ET usually occurs at what age?
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usually after 2 yers, typically between 3-5 usually happens suddenly
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The cause of early onset non-accomodative ET?
What amount of ET is typical? |
(just like infantile esotropia)
innervational due to excessive tonic convergence with poor control of NFV 30-70 pd constant alternating ET similar at distance and near |
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Treatment of early onset nonaccomodative ET?
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a.treat significant RE (treat 2.5 Hyperopia or higher ,if small hyoperia, dont treat)--> repeat CT after 1 month
b. treat amblyopia by constant occlusion (alternating suppression) c. REFER FOR SURGERY, once amblyopia and supperession are gone) d. Post surgical VT |
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Acute Aquired comitant non-accomodaive ET tends to look like wat?
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constant unilateral ET
moderate angle 20-30 pd, could have AC, suppresion, or both can lead to amblyopia. Sensory adaptaions are comon: AC is moderalte to deeply embedded |
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Treatment of acute aquired comitant nonaccomodative ET?
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a. Correct Rx
b. Consider a bifocal of it improves function c. Consider prism to stimulate fovea and cause normal binocualr vision while disrupting AC |
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Symptoms of acute aquired comitant non-accomodtive ET
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poor cosmesis
sudden onset between age 3-5 diplopia is RARE Constant unilateral ET (sometimes alternating) MODERATE angle -20-30 pd |
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____________ esotropia= despite full correction of RE and correction of AC/A ratio thru bifocal, ET persists at distance AND near.`
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partially accomodative
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prevelance of partiall acommodative esotropia?
age of onset? |
30% of all eso
1-3 yrs most commonly |
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Is diplopia common in partially accomodative esotropia?
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no
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deviation angle of partially accomdative esos?
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20-30 pd, constant and unilateral typically
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Is amblyopia common in partially accomodative eso?
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yes
due to it being constant and unilateral |
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Sensory adaptations for partially accomodative esos?
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AC is common and often moderately embedded.
suppression also tends to occur |
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There must be significant _________ or high __________ to use the term accomodative or partially accomodative ET
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hyperioa (greater +1.5D)
high AC/A (greater than 6/1) |
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Treatment of partially accomodative eso
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full re
occlusion or atropine for amblyopia and ecentric fixation surgery for cosmesis if no AC Consider prism to move image to fovea id NC is present Start VT to eliminate AC for functional cure Consider surgery if angle is GREATER than 20 pd nd if AC is only mildly embedded |
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___________esotropia=a nonaccomdative ET that is present at DISTANCE only or is greater at D than N
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divergence insufficiency esotropia
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divergence insufficiency esotropia age of onset
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older than 10 yrs, most pts in 20s and 30s
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T/F pts with divergence insufficiency esotropia have LOW NFV and LOW AC/A
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T
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divergence insufficiency esotropia symptoms?
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doulbe vision WORSE at distance, headaches, asthenopia
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divergence insufficiency esotropia angle of deviation
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greater at distance 8-30 pd
intermitent or constant comitant |
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Sensory adaptations for pts with divergence insufficiency esotropia
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none!! pt has doulbe vision!! NO AC because pt is older than 7 yrs of age
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what must you rule out in pts with divergence insufficiency esotropia?
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lateral rectus paresis!!
ecepct in divergence insufficiency esotropia, it is comitant!! still need to refer ALL pts for neuro consult |
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Treatment of divergence insufficiency esotropia
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correct RE
prescribe BO prism for distance to eliminate diplopia Initate VT surgery is NOT indicated |
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___________esotropia=esotropia whch previously was maintained as an esophoria due to fusional divergence. The NFV is no longer able to compensate
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decompensated esotropia/esophoria
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decompensated esotropia/esophoria symtpoms/age of onset?
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mostly seen in teens and adults
recent onset of double vision at D and N may be intermittent and ten become constant by end of day |
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decompensated esotropia/esophoria deviation
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size is 10-20 pd at D and N
comitant |
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Are there sensory adaptions to decompensated esotropia/esophoria?
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NO! pt is older than 7.. pt will see DOUBLE
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Treatment for decompensated esotropia/esophoria
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correct RE
use prism IMMEDIATELY to stop diplopia VT to increase NFV SURGERY FOR LARGE ANGLES (>20pd) as long as there is no AC or suppression |
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Secondary esotropias are usually due to
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a loss of visual function in on eye:
congential cataract corneal scar optic atropy macular disease ptosis |
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What is SESNOSRY esotropia?
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an ET that develops due to a reduction or loss of visual function in one eye
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what is the nagle usually for sensory esotropes?
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10-45 pf, constant and unilateral.
Decreased VA as much as 20/200 amblyopia is possible can be comitant OR non-comitant associated with HYPER deviations CAN do surgery to provide some cosmetic improvement |
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Wat is consecutive ET due to?
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due to surgery for XT
CAUSES diplopia and asthenopia if surgery was done before age 6 --> can lead to amblyopia. may need to repeat surgery |
