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38 Cards in this Set

  • Front
  • Back
Superior Rectus:

Angle of insertion
Actions
23 degrees

elevation
incyclotorsion
adduction
Inferior rectus

Angle of insertion
Actions
23 degrees

depression
excyclotorsion
adduction
Superior oblique
54 degrees

incyclotorsion
depression
abduction
Inferior oblique
51 degrees

excyclotorsion
elevation
abduction
Describe Hering's Law of Equal Innvervation
muscles work in pairs to move 2 eyes equally. Paired/yoked muscles = LR and MR, SR and IO, SO and IR.
Sherrington's Law
Muscles "share" an arm

agonist and antagonist are reciprocally innervated.

See Duane's Syndrome
Listing's Law
Eye rotates around certain axes (Listing's plane)
List latency (slow to fast):
saccades
smooth pursuit
VOR
vergence (disconjugate movements)
saccade - 200 ms
vergence - 160
smooth pursuit - 125
VOR - 15
List speed (slowest to fastest):
saccades
smooth pursuit
VOR
vergence (disconjugate movements)
vergence - 10 deg/sec
smooth pursuit - 50
VOR - 300
saccade - 1000
Microsaccades
Microtremors
Microdrifts

What is each used for?
Which is fastest?
Which are yoked and disconjugate?
Microsaccades: yoked, used for reading
Microtremors: disconjugate, fastest
Microdrifts: used in slow eye movements

micro -saccades and -tremors counteract errors in monocular fixation
VOR

1 - What kind of movements is it good for?
2- How long does it last?
3 - Sign of vestibular dz?
4 - Water in ear causes what?
1 - Works for fast head movements, not slow, steady movements.
2 - Only lasts for 30 sec, at which point OKN takes over.
3 - Acute vestibular dz or lesion can cause horizontal nystagmus
4 - COWS refers to direction of fast-phase
How to decrease nystagmus
-Conv (BO; minus lens at dist, plus at near)
-Yoked prism to null-point
-CL (increase pt awareness)
Describe Foster-Kennedy syndrome eye movement dysfunction.
Lesion on right side of frontal eye field = no saccade to left, can pursuit to left.
What part of brain controls pursuits?
What is the limit for speed?
20, 50, 70 deg/sec
Parietal lobe. Lesion on right = can't pursuit right but can saccade right.

Limit = 50 deg/sec. Beyond this, saccades pick up foveation.
Which type of vergence is initiated by diplopia, and which is initiated by blur?

Tonic, proximal, fusional, accommodative
diplopia: fusional
blur: accommodative
What is a comitant deviation/strabismus? Noncomitant? Where do the following fall:

decompensated phoria,
anatomical restriction,
innervation problem
Comitant deviation: misalignment that's same in all positions of gaze. Example: decompensated phoria.

Noncomitant: No same. Example: anatomical restriction or muscle palsy
Explain 3 types of Duane's Retraction Syndrome.

Explain the neuro wiring problems and what they cause
Type 1 - limited abDuction. CN6 affected or absent.
Type 2 - limited aDDuction (CN3 dually innervating MR and LR)
Type 3 - limited abDuction & aDDuction (3 D's; co-innervation of MR and LR by CN3, as well as loss of innervation of LR).

Globe retraction and narrowing of palp fissure may be present in types 2 and 3.
Describe Brown's syndrome
Acquired (scarring or inflamm) or congenital (SO too short of tendon inelastic) SO tendon sheath syndrome. (+) Forced duction when adducted and pushing up.

Present w/small hypotropia in primary gaze.
Park's 3 step:
Does it work w/2 muscles?

Patient presents with head tilt left. Which SO affected?

Example: OD hyper, worse when look right, worse head tilt right
Only works w/1 muscle

Right SO. Rt SO can't intort, but left eye can, so tilt head to compensate.

Example: OS IO
Expected phoria findings for non-presbyope for distance & near?
Distance: 0-2 XP
Near: 0-6 XP
Describe the Phi phenomenon during cover test
Esophore perceives object as moving in opposite direction of paddle; exophore same direction.
Crossed diplopia = eso or exo?
Exo (x = crossed). The object crosses before the eyes.
Describe the 4 types of fixation disparity curves. What do the x & y intercepts represent?
X: BI to BO
Y: eso to exo

Type 1: normal
Type 2: eso (top half of type 1, eats up BO)
Type 3: exo (bot half of type 1, eats up BI)
Type 4: Narrow
What is the difference between calculated AC/A and Gradient AC/A?
Calculated: distance and near (like Newman's examples). Remember: PD of 60 convergence demand at 40 cm = (6.0)(2.5) = 15 prism D.

Gradient: same distance, dif lenses. (2 exo, 6 thru +1 = 4/1 ratio)
How to test PFV?
How to test NFV?
PFV: BO or plus lenses
NFV: BI or minus lenses
Expected findings for NPC (know this):
5 cm break, 7 cm recovery
beyond 10 cm is abnormal
How does minus lens test compare to push-up test?
Minus lens to blue shows 2 D less than push-up (due to minification of minus lens, lateral mag of push-up, and extra proximal accomm w/push-up)
Expected findings for vergence facility and accomm facility
Vergence: 12 BO, 3 BI; normal 15 cyc/min

Accomm: +/- flippers, 11 cpm monoc, 8 cpm binoc
Describe amblyogenic factors.
Strabismic amblyopia: suppressing fovea prevents confusion; suppr periph retinal counteracts diplopia

Occlusion (deprivation) amblyopia

Refractive amblyopia:
Myopia: more than 8 or 3 aniso
Hyperopia: more than 5 or 1 aniso
Ast: more than 2.5 or 1.5 aniso
Hirschberg:
1- Measures lambda or kappa?
2- How much is a shift of 1 mm?
3- Does this measure or neutralize deviation?
1- Lambda. If done monoc, measures kappa
2- 1 mm shift = 22 prism D
3- measures. Krimsky allows you to change prism on fixating eye until non-fixating eye matches.
What is ARC?
What are the types of ARC?
Definition: reprogramming of fovea to match an eye turn.

Harmonious AC: angle of anomaly equals the angle of deviation.

Unharmonious AC: angle of anomaly is less than angle of deviation (reprogramming doesn't move enough to eliminate diplopia)

Paradoxical type I AC: new fovea moves in wrong direction.
Explain the Bagolini lenses.
What do exo & eso strabs see?
Right eye sees /; left eye sees \
Ortho: sees X w/light ball in middle
Exo: the 2 lines cross higher w/balls under
Eso: the 2 lines cross lower w/balls above
On Bruckner test, which eye is brighter w/a strabismic
the non-fixating eye

Bruckner measures strab, microtropia, aniso, media opacities
4 BO test.
What does this test screen for?
Explain the normal response.
Screens for microstrabismus.
Normal response: versional movement of both eyes toward apex of prism, then convergence refixation of non-covered eye.

Microtropia:
Prism over good eye = no convergent refixation of non-covered tropic eye
Prism over microtropic eye = nothing happens (falls w/in suppression scotoma)
Visuoscopy: if the scope grid is between fovea and nerve in right eye, is it nasal or temporal eccentric fixation?
nasal eccentric fixation.

If grid is superior = superior ecc. fix.
Red lens sees:
Red light as _______
Green light as ______
White light as ______
Red as red
Green as black
White as red
W4D
---R
-G--G
---W
If a pt has a lag on FCC, which lines are clearer?
Horizontal. FCC creates interval of sturm and if lagging, horizontal (more anterior; vertical more posterior) are closer to retina.