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48 Cards in this Set

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What is strabismus?
Ocular misalignment=both eyes are not moving in the same direction
What is the term is an eye that deviates toward the nose?
Esotropia
What is the term for an eye that deviates outward?
Exotropia
What is the term for an eye that deviates upward?
Hypertropia
What is the term for an eye that deviates downward?
Hypotropia
Strabismus is usually onset at what age?
6 mos.
What strabismic ocular deviations during the first few months (2-4 mos.) indicate?
Strabismus is common up till age 2-4 mos. and does NOT always indicated a true problem.
What is the most common strabismus in infants?
Esotropia
What is pseudoesotropia?
Eyes look like they deviate, but they really do not when checked with corneal light reflex and cover-uncover test.
What tests checks where the penlight reflection falls on the cornea?
Corneal light reflex
In normal eyes, what does the corneal light reflex show?
Light reflects from the same spot on both eyes.
In pseudoesotropia, what does the corneal light reflex show?
Light should be reflected on the same spot as well.
What 3 things are used in the diagnosis of pseudoesotropia?
1.Wide epicanthus (nose bridge) and skin folds
2.Corneal-light reflex
3.Cover-uncover test
If the previously covered eye moves to fixate on the object that the previously uncovered eye was looking at in the cover-uncover test, then what exists?
True esotropia
If the previously covered eye does NOT move to fixate on the object that the previously uncovered eye was looking at, then what exists?
Pseudoesotropia
Do children outgrow crossed eyes?
NO
What physical findings do children with pseudoesotropia show?
1.Wide epicanthus
2.Normal corneal light relfex and cover-uncover tests
3.Permanently crossed eyes.
When is the onset of infantile esotropia?
6 months
-Possible irregular autosomal dominant or recessive
-Often (+) family history
-Reduced binocular function in parents of patients with infantile esotropia--suggest a form of fruste
-Increase incidence: cerebral palsy, hydrocephalus, mom smoked cigarrettes
This is the epidemiology of what type of strabismus?
Infantile esotropia
-Poor abduction due to tight medial rectus muscles, which dominate over the lateral rectus
-Apparent abduction deficit due to cross fixation
-Differentiate from 6th pareses
These are the clinical symptoms of what type of strabismus?
Infantile Esotropia
When does acquired strabismus occur?
Anytime after 6 mos.
Convergent deviation of eyes associated with activation of the accomodative reflex refers to what type of strabismus?
Acquired Esotropia
What is the most common type of acquired strabismus?
Acquired Esotropia
What are the 3 types of acquired strabismus?
1.Accomodative Refractive
2.Nonaccomodative: Nonrefractive
3.Mixed (both accomodative and nonaccomodative)
-Uncorrected hyperopia
-Accomodative convergence
-Insufficient fusional divergence
This is the pathogenesis for what type of strabismus?
Acquired Esotropia
-Primarily glasses: can cause eyes to realign and correct the hyperopia
-Surgery if necessary
This treatment is for what type of strabismus?
Acquired Esotropia
-More common than infantile exotropia
-Onset: 6 mos. to 4 years
-Pathogenesis: mechanical and innervational
-Treatment: patching, glasses and surgery
What type of strabismus?
Intermittent Exotropia
What is the etiology of neurologic strabismus?
Cranial nerve palsies may be congenital or acquired.
Trauma is the most common cause of this type of acquired palsy?
3rd nerve palsy
-Frequently congenital (infantile) in children
-Trauma is the most common cause of acquired palsy
-Acquired palsy is more ominous than congenital
-Affected anatomy: pupil, upper eyelid, and motility of muscles: medial rectus, superior rectus, inferior oblique=only thing not affected is outward deviation b/c that's innervated by CN VI.
-What nerve palsy is involved?
3rd nerve palsy
-Usually secondary to closed head trauma, but can be congenital as well
-Torticollis if unilateral
-Facial asymmetry with head tilt
-New onset may represent decompensation of congential palsy
-Treatment:
-->monitor-may resolve in 6-12 mos. if traumatic
-->Prism glasses
-->Surgery
What type of palsy is involved?
Fourth nerve palsy
-Congenital is rare and generally resolves within 6 weeks.
-Trauma is most common cause in healthy children
-Affects the lateral rectus, the medial rectus dominantes over the lateral rectus
-Bilateral palsy may be due to intracranial abnormality or increase in intracranial pressure
-Follows a nonspecific, viral illness
-Treatment if NO neurological signs:
-->rule out middle ear infection
-->blood count (lymphocytosis)
-->consider neuroimaging
-->follow carefully
-Management:
-->Monitor--be conservative for 6 mos.
-->Botox injection to medial rectus muscle to release the pull of the medial rectus
-->Prism glasses
-->patching
-->Surgery after 6 mos.
PALSY OF WHAT NERVE?
Sixth nerve palsy
-Monocular fixation
-Buchner
This type of visual evaluation is done in what type of children?
Pre-verbal children
What is one of the most common causes of amblyopia?
Uncorrected strabismus
What does depth perception depend on?
Good binocularity
Visual impairment of one eye from lack of use in an otherwise healthy eye; poor vision is not correctable by glasses....what term describes this?
Developmental Amblyopia
What is the most common cause of developmental amblyopia?
Strabismus
-Strabismus is the most common cause
-Visual deprivation due to occlusion (eg.cataract, ptosis, hemangioma)
-Anisometropia-unequal correction in the eyes
This describes the etiology for what?
Developmental Amblyopia
Treatment:
-Exclude an organic lesion (eg.hemangioma, etc.) as the cause of poor vision. If brain does not receive images, then normal development of the visual system does not ensue.
-Appropriate therapy is based on etiology. (Eg. remove cataract if present, etc.)
-Patch: occlusion of the preferred eye to force the other eye to function
-Glasses: prescribed for anisometropia
What does this describe treatment for?
Developmental Amblyopia
-Weaken or reduce muscle tension (like lengthening a rubber band to loosen)
-What type of surgery does this refer to?
Recessive surgery
-Strengthen or increase muscle tension (like shortening a rubber band to strengthen)
-What type of surgery does this refer to?
Resective surgery
What is called "white pupil"?
Leukocoria
-Infantile cataract is the most common cause
-Retinoblastoma
Both of these can cause what?
Leukocoria
What is the most common intraocular malignancy in children?
Retinoblastoma
-Retinopathy of prematurity
-Inflammation
-Persistent fetal vasculature
-Coat's Disease
-vonHippel's Disease
-Norrie's Disease
-Infection
-Organized intraocular hemorrhage
These are all causes of what?
Leukocoria
What is the most common cause of epiphora and mattering in an infant?
Nasolacrimal duct obstruction
Treatment:
-hygiene, massage, and topical antibiotics
-probing and irrigation if symptoms persist with conservative treatment
-lacrimal intubation-putting in a tube to keep the lacrimal duct open
-Dacryocystorhinostomy (DCR): a surgery if all else fails
This is the treatment for what?
Nasolacrimal duct obstruction
What are some other causes of chronic epiphora?
Infantile glaucoma