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49 Cards in this Set
- Front
- Back
What will the UCT evaluate? What results do you find? Having a (+) ____ will contaminate the UCT results
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Whether bifixation present under associated conditions; Determines direction and eye laterality (ONLY estimates frequency and magnitude); +EF
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T/F Must make sure pt is wearing best correction during UCT, not ACT.
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False, both UCT and ACT must have best rx
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What's the difference between primary vertical and secondary vertical?
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Primary: present when eyes are in ortho alignment.
Sec: present only when eyes are misaligned (why you need to neutralize horizontal before vertical) |
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How do high spectacle powers change a pts deviation on ACT?
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>+5.00 will DECREASE measured deviation;
>-5.00D will INCREASE deviation |
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Equation for calculated AC/A?
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AC/A = pd(cm) + m(<Dn - <Df)
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What is the 4 BO prism test used for? In which case is it especially useful? Does the pt focus at near or distance?
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Assesses whether there is bifoveal fusion or suppression of one fovea; small angle ET; Distance
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Double maddox rod test: If RE is rotated EXtorsionally, how would red line be rotated if red lens over RE?
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Red line would need to be rotated INtorsionally (toward nose)
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What are the 3 general etiological factors that cause strabismus?
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anatomical, optical, innervational
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Most concomitant deviations are __________ in origin, whereas most nonconcomitant deviations are from what type of origin?
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Supranuclear; Nuclear or infranuclear
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According to Rush & Younge, what are the 3 most common causes of 3, 4, 6 nerve paresis in adults? Children?
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Adults: Trauma, vascular, neoplasm; Kids: acute viral illness, trauma, congenital.
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Which type of deviation, concomitant or nonconcomitant, may represent a life-threatening situation? Which diagnostic question would you ask?
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Nonconcomitant; Ask about diplopia (can attribute to brain)
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What is the most likely reason for muscle overaction?
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underacting contralateral synergist (Hering's law of equal innervation)
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What would you suspect if your pt came in with their head tilted toward their RIGHT shoulder?
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Left SO underaction
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What is the difference between primary vs secondary deviations on ACT?
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Primary: normal eye fixating, prism in front of deviated eye.
Sec: Paretic eye fixating, prism in front of normal eye. |
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During direct observation, how can you determine if an abnormal head position is ocular torticollis or congenital torticollis?
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Ocular - tilt will go away with patching; congenital - tilt remains with patching
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When would you do duction testing? Forced duction testing?
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Duction: when see UA on version testing; FD: When see UA on duction testing (determines if mechanical or innervational cause)
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During forced duction testing, what type of anomaly do you suspect if (+) restriction? (-) restriction?
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(+) = mechanical;
(-) = paresis (eye moves when forced) |
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Which test is good for determining newly acquired paresis?
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Past pointing (spatial localization testing)
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Which will be greater in pd, primary deviations or secondary deviations? Why?
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Secondary because paretic eye is fixating (prism over normal eye). So highest amount of prism to fix underaction will be in the problematic eye.
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The two subjective diagnostic testing methods Red lens/maddox rod and Hess-Lancaster assume what about the pt?
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They do not have AC or deep suppression
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What are the classifications for nonconcomitant deviations?
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<5pd = Concomitant
6-10pd = Mild 11-15pd = Moderate >15pd = Marked |
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Who is most likely at risk for developing consecutive XT?
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Moderately sized ET with +4.5D or greater hyperopia and poor potential for normal BV
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What would you see on ACT if your pt had a dissociated vertical deviation (DVD)?
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Spontaneous turning of one or both eyes upward
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What would you see on versions if your patient had bilateral overacting Inferior Oblique’s (IOs)?
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Upward and nasal movement
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What types of A-V pattern stabismus are most common? Least?
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V-Eso > A-Eso > V-Exo > A-Exo
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How to you differentiate paretic vs. Nonparetic strabismus?
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Paretic = Acute, sudden, diplopic, differing primary/secondary deviation, past-pointing; Nonparetic = chronic, childhood, no head posture
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How do you differentiate congenital/old vs recent paralysis?
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Recent - diplopia always present, incomitant, past-pointing Congenital - toticollis
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What are the three stages that a recent paresis may under go?
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1)Weakness of paretic muscle, followed by OA of its direct antagonist. 2)Contracture of direct antagonist. 3) Spread of concomitancy
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Which paralysis would cause the eye to turn down and out? What also accompanys this paralysis?
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Complete third nerve palsy; ptosis and fixed, dilated pupil
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What are the most common causes of complete 3rd nerve palsies?
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(1) Undetermined. (2) Vascular. (3) Trauma. (4) Aneurysm
VTA |
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Superior rectus paresis will present with what?
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hypo-deviation of affected eye and limitation of elevation when eye is abducted. Often head is tilted AWAY from affected side
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What is a ddx of superior rectus paresis?
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mechanical (limited elevation) or thyroid myopathy
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Medial rectus paresis will present with what?
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limited/absence of adduction, probable XT in primary gaze, face turned TOWARD affected side
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Which palsies would present with pt head tilted TOWARD affected side? AWAY from affected side?
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MR, LR, IR, and IO paresis would have pt present tilted toward side; SR, SO(CN4) would be away
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What are the most common etiologies for CN4 SO palsy in adults? Children?
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Trauma, Vascular, Neoplasms (TVN); Congenital, trauma, inflammation (CTI)
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What are the most common etiologies for CN6 LR palsy in adults? Children?
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Vascular, trauma, neoplasm (VTN); Neoplasm, trauma, inflammation (NTI)
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What kind of oculomotor anomaly is endocrine myopathy often associated with?
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Graves
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Which test that DIRECTLY asses the angle of anomaly is NOT effected by (+) EF?
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Maculo-macula test of cuppers (bifoveal test)
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What do the 3 categories of Duane's syndrome look like?
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I: AbDuction deficit
II: ADDuction deficit III: AbDuction and aDDuction deficit. |
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In acute-onset esotropia, whould should NOT be present?
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Amblyopia, suppression or AC
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T/F If an esotrope is comitant, there is no neurological disease
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False, it does not rule out path.
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What is Cyclic esotropia?
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Alternate day Esotropia (24 hrs normal then 24hrs ET)
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What are some causes of Paretic esotropia?
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Mechanical restriction, Duane's I and III, Thyroid myopathy, MR fibrosis, trauma, LR6 palsy.
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What is Blind-spot esotropia?
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Blind spot of deviating eye consistently overlying fixation area NC
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What would you observe on the UCT with microesotropia? Visuoscopy?
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No movement; + EF which is equal to the angle of anomaly
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What pt will typically have monofixation syndrome (MFS)?
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Infantile ET that underwent surgery to have cosmetically straight eyes, central/paracentral suppression, peripheral fusion, and No global but limited local stereo
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Which one of the secondary exotropias are usually caused by pathology?
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Sensory exotropia - constant, unilateral XT following loss or severe reduction of vision in one eye.
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What are two ways in which exotropia classified?
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Constant XT or intermittent XT
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which muscle is least likely to be paralyzed? What is the etiology, most likely?
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IO; congenital
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