Term
| When does the exam begin? |
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Definition
| The exam begins when you first observe your patient. (eg. Is the patient reading? Head tilt? Leaning on something?) |
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Term
What is not an acceptable CC in the case of an obvious strabismus?
A. "We just wanted to get her eyes checked."
B. "Her eye is so… I mean, just look at it! What in Cherry Hill is that?!"
C. "She doesn't have any complaints, but we've noticed that she always looks just a little cross-eyed." |
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Definition
A. "We just wanted to get her eyes checked."
Do not accept "We just wanted to get her eyes checked" as a reason for the visit in cases of obvious strabismus. |
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Term
Given three head postures, which of 1, 2, or 3 simulates the gestures of A, B, or C?
1. Tilt A. "Yes"
2. Turn B. "No"
3. Tip C. Ear toward shoulder |
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Definition
Tilt = Ear toward shoulder
(...like trying to tilt a pinball machine)
Turn = "No"
(...like what a car's nose does when you turn the wheel)
Tip = "Yes"
(...like the motion you feel inside the car as it balances nose-forward on the edge of a cliff due to your not turning hard enough) |
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Term
| What's the good thing about seeing a head tilt (or other alternative posture)? |
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Definition
| The tilt implies that the patient does have some fusional ability. |
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Term
What is not a common sign suggesting some amblyopic/strabismic vision problem?
A. Closing one eye in bright light
B. Excessive blinking or eye rubbing
C. Some funny head posture
D. Absence of a blink reflex when startled |
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Definition
A. Closing one eye in bright light
(Seen in X(T)s, especially.)
B. Excessive blinking or eye rubbing
(Tends to yield blepharitis, btw…)
C. Some funny head posture
(Remember this implies some fusion, too.)
D. Absence of a blink reflex when startled
(Yeah, I just made that up.) |
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Term
| Asthenopia is most likely seen in the (younger / older), (constant / intermittant) strabs. |
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Definition
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Term
When a strabismus presents with diplopia, what's the first thing you should think of?
Conversely, when a strabismic patient is not complaining of diplopia, what do you know right away? |
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Definition
Diplopia means that the onset of the strabismus was very recent.
Lack of diplopia means that the strabismus is very long-standing. |
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Term
| If a patient presents with diplopia via strabismus, but you can determine that the strabismus was not acquired, what might the problem be (in a word)? |
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Definition
Decompensation
The patient has always had a problem, but was young and limber enough to compensate for it. Now, age-ridden weariness and the fatigue of reaching the end of their mortal coil is taking that compensation away.
…Decompensation. Letting you see both sets of grandkids. |
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Term
| Is it uncommon to have a strab patient coming in for a second opinion on another doc's management plan? |
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Definition
| Nah. I mean, who likes vision therapy? |
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Term
| Describe Sheard's. What is it a criterion for? |
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Definition
Sheard's --> 2x phoria = compensation ability
Comfort criterion (ie. helps determine the severity of asthenopia from strabismus) |
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Term
| If a patient has poor fusional vergence (eg. they're strabismic when they read), why might they not even complain about it? |
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Definition
| They might not complain about a fusional vergence problem because they develop a habitual avoidance of the tasks that tend to tax their system. (eg. They don't do much reading.) |
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Term
| Might a patient progress from intermittent to constant strabismus? |
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Definition
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Term
| What might push an intermittent strab toward being constant? |
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Definition
A high POTS value. (So here's an example when it's bad to be high on pot...s...)
In other words: A greater frequency of strabismus, encouraging more sensory adaptation (and therefore fewer symptoms). This is especially true if the patient is young and neurologically plastic. |
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Term
| Why is it important to do a thorough DDx of what you might just call "amblyopia" and be done with the matter? |
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Definition
| Because the unilateral vision loss could be due to organic causes (eg. a hypoplastic disc or a tumor or something crazy like that) |
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Term
| What might "sudden onset" amblyopia otherwise be known as? (Besides malingering or a brain tumor?) |
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Definition
"Sudden discovery" amblyopia.
ie. The patient had some reason to close one of their eyes one day and suddenly noticed their poor vision in the other eye. |
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Term
| Can functional amblyopia be bilateral? |
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Definition
Rarely, but sure.
Possibly due to high isoametropia. |
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Term
| What are some possible causes of unilateral functional amblyopia? |
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Definition
| Uncorrected RE, strabismus, form deprivation (eg. ptosis, cataract) |
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Term
| T/F: Time of onset is a super-duper critical piece of information for the prognosis of strabismus. |
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Definition
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Term
| Between "congenital," "infantile," and "early onset" strabismus, which term is less preferred? |
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Definition
| "Congenital" is less preferred because babies aren't actually born strabismic - it (usually ET) may show within the first 3 days. |
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Term
| When in life are the most common periods of onset of strabismus? |
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Definition
< 6 yo and > 50 yo
(50% of childhood strabismus onset is before 1 yo = "Congenital" / "Infantile" / "Early Onset") |
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Term
| According to Archer ('89), neonates start as exos, but what predictable time period might incite ET to develop? |
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Definition
| 2-4 months (ie. about the time that binocular wiring starts to kick in) |
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Term
| "Acquired Strabismus" begins after what age? "Early Acquired"...? "Late Acquired"...? |
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Definition
> 1 yo = "Acquired Strabismus"
< 5 yo = "Early Acquired Strabismus"
> 5 yo = "Late Acquired Strabismus" |
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Term
| An infant presents with ET once or twice over the course of their first 6 months. What is your first thought? |
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Definition
| Probably OK. Sometimes, completely normal, developing visual motor systems end up with a quick error or two as they're figuring things out. |
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Term
| Are parents statistically reliable reporters of whether or not their child is strabismic? |
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Definition
Sensitivity (Recognized strab) = Not really. (65% of real strab recognized)
Specificity (Recognized no strab) = Yep. (99%) |
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Term
| When is a parent's judgement of their child's eye position the least reliable? |
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Definition
| Within the infant's first year, esp because of epicanthal folds/wide bridge and the baby's poor binocularity in their first 2 months. |
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Term
| Strabismus at 2 years old is likely due to problems in what visual system? |
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Definition
| Accommodation (thought post-viral ET is not unheard of) |
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Term
| What are three particularly cautionary forms of strabismus? (Two of which are Early Onset / Infantile) |
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Definition
XT remaining after 6 mo
ET remaining after 2 mo
Sudden-onset |
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Term
| Some say that time of onset of strabismus is less important than... |
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Definition
| …the time span between onset and treatment. |
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Term
Patching is good for…
A. Improving VAs
B. Improving alignment
C. Both A and B |
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Definition
A. Improving VAs
Patching is for improving VAs, not alignment. (…says Dr. London.) |
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Term
| Strabismus sees a high familial incidence of up to 70%. Moreso, if the patient's sibling is XT OD, what can you tell me about the patient's eyes? |
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Definition
| If the patient has strabismus (70% likelihood), there is a 96.5% likelihood that he/she will also be XT OD. |
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Term
What are some familially-influenced factors that put a parent's child at risk for developing strabismus?
(High / Low) AC/A Ratio
(Myopia / Hyperopia) > 1.50 D
Poor (Accommodative / Vergence) Ability
(Eso- / Exo-)phoric Tendency |
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Definition
High AC/A Ratio
Hyperopia > 1.50D
Poor Vergence Ability (can't compensate)
Eso- / Exo- (either/both) -phoric Tendency |
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Term
What are some other risk factors toward developing strabismus?
(High / Low) birth weight
History of maternal (cigarette smoking / undereating)
Maternal (ethnicity / age)
(Neurological / Physiological) abnormalities |
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Definition
Low birth weight
History of maternal cigarette smoking
Maternal age
Neurological abnormalities |
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Term
Comparing Early Onset Strabismus to Adult Onset Strabismus is like comparing…
A. Apples to Oranges
B. Apples to slightly bigger Apples
C. Apples to slightly smaller Apples |
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Definition
A. Apples to Oranges
Adult onset strabismus is a different entity. Now you have to worry about pathology, head trauma, etc. |
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Term
| If a patient is experiencing torsional diplopia, where is the problem likely to be located? |
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Definition
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Term
If the angle of strabismus or diplopia changes throughout the day, what is the least likely DDx?
A. Myasthenia Gravis
B. Multiple Sclerosis
C. Parkinson Disease
D. Inadequate Fusional Ability |
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Definition
C. Parkinson Disease
A (MG), B (MS), and D (bad fusion) are all good reasons why diplopia might get worse as the day goes on. |
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