What previous eye condition is mentioned in the patient's history?
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Strabismus.
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What previous eye condition is mentioned in the patient's history?
Strabismus.
What is the purpose of the prism cover test?
To measure strabismus.
What is the most common type of strabismus?
Esotropia.
How is Hirschberg's test performed?
By shining a light in the patient's eyes and observing the reflection on the corneas.
What is the classification of esotropia in infants?
Infantile esotropia occurs in children less than 6 months old.
What are the two main classifications of exotropia?
Congenital and acquired.
What is diplopia?
Double vision.
What is Ocular Myasthenia Gravis?
A neuromuscular disorder that affects the muscles controlling eye and eyelid movement.
What is Thyroid Eye Disease?
An autoimmune condition affecting the eyes, often associated with thyroid disorders.
What surgical option is available for managing strabismus in children?
Strabismus surgery.
What is the primary function of Cranial Nerve VI (CN6)?
Abduction of the eye.
What does adduction refer to in eye movement?
Moving the eye towards the nose.
What is a common cause of CN3 palsy?
Vascular issues, specifically posterior communicating artery (PCOM) aneurysm.
What is ptosis?
Droopy eyelid.
What are the symptoms of CN3 palsy?
Oculomotor nerve palsy, causing ptosis, dilated pupil, and inability to move the eye in certain directions.
What are the key aspects to consider in the history of diplopia?
Onset and orientation, constant vs intermittent, and associated symptoms.
What condition should be ruled out when evaluating CN3 palsy?
Posterior communicating artery aneurysms.
Which muscles are innervated by the superior division of the oculomotor nerve?
Levator palpebrae superioris (LPS) and superior rectus (SR).
What are common types of strabismus seen in children?
Esotropia and exotropia.
What is the purpose of the ice pack test?
To assess the presence of ocular myasthenia gravis by observing improvement in ptosis or diplopia after cooling the eyelids.
What is tropia?
True strabismus.
What is a common clinical presentation of strabismus?
Eye deviation.
What is Hirschberg's test used for?
To assess ocular alignment and detect strabismus.
What is CN6 palsy associated with?
Abducens nerve palsy, leading to inability to abduct the eye.
What percentage of children with strabismus have exotropia?
25%.
What does the position of the light reflection indicate in Hirschberg's test?
It indicates the degree of strabismus present.
What imaging technique is used in the ER to assess CN3 palsy?
CT/CTA.
What cranial nerve palsy is associated with horizontal diplopia?
CN6 palsy.
What is childhood strabismus?
A condition where the eyes do not properly align with each other during gaze in children.
In which conditions might a fatigability test be particularly useful?
In diagnosing conditions like myasthenia gravis or other neuromuscular disorders.
What is a neuromuscular condition?
A disorder that affects the muscles and the nerves that control them.
What are the types of acquired exotropia?
Intermittent XT, constant XT, and sensory XT.
What is the role of CN3 in diplopia?
CN3 palsy can cause both horizontal and vertical diplopia.
What role do muscles play in movement?
They contract to produce movement and maintain posture.
What characterizes sensory exotropia?
It occurs in a non-seeing eye.
What is the role of acetylcholine in a normal individual?
It attaches to acetylcholine receptors (AChR’s) on skeletal muscle to initiate contraction.
What are common symptoms of CN6 palsy?
Diplopia (double vision) and inability to move the eye laterally.
What is ptosis in the context of Cranial Nerve 3 palsy?
Drooping of the upper eyelid.
What imaging technique shows enlargement of the extraocular muscles in Thyroid Eye Disease?
CT scan of the orbit.
What is CPEO in relation to diplopia?
Chronic Progressive External Ophthalmoplegia, a muscular condition that can cause diplopia.
Which cranial nerve is affected in CN6 palsy?
Cranial Nerve VI (Abducens nerve).
What can cause Cranial Nerve 3 palsy?
Aneurysms, tumors, or diabetes.
What is Cranial Nerve 6 responsible for?
It controls lateral eye movement.
What abnormal posture may be observed in individuals with strabismus?
Abnormal head posture.
What percentage of strabismus cases does esotropia account for?
50 - 75%.
What are congenital causes of IOOA SOUA?
Congenital factors can lead to IOOA SOUA.
What is abduction in terms of eye movement?
Moving the eye towards the ear.
How can head trauma contribute to IOOA SOUA?
Head trauma can cause IOOA SOUA.
What does supraduction mean?
Moving the eye upward.
What is the pathophysiology of Thyroid Eye Disease (TED)?
Autoimmune inflammation of the extraocular muscles (EOM).
Which cranial nerve palsy can cause vertical diplopia?
CN4 palsy.
What is the purpose of the Cover Test?
To assess eye alignment and detect strabismus.
Which condition is associated with neuromuscular junction (NMJ) issues that can cause vertical deviations?
Myasthenia gravis.
Which muscles are innervated by the inferior division of the oculomotor nerve?
Medial rectus (MR), inferior rectus (IR), and inferior oblique (IO).
What symptoms might indicate strabismus in a child?
Crossed eyes, squinting, or difficulty focusing on objects.
How is the ice pack test performed?
An ice pack is placed over the eyelids for a few minutes, and then the patient's eyelid position is evaluated.
Why is the orientation of diplopia important in history taking?
It helps in diagnosing the underlying cause and determining the appropriate management.
What appearance do patients with Thyroid Eye Disease often have?
A staring look.
What is the difference between constant and intermittent strabismus?
Constant strabismus is always present, while intermittent strabismus occurs occasionally.
What does EOM stand for?
Extraocular Muscles.
What are the management options for Thyroid Eye Disease?
Management may include medications, radiation therapy, and surgery in severe cases.
What characterizes fully accommodative esotropia?
It corrects with glasses for hyperopia.
What can cause adult strabismus?
Neurological disorders, trauma, or previous eye surgery.
What organs are part of the digestive system?
Mouth, esophagus, stomach, intestines, liver, pancreas, and gallbladder.
How does muscle fatigue present in Myasthenia Gravis?
Fatigable, worse towards the end of the day, and intermittent.
What examination finding is noted in extraocular muscles (EOM) in MG?
Restriction of muscle.
What is the definition of strabismus?
Misalignment of the eyes.
What symptom is associated with dysfunction of Cranial Nerve VI?
Horizontal diplopia.
What does CN4 palsy affect?
Trochlear nerve, resulting in difficulty looking down and inwards.
What is physiologic diplopia?
A type of double vision that occurs under normal conditions, often when looking at objects at different distances.
What are some causes of CN3 palsy?
Intracranial aneurysms, compressive lesions in the cavernous sinus, diabetes mellitus, and trauma.
When does physiologic diplopia typically occur?
When viewing objects at varying distances, particularly when one eye is fixated on a near object and the other on a distant object.
What microvascular conditions are associated with IOOA SOUA?
Diabetes and hypertension.
What is infraduction?
Moving the eye downward.
What are common symptoms of Ocular Myasthenia Gravis?
Ptosis (drooping eyelids) and diplopia (double vision).
What is a common method used in a fatigability test?
Repetitive muscle contractions or sustained muscle activity.
How does the Cover Test work?
One eye is covered while observing the uncovered eye for movement.
What muscle condition can lead to vertical deviations and is associated with thyroid eye disease?
Double elevator palsy.
What autonomic function travels with the inferior division of the oculomotor nerve?
Parasympathetics for pupil constriction.
What does a movement of the uncovered eye during the Cover Test indicate?
It indicates a misalignment or strabismus in the covered eye.
How is Thyroid Eye Disease diagnosed?
Diagnosis is typically made through clinical examination and imaging studies.
What can cause CN6 palsy?
Causes can include trauma, tumors, vascular issues, or increased intracranial pressure.
What are the two classifications of esotropia based on age?
Infantile (<6 months) and Acquired (6 months - 7 years).
When is strabismus surgery considered in adults?
If the strabismus is stable.
What are common symptoms of Myasthenia Gravis?
Intermittent fatigable diplopia and/or ptosis.
How does Cranial Nerve 3 palsy affect vision?
It can lead to double vision (diplopia).
What are the major components of the human circulatory system?
The heart, blood vessels, and blood.
Which muscle is affected by Cranial Nerve 4 palsy?
Superior oblique muscle.
What is the function of the nervous system?
To transmit signals between different parts of the body and coordinate responses.
What is the largest organ in the human body?
The skin.
What is the primary function of Cranial Nerve IV (CN4)?
Incyclotorsion, depression, and abduction of the eye.
What symptoms are associated with dysfunction of CN4?
Vertical/torsional diplopia and head tilt.
What is the purpose of a fatigability test?
To assess the endurance and fatigue levels of a muscle or muscle group.
What does DDx stand for in medical terminology?
Differential Diagnosis.
What is a normal finding in Hirschberg's test?
The light reflection should be centered on the cornea of both eyes.
How can amblyopia be treated in children?
Through patching if needed.
What is a common cause of vertical deviations related to nerve issues?
CN4 palsy.
Is physiologic diplopia a permanent condition?
No, it is usually temporary and resolves when the eyes are aligned properly.
What role do tumors play in IOOA SOUA?
Tumors can be a cause of IOOA SOUA.
What is strabismus?
Strabismus is a condition in which the eyes do not properly align with each other when looking at an object.
What causes physiologic diplopia?
It is caused by the brain's inability to fuse images from both eyes when they are not aligned.
How can an aneurysm lead to IOOA SOUA?
An aneurysm can cause IOOA SOUA.
What condition at the neuromuscular junction can lead to diplopia?
Myasthenia Gravis (MG).
What syndrome is associated with vertical deviations?
Brown syndrome.
What is the most common type of strabismus?
Esotropia (50 - 75%).
What are some management strategies for childhood strabismus?
Eyewear, vision therapy, or surgery.
What does ophthalmoplegia refer to?
Paralysis or weakness of the eye muscles.
What is the result of defective transmission at the neuromuscular junction (NMJ) in MG?
Muscle fatigability and weakness.
How is CN6 palsy diagnosed?
Through clinical examination and imaging studies to identify underlying causes.
What is adult strabismus?
A condition where the eyes do not properly align when looking at an object.
Which cranial nerves innervate the extraocular muscles?
Oculomotor (III), Trochlear (IV), and Abducens (VI).
What is the role of the respiratory system?
To facilitate gas exchange, primarily oxygen and carbon dioxide.
How is Cranial Nerve 6 palsy diagnosed?
Through clinical examination and imaging studies.
What can cause Cranial Nerve 4 palsy?
Trauma, vascular disease, or tumors.
What symptom may occur in older children and adults with strabismus?
Diplopia.
What is the first step in managing strabismus in children?
Treat the underlying cause.
What are the limitations in eye movement associated with CN3 palsy?
Limited right supraduction, infraduction, and adduction, along with ptosis.
What should be checked for in children with strabismus?
Refractive errors (glasses).
What does a fatigability test typically measure?
The ability of muscles to sustain activity over time.
What is the primary function of nerves in the body?
To transmit signals between the brain and other parts of the body.
How common is congenital exotropia?
It is rare.
What associated symptoms should be noted in a diplopia history?
Myasthenia gravis, thyroid issues, focal neurological deficit, and high intracranial pressure (ICP).
What is a common symptom of Thyroid Eye Disease?
Proptosis.
What is Cranial Nerve 3 also known as?
Oculomotor nerve.
What is the difference between constant and intermittent diplopia?
Constant diplopia occurs all the time, while intermittent diplopia occurs occasionally.
What special sign is characterized by the retraction of the eyelids?
Eyelid retraction.
What are the two main types of strabismus?
Esotropia (inward turning of the eye) and exotropia (outward turning of the eye).
What is a primary symptom of CN6 palsy?
Limited abduction of the right eye.
What type of glasses can be used to manage strabismus?
Prism glasses (stick on Fresnel or ground in).
What happens to acetylcholine receptors in Myasthenia Gravis (MG) patients?
Acetylcholine receptor antibodies (AChR - Ab’s) bind to AChR’s and reduce their number.
What treatments are available for Ocular Myasthenia Gravis?
Treatments include medications like anticholinesterase agents, immunosuppressants, and in some cases, surgery.
What is the primary function of the human skeletal system?
To provide structure, support, and protection to the body.
What is Cranial Nerve 4 also known as?
Trochlear nerve.
What is a common symptom of Cranial Nerve 4 palsy?
Vertical diplopia (double vision).
How is adult strabismus diagnosed?
Through a comprehensive eye examination and assessment of eye alignment.
What is a potential treatment for Cranial Nerve 6 palsy?
Management may include prism glasses or surgery in severe cases.
What is the role of the immune system?
To defend the body against pathogens and diseases.
What past medical history (PMHx) conditions are noted?
Diabetes Mellitus (DM), Hypertension (HTN), dyslipidemia, infections (URTIs), vaccinations.
What is the first step in managing strabismus in adults?
Treat the underlying cause (e.g., MG, Thyroid, intracranial pathology).
What are common symptoms of Thyroid Eye Disease?
Symptoms include bulging eyes, dryness, irritation, and vision changes.
What is CN6 palsy?
A condition resulting from the dysfunction of the sixth cranial nerve, affecting lateral eye movement.
What is one non-surgical management option for strabismus in adults?
Patching one eye.
What causes Thyroid Eye Disease?
It is caused by an autoimmune response that affects the muscles and tissues around the eyes.
How can strabismus affect a child's vision?
It can lead to amblyopia or double vision if not treated.
What indicates a positive result in the ice pack test?
A noticeable improvement in eyelid droop or double vision after the ice pack is removed.
What are some potential causes of CN6 palsy?
Tumour, microvascular occlusion, trauma, aneurysm, raised intracranial pressure.
What is the significance of detecting strabismus early?
Early detection can lead to more effective management and treatment.
What is accommodative strabismus?
A type of strabismus that occurs due to focusing efforts, often seen in children who are farsighted.
What is the primary function of the extraocular muscles?
To control eye movements.
What is a common management strategy for CN6 palsy?
Prism glasses to help align vision and reduce diplopia.
What is partially accommodative esotropia?
It partially corrects with glasses for hyperopia.
What are common symptoms of adult strabismus?
Double vision, eye strain, and difficulty with depth perception.
What are common ocular symptoms of Myasthenia Gravis (MG)?
Droopy eyelids and/or diplopia.
What position may a patient with Cranial Nerve 4 palsy adopt to compensate for their condition?
Head tilt towards the unaffected side.
What causes Ocular Myasthenia Gravis?
It is caused by an autoimmune response that disrupts communication between nerves and muscles.
What are common symptoms of Cranial Nerve 3 palsy?
Ptosis, ophthalmoplegia, and dilated pupil.
What does phoria refer to?
Latent strabismus, present when breaking fusion.
How is Ocular Myasthenia Gravis diagnosed?
Through clinical examination, blood tests for antibodies, and electrodiagnostic tests.
What muscular condition is associated with diplopia and involves thyroid dysfunction?
Thyroid Eye Disease (TED).
What injectable treatment can be used for strabismus management?
Botox in the muscle.
What is a characteristic finding in the extraocular muscles in Thyroid Eye Disease?
Restriction of extraocular muscles in any pattern.
What is non-accommodative strabismus?
Strabismus that is not related to focusing efforts and does not improve with glasses.
How many extraocular muscles are there?
Six.
What is a common symptom of Cranial Nerve 6 palsy?
Diplopia (double vision).
What can cause Cranial Nerve 6 palsy?
Causes can include trauma, tumors, or increased intracranial pressure.
What systemic symptoms are associated with Myasthenia Gravis?
Dysarthria, dyspnea, dysphagia, and muscle fatigue.
What are the main types of muscle tissue in the human body?
Skeletal, cardiac, and smooth muscle.
What is the function of the endocrine system?
To regulate bodily functions through hormones.
What is included in the past ocular history (POHx)?
Childhood strabismus, previous strabismus surgery, previous episodes of diplopia, lazy eye.
Why is Myasthenia Gravis referred to as a 'big mimicker'?
Because it can mimic other conditions due to its symptoms.
What defines non-accommodative esotropia?
There is no significant refractive error.
What are some causes of esotropia?
CN6 palsy, thyroid eye disease, Myasthenia gravis, sensory ET (non-seeing eye such as retinoblastoma).
What are the management options for adult strabismus?
Options include glasses, prisms, vision therapy, and surgery.
What is the examination finding for levator palpebrae superioris in MG?
Ptosis.
What is a common finding in the orbicularis oculi muscle in Myasthenia Gravis?
Weak orbicularis.
What type of surgery is mentioned in the past surgical history (PSHx)?
Neurosurgery.
What previous episodes related to vision are noted in the patient's history?
Episodes of diplopia.