Podcast
Questions and Answers
What is the primary treatment for Ocular Myositis?
What is the primary treatment for Ocular Myositis?
- Prisms
- Surgery
- Corticosteroids (correct)
- Botox
The ______ barked
The ______ barked
dog
What is the main cause of Dissociated Vertical Deviation?
What is the main cause of Dissociated Vertical Deviation?
- Reduced light entering the eye (correct)
- Facial asymmetry
- Inferior oblique weakening
- Superior rectus recession
Pseudostrabismus is a condition where there is a manifest deviation of the visual axes.
Pseudostrabismus is a condition where there is a manifest deviation of the visual axes.
What is the purpose of investigating binocular single vision and fusional control in the management of Pseudostrabismus?
What is the purpose of investigating binocular single vision and fusional control in the management of Pseudostrabismus?
The _______________ muscle is responsible for torsion.
The _______________ muscle is responsible for torsion.
What is a common sign of torsion?
What is a common sign of torsion?
Match the following terms with their definitions:
Match the following terms with their definitions:
Anterior transposition of IO is a surgical procedure used to treat Dissociated Vertical Deviation.
Anterior transposition of IO is a surgical procedure used to treat Dissociated Vertical Deviation.
What is the primary concern when diagnosing muscle inflammation/swelling on a CT scan?
What is the primary concern when diagnosing muscle inflammation/swelling on a CT scan?
True or False: A disorder of supranuclear pathways can result in diplopia.
True or False: A disorder of supranuclear pathways can result in diplopia.
What is the purpose of the horizontal gaze centre in the midbrain?
What is the purpose of the horizontal gaze centre in the midbrain?
The _______________________ pathway lies at the region of the thalamus and midbrain.
The _______________________ pathway lies at the region of the thalamus and midbrain.
Match the following brain areas with their functions in eye movement control:
Match the following brain areas with their functions in eye movement control:
What is the typical latency or delay of the ocular motor system's response to a saccadic eye movement?
What is the typical latency or delay of the ocular motor system's response to a saccadic eye movement?
True or False: The basal ganglia and thalamus are involved in smooth pursuit control.
True or False: The basal ganglia and thalamus are involved in smooth pursuit control.
What is the typical presentation of Double Elevation Palsy?
What is the typical presentation of Double Elevation Palsy?
The _______________________ test may show full passive movement (negative result) or it may be positive in Double Elevation Palsy.
The _______________________ test may show full passive movement (negative result) or it may be positive in Double Elevation Palsy.
What is the primary concern when diagnosing muscle inflammation/swelling on a CT scan?
What is the primary concern when diagnosing muscle inflammation/swelling on a CT scan?
A disorder of supranuclear pathways can result in diplopia.
A disorder of supranuclear pathways can result in diplopia.
What is the function of the middle temporal visual area in the superior temporal sulcus?
What is the function of the middle temporal visual area in the superior temporal sulcus?
The horizontal gaze centre projects to the ipsilateral abducens nucleus and to the _______________ sub nucleus of third nerve on opposite side via MLF.
The horizontal gaze centre projects to the ipsilateral abducens nucleus and to the _______________ sub nucleus of third nerve on opposite side via MLF.
What is the typical presentation of Double Elevation Palsy?
What is the typical presentation of Double Elevation Palsy?
Match the following brain areas with their functions in eye movement control:
Match the following brain areas with their functions in eye movement control:
The basal ganglia and thalamus are involved in saccade control.
The basal ganglia and thalamus are involved in saccade control.
What is the typical latency or delay of the ocular motor system's response to a saccadic eye movement?
What is the typical latency or delay of the ocular motor system's response to a saccadic eye movement?
The vertical pathway lies at the region of the _______________ and midbrain.
The vertical pathway lies at the region of the _______________ and midbrain.
What is the function of the superior temporal sulcus in smooth pursuit eye movement?
What is the function of the superior temporal sulcus in smooth pursuit eye movement?
What is the primary goal of surgery in Dissociated Vertical Deviation?
What is the primary goal of surgery in Dissociated Vertical Deviation?
True or False: Ptosis can give the appearance of a horizontal deviation.
True or False: Ptosis can give the appearance of a horizontal deviation.
What is the purpose of investigating binocular single vision and fusional control in the management of Pseudostrabismus?
What is the purpose of investigating binocular single vision and fusional control in the management of Pseudostrabismus?
The _______________ muscle is responsible for torsion.
The _______________ muscle is responsible for torsion.
What is a common sign of torsion?
What is a common sign of torsion?
Match the following terms with their definitions:
Match the following terms with their definitions:
The fovea-optic disc relationship is observed in congenital cases to measure torsion _______.
The fovea-optic disc relationship is observed in congenital cases to measure torsion _______.
True or False: A wide IPD gives the appearance of a convergent deviation.
True or False: A wide IPD gives the appearance of a convergent deviation.
What is the characteristic feature of CPEO Myositis?
What is the characteristic feature of CPEO Myositis?
Kearns Sayre syndrome is associated with CPEO Myositis.
Kearns Sayre syndrome is associated with CPEO Myositis.
What is the typical age of onset for CPEO Myositis in Kearns Sayre syndrome?
What is the typical age of onset for CPEO Myositis in Kearns Sayre syndrome?
CPEO Myositis is a type of mitochondrial disorder associated with ____________.
CPEO Myositis is a type of mitochondrial disorder associated with ____________.
What is the primary investigation for Ocular Myositis?
What is the primary investigation for Ocular Myositis?
Ocular Myositis is a chronic condition that requires lifelong treatment.
Ocular Myositis is a chronic condition that requires lifelong treatment.
Match the following clinical features with the correct condition:
Match the following clinical features with the correct condition:
What is the primary management strategy for Ocular Myositis?
What is the primary management strategy for Ocular Myositis?
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Study Notes
CPEO Myositis
- Chronic progressive external ophthalmoplegia (CPEO) is a mitochondrial disorder associated with Kearns-Sayre Syndrome
- Clinical features:
- Progressive symmetrical loss of motility, with upgaze being the first to be affected
- Bilateral ptosis and orbicularis weakness
- Normal pupils and accommodation
- Diplopia is not usually complained of due to symmetrical and slow progression
- Final stages have virtually no eye movements with a positive forced duction test (FDT) due to secondary fibrosis
- Limitation of eye movement
- Kearns-Sayre Syndrome:
- CPEO in childhood (before the age of 20 years)
- Fine pigmentary retinopathy
- Clinical features: heart conduction block, deafness, cerebellar ataxia
- Management:
- Funduscopy
- ECG
- Orthoptic assessment (including UFOF, ptosis preps/Fresnel's)
Ocular Myositis
- Inflammation of one or more extraocular muscles (EOMs) resulting in impairment of function
- Sudden onset, can be acute or chronic (acute onset can become chronic)
- Clinical features:
- Painful diplopia
- Acute pain (periocular pain)
- Proptosis
- Oedema (periorbital/chemosis/swelling of the conjunctiva/eyelid swelling and redness)
- Underlying inflammatory disease/autoimmune disorder
- Restricted ocular motility and strabismus
- Investigations:
- Case history (painful diplopia and photophobia)
- Visual acuity (reduced)
- Cover test (type of strabismus relates to the affected EOM)
- Ocular motility (exophthalmos and lid oedema is evident in multiple EOM paresis)
- Diagnosis and management:
- Corticosteroids (highly effective in medical management of inflammation)
- Surgery may be required for residual restrictive strabismus
- Prisms may be required
- Consider Botox
- Self-limiting, usually resolves within 8 weeks
- CT scan shows marked inflammation/swelling of one or more muscles, including the tendon
- Ensure it is not Rhabdomyosarcoma, a highly malignant tumor that presents in childhood, usually associated with acute proptosis and strabismus
Supra/Infra/Inter Pathways
Supranuclear Disorders
- Signals controlling ocular movement are initiated in the cerebral hemispheres and then transmitted to the gaze centres in the midbrain and oculomotor nuclei
- Supra-nuclear neuronal pathways conduct impulses from cerebral hemispheres to gaze centres
- Control saccades, pursuits, and vestibular
- Disorder results in palsies of conjugate (connected) movement
Gaze Palsies
- Inability to make conjugate eye movements in one direction
- Does not cause diplopia as visual axis usually remains parallel
- Investigating each reflex and conjugate movement makes it possible to establish where the lesion lies
- E.g. frontal lesion = unilateral saccadic palsies, occipital lesion = unilateral pursuit palsies
Other
- Double elevation palsy: often congenital, presumed to be caused by a supranuclear defect
- Dissociated vertical deviation: spontaneous elevation of either eye intermittently when the stimulus to fixate is reduced
- Pseudostrabismus: appearance of strabismus when no manifest deviation of the visual axes is present
- Torsion: oblique muscle is responsible, can be measured objectively or subjectively
CPEO Myositis
- Chronic progressive external ophthalmoplegia (CPEO) is a mitochondrial disorder associated with Kearns-Sayre Syndrome
- Clinical features:
- Progressive symmetrical loss of motility, with upgaze being the first to be affected
- Bilateral ptosis and orbicularis weakness
- Normal pupils and accommodation
- Diplopia is not usually complained of due to symmetrical and slow progression
- Final stages have virtually no eye movements with a positive forced duction test (FDT) due to secondary fibrosis
- Limitation of eye movement
- Kearns-Sayre Syndrome:
- CPEO in childhood (before the age of 20 years)
- Fine pigmentary retinopathy
- Clinical features: heart conduction block, deafness, cerebellar ataxia
- Management:
- Funduscopy
- ECG
- Orthoptic assessment (including UFOF, ptosis preps/Fresnel's)
Ocular Myositis
- Inflammation of one or more extraocular muscles (EOMs) resulting in impairment of function
- Sudden onset, can be acute or chronic (acute onset can become chronic)
- Clinical features:
- Painful diplopia
- Acute pain (periocular pain)
- Proptosis
- Oedema (periorbital/chemosis/swelling of the conjunctiva/eyelid swelling and redness)
- Underlying inflammatory disease/autoimmune disorder
- Restricted ocular motility and strabismus
- Investigations:
- Case history (painful diplopia and photophobia)
- Visual acuity (reduced)
- Cover test (type of strabismus relates to the affected EOM)
- Ocular motility (exophthalmos and lid oedema is evident in multiple EOM paresis)
- Diagnosis and management:
- Corticosteroids (highly effective in medical management of inflammation)
- Surgery may be required for residual restrictive strabismus
- Prisms may be required
- Consider Botox
- Self-limiting, usually resolves within 8 weeks
- CT scan shows marked inflammation/swelling of one or more muscles, including the tendon
- Ensure it is not Rhabdomyosarcoma, a highly malignant tumor that presents in childhood, usually associated with acute proptosis and strabismus
Supra/Infra/Inter Pathways
Supranuclear Disorders
- Signals controlling ocular movement are initiated in the cerebral hemispheres and then transmitted to the gaze centres in the midbrain and oculomotor nuclei
- Supra-nuclear neuronal pathways conduct impulses from cerebral hemispheres to gaze centres
- Control saccades, pursuits, and vestibular
- Disorder results in palsies of conjugate (connected) movement
Gaze Palsies
- Inability to make conjugate eye movements in one direction
- Does not cause diplopia as visual axis usually remains parallel
- Investigating each reflex and conjugate movement makes it possible to establish where the lesion lies
- E.g. frontal lesion = unilateral saccadic palsies, occipital lesion = unilateral pursuit palsies
Other
- Double elevation palsy: often congenital, presumed to be caused by a supranuclear defect
- Dissociated vertical deviation: spontaneous elevation of either eye intermittently when the stimulus to fixate is reduced
- Pseudostrabismus: appearance of strabismus when no manifest deviation of the visual axes is present
- Torsion: oblique muscle is responsible, can be measured objectively or subjectively
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