BV 11 - Myo neuro mechanical

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sookylala
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290531
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BV 11 - Myo neuro mechanical
Updated:
2014-12-03 10:16:20
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paretic
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  1. Ocular neuromyotonia?
    • acquired
    • rare, transient involuntary spasm of EOM resulting in strab
    • often hx of radiotherapy
  2. Monocular elevation deficiency?
    • congenital deficiency of monocular elevation in primary and abad-duction
    • hypotropia of deficit eye
    • SR palsy and IR contracture
    • assoc: pseudoptosis and jaw winking
    • tx: surgery
  3. Treatment for nerve palsies
    • ischemic: spontaneous resolving
    • vasculopathy: GP to treat underlying cause
    • aneurysm/compression: refer for MRI
    • GCA: ESR and c-reactive protein
    • trauma: CT
    • nonsurgical: fresnel prism, botox, alt occlusion
  4. Duane's type 1, 2 and 3?
    • type 1: abduction limited + widen, adduction- globe retraction and narrowing, ST
    • type 2: abduction widening, adduction- limited, retraction and narrow, XT
    • type 3: abd and ad limited
  5. Brown syndrome?
    • SO sheath syndrome
    • vert diplopia in elevation
    • hypertropia of affected eye- head tilt backwards
    • Features: elevation worse ad, less primary, ok in ab, no SO overaction, V pattern, +ve forced duction testing
  6. What is the cause of myasthenia gravis?
    ACH receptor site antibodies reduce effectiveness of ACh- muscles become exhausted
  7. What are 3 key ocular signs of myasthenia gravis?
    • 1. Ptosis: bilateral, variable, switches eye, worse end of day
    • 2. diplopia: vertical, variable, intermittent
    • 3. obicularis weakness: cant prevent examiner from closing eyes, incomplete closure- exposure keratitis
  8. What are the 3 types of lid retraction in myasthenia gravis?
    • 1. cogan's lid twitch: prolonged downgaze, primary gaze will reveal upper lid twitch
    • 2. transient lid retraction: prolonged upgaze
    • 3. paraodixical sign: ptotic eye fixating- contralateral lid retraction, if lift lid of ptotic eye- innvervation will disappear
  9. What are the goals of tx for myasthenia gravis?
    • relief from diplopia and obstructed vision
    • tx: prism, occlusion, ptosis crutch
  10. Chronic progressive external ophthalmaplegia?
    progressive systemic loss of ocular motility
  11. What are some features of CPEO?
    • symmetrical ptosis
    • obicularis weakness
    • gradually- no ocular motility
  12. Management of CPEO?
    • ECG: heart problems
    • Prism: early maybe diplopic
    • Ptosis crutches or surgery: avoid overwidening- px cant elevate eyes
  13. Orbital myositis and pseudotumour?
    • myositis: inflammatory swelling of one or more EOM
    • pseudotumour: muscles + other structures
  14. Features of an orbital myositis?
    • limitation of movement- paretic in direction of muscle
    • diplopia
    • pain worse with eye movement
    • lidswelling, redness, proptosis
  15. Management of orbital myositis?
    • self limiting
    • steroids
    • prism
    • botox
  16. Strabismus fixus features?
    • rare
    • congenital
    • eyes are tethered in extreme position of gaze
    • head turn to fixate with preferred eye
    • ON blood supply strangulated
  17. Strab fixus tx?
    • surgery at early age
    • ocular motility still severely limited
    • but cosmesis is improved
  18. Orbital blow out fracture sequelae?
    • fracture of orbital floor - usually anterior and nasal floor bone are the thinnest
    • orbital contents can prolapse into maxillary sinus
    • orbita fat, IO, IR can be entrapped
    • hypo in primary
  19. Signs and sx of orbital blow out fracture?
    • diplopia
    • eye movement- limited depression and elevation
    • enophthalmos
    • pain- if gaze away from lesion site
  20. Immediately after orbital blow out injury?
    • swelling and ecchymosis of orbital tissue
    • proptosis
    • swelling subsides 4-6W
    • CT/Xray: restricted eye movements due to: swelling, hb, entrapment
  21. Immediate investigation of orbital blow out fracture?
    • VA
    • head posture
    • motility
    • pupils
    • Hess chart
    • measurement of deviation
    • IOP
    • CT scan
  22. Management of orbital blow out fracture?
    monitor 2-3 days 1st few weeks
  23. What to look out for after swelling subsides?
    • Macular edema
    • Retinal detachment
    • Hemorrhage
    • Ocular motor palsies
    • Hyphaema
    • Angle recession
    • Iris sphincte rrupture
    • Lens subluxation
    • Choroidal rupture
  24. Treatment of orbital blow out fracture?
    • ice pack first few days
    • broad spectrum ab- prophylaxis
    • nasal decongestants
  25. Early surgery for orbital blow out fracture?
    • sx diplopia
    • positive forced duction
    • entrapped tissue
    • no improvement after 7-14 days
  26. Other indications of surgery?
    • early enophthalmos >3mm
    • significant globe ptosis
    • significant inferior displacement
  27. Conservative orbital fracture managment indications?
    • normal eye movements
    • no entrapment
    • small fractures
    • small enophthalmos

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