exam

Case History:

Symptoms – complaints of sudden onset diplopia and a drooping of the right lid

GH – No meds

FH – Nil

Most correctly identified as a Right III Nerve palsy, due to ptosis, RXT

Assess pupil function to a light and a target, AND VERBALLY TELL THE EXAMINER
WHAT YOU ARE observing/ checking for at each stage (10 marks)

• assessed pupils to a light and observed direct and consensual responses.

• performed the swinging flashlight test. Few student assessed pupils to an accommodative target.

• Not all removed glasses for pupil assessment (light). Sometimes the torch was held too far away from each eye resulting in the torch being presented to both R+L eye

Assess the patient’s deviation at distance, by prism cover test, in 5 positions of gaze

and record your results below (20 marks)

Communication was good for this test and students gave clear instructions.

• Marks were mainly lost for incorrect head position, not assessing in max position of gaze, not keeping the consistent eye constant.

• Not recording fixing eye.

• Not taking to point of reversal when measuring.

ased on the case history (written above) what additional orthoptic investigations,

other than those you have already performed, would be undertaken to reach a

diagnosis for this patient? (10 marks) (1/2 mark for test, 1 mark for explanation

assessment of 4th Nerve function: assessment of SO

function in its position of action is difficult due to MR restriction. Lid assessment was

mentioned but specific assessments not highlighted. Motility, CT and Hess

Explain the horizontal anatomical muscle theory that may explain this display of eye

LR works more in upgaze where the problem is here therefore the LR could be inserted too low producing a V exo

Explain the vertical muscle innervation theory that could result in this display of eye

Exo deviation therefore problem with adducting action of one of the vertical muscles. Gets worse in elevation

• Therefore the SR may be underaction because its primary action is elevation and the problem is on upgaze – and its tertiary action is adduction. There will be less pull inward whilst patient elevates and uses their weak SR = in V exo

ORBITAL fractures

Ecchymosis, diplopia, conjunctival haemorrhage, AHP, enophthalmos, retraction, infra

orbital anaesthesia, positive FDT

Outline the Orthoptic assessments required for this investigation, provide a reason

CH – cause , VA, CT, OM, Measurement – FR/FL, Field of BSV, Field of uniocular fixation, BV