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OMG….BV patientWHAT SHOULD I DO??
Prepared by Anis Suzanna Binti Mohamad Optometrist Ophthalmology Department, Hospital Sultanah Bahiyah
IF I AM OPTOMETRIST….
SOP
BASIC TEST
Hirschberg Cover test (CT) Ocular motility test (OMT) Prism Cover test/ Krimsky test Amplitude of accommodation (AA) Near point convergence (NPC)
1) HIRSCHBERG
Purpose: To determine the approximate positions
of the visual axes of the two eyes under binocular conditions
Used to identify a strabismus when other more precise methods cannot be used.
EQUIPMENT
Penlight
STEP-BY-STEP PROCEDURE
1) Direct the penlight toward the patient’s eye from a distance of 50 to 100 cm.
2) Instruct patient to look at the light.3) Place your eye directly behind the penlight and
observe the location of the corneal light reflexes in each of the patient’s eyes.
4) Compare the locations of the eyes’ corneal reflexes:1) If the two reflexes are in the SAME relative positions in each
of the two eyes-pt does not have strabismus.2) If the two reflexes are NOT in the same relative positions in
the two eyes, the patient has a strabismus. Determine the direction of the deviation by observing the position of the two reflexes relative to the position of angle kappa in the fixating eye.
Relationship between the position of the corneal reflex and the type of the deviation on
the Hirschberg test
Position of the corneal reflex relative to the position of
angle Kappa in the fixating eye
Type of deviation
Nasal Exo Temporal Eso
Above HypoBelow Hyper
RECORDING If there is no strabismus, record “Symmetry” or
“Orthophoria “. If there is a strabismus, record the eye that is
deviated, the size of the deviation, and the direction of the deviation. Eg: RE corneal reflection displaced 15°/30°/45° temporally
EXAMPLES
2) COVER TEST
Purposes: Objective test used to detect a
squint All diagnosis of squint is based on
the results of the cover test
EQUIPMENT
Fixation targets 33cm – spotlight, detailed target, small picture
or a Snellens letter 6m – spotlight, small toy or picture or Snellens
letter >20m – easily seen landmark at eye level
Occluder Black paddle Spielman Card
STEP-BY-STEP PROCEDURE One eye is covered
Watch the movement of the uncovered eye to take up fixation
If no movement of the eye is noted cover the other eye and watch the uncovered eye.
If no movement has been seen repeat the test but this time watch the movement of the covered eye when the occluder is removed.
EXAMPLE
Types of squint MANIFEST - OBVIOUS SQUINT
Look for movement of the uncovered eye
Cover the straight eye
Cover the eye with the best visual acuity or the lowest refractive error
LATENT – HIDDEN SQUINT
Movement of the covered eye
RECORDING
RE moderate esotropia
LE moderate exotropia
1. With or without glasses2. Distance (at 6m/at 33cm)3. Rate of recovery for phoria 4. Note if diplopia is present upon remoal of cover (if present
indicates poor recovery or control)5. Note laterality of deviation (RE, LE or alternating)6. Constancy of the deviation (contant/intermittent)7. Note characteristic of deviaion whether there is any change from
phoria to tropia
3) OCULAR MOTILITY TEST A.k.a extraocular motilities (EOM)
test
Equipment Penlight
STEP-BY-STEP PROCEDURE
1. Patient head must be straight and ask to remove spectacles.
2. Ask patient to follow the light with their eyes without moving their head. Ask pt to report any diplopia or pain during the test.
3. Place the torch at pt’s eye level ~50cm away.4. Note the corneal reflex.5. Move the target to the 9 position of gaze (Broad H or
Union jack) pattern can be used.6. Carefully look for any misalignment of the eyes as well as
lid position.7. Determine whether the movement of the eyes is smooth
(pursuit) and accurate.8. Perform cover test at all position of gaze (if necessary).9. Duction test must be performed if underaction of any
muscle is observed.
9 position of gaze
RECORDING
Underaction (u/a) Overaction (o/a) Jerky movement or nystagmus at
any position Pain or diplopia
Abnormalities of EOM using numerical grade
EXAMPLE
1. Limitation on ADDUCTION of LE
2. Downshoot of LE
BV assessment sheet
BV assessment sheet
HANDS ON
Hirschberg Cover test EOM
THANK YOU, HAVE A NICE DAY