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2008 Series -  June 17, 2008 Lecture 29 of 53  NEXT»

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This 19-year-old male suffered blunt injury to the left eye nine months earlier. He was examined at the time by an oculo-plastic surgeon who determined that since there was no restriction to forced ductions it would not be necessary to treat this patient with surgery. The patient was treated with local and oral steroids.

Now the patient presents with a large left hypertropia greater in down left gaze where it measures more than 40 prism diopters. Forced elevation of the left eye shows little if any restriction and in far up gaze, especially looking to the right, the eyes are aligned. Visual acuity is 20/20 in each eye; the refraction is +0.50 in each eye; the anterior segment, lens media and retina are all normal in each eye. The patient assumes a head posture as shown above to avoid diplopia. He can fuse while holding his head in this position.

1. The CT scan confirms the following:

a. paralysis of the left inferior rectus
b. entrapment of the inferior rectus
c. blow out fracture
d. loss of feeling in the left cheek
e. all of the above

2. The most important next step in establishing a proper diagnosis and devising a treatment plan is:

a. check forced ductions to depression in the left eye and generated force to down gaze in the left eye
b. sensation over the left cheek
c. diplopia fields
d. saccadic velocity in the left eye to up gaze
e. all of the above

3. If the left lateral rectus is paralyzed, the next most important thing to know about the patientís condition is:
a. how much the diplopia is bothering him
b. what the patient does for a living
c. whether there is restriction to forced depression of the left eye
d. the level of stereopsis
e. the patient's response to Botox in the left superior rectus as a diagnostic test

For answers to the above, click here on or after June 24, 2008.



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