Board Certified Ophthalmologist Board Certified Ophthalmologist Pediatric Ophthalmology and Strabismus Questions and Answers 2 — Questions and Answers
Question 1: A 4-year-old presents with a head tilt to the left shoulder. Which cranial nerve palsy is most likely responsible?
- Third nerve palsy
- Fourth nerve palsy (Correct answer)
- Sixth nerve palsy
- Seventh nerve palsy
Correct answer: Fourth nerve palsy
A compensatory head tilt to the contralateral shoulder is the hallmark of a superior oblique (fourth nerve) palsy.
Question 2: What is the critical period for amblyopia treatment in most children?
- Birth to 2 years
- Birth to 7-8 years (Correct answer)
- Birth to 12 years
- Birth to 18 years
Correct answer: Birth to 7-8 years
The visual system remains plastic and responsive to amblyopia treatment until approximately age 7-8 years, though some benefit may extend beyond this.
Question 3: Which type of esotropia is characterized by a high accommodative convergence to accommodation (AC/A) ratio?
- Infantile esotropia
- Sensory esotropia
- Partially accommodative esotropia with high AC/A ratio (Correct answer)
- Duane syndrome
Correct answer: Partially accommodative esotropia with high AC/A ratio
A high AC/A ratio esotropia shows significantly more deviation at near than at distance, often requiring bifocal correction.
Question 4: A 6-month-old infant presents with a large-angle constant esotropia of 45 prism diopters. What is the recommended management?
- Observation until age 2
- Full hyperopic correction with glasses
- Bilateral medial rectus recession surgery (Correct answer)
- Botulinum toxin injection to both lateral recti
Correct answer: Bilateral medial rectus recession surgery
Infantile esotropia with a large constant angle typically requires surgical correction, most commonly bilateral medial rectus recession.
Question 5: Which condition is most commonly associated with dissociated vertical deviation (DVD)?
- Duane retraction syndrome
- Infantile esotropia (Correct answer)
- Intermittent exotropia
- Brown syndrome
Correct answer: Infantile esotropia
DVD is strongly associated with infantile esotropia and occurs in up to 90% of cases over time.
Question 6: In retinopathy of prematurity (ROP), at which zone does disease carry the worst prognosis?
- Zone I (Correct answer)
- Zone II
- Zone III
- Zone IV
Correct answer: Zone I
Zone I ROP involves the most posterior retina and carries the worst prognosis due to the large area of avascular retina.
Board Certified Ophthalmologist Board Certified Ophthalmologist Pediatric Ophthalmology and Strabismus Questions and Answers 2
A 4-year-old presents with a head tilt to the left shoulder.
Which cranial nerve palsy is most likely responsible?