CO Diagnosis & Management of Strabismus and Amblyopia 3 — Questions and Answers
Question 1: A patient with a right superior oblique palsy will most likely adopt which compensatory head posture?
- Head tilt to the right, chin up
- Head tilt to the left, chin down (Correct answer)
- Face turn to the right
- Face turn to the left
Correct answer: Head tilt to the left, chin down
In right SO palsy, patients tilt their head to the left shoulder to reduce the hyperdeviation caused by the palsied muscle.
Question 2: The Parks three-step test is designed to isolate which type of muscle palsy?
- Horizontal rectus palsies
- Cyclovertical muscle palsies (Correct answer)
- Inferior oblique overaction
- Divergence paralysis
Correct answer: Cyclovertical muscle palsies
The Parks three-step test uses three sequential observations to identify which of the eight cyclovertical muscles is paretic.
Question 3: Which of the following is the MOST appropriate initial management for a 6-month-old with infantile esotropia measuring 45 prism diopters?
- Immediate surgical correction
- Full optical correction of any hyperopia and observation for 6 weeks (Correct answer)
- Patching the left eye only
- Prism glasses to fully correct the deviation
Correct answer: Full optical correction of any hyperopia and observation for 6 weeks
Before surgery, any significant refractive error must be corrected first to rule out an accommodative component, then early surgery is planned.
Question 4: The Bagolini striated lens test is used to assess:
- Contrast sensitivity
- Binocular function and suppression under natural viewing conditions (Correct answer)
- Accommodative convergence ratio
- Fusional vergence ranges
Correct answer: Binocular function and suppression under natural viewing conditions
Bagolini lenses have minimal optical interference and allow testing of binocular status under conditions close to everyday vision.
Question 5: A child consistently fails visual acuity screening in one eye despite having no refractive error or structural pathology. The next best step is:
- Referral for MRI of the brain
- Repeat cycloplegic refraction and cover test evaluation (Correct answer)
- Patching the better eye empirically
- Prescribing reading glasses
Correct answer: Repeat cycloplegic refraction and cover test evaluation
Cycloplegic refraction may reveal latent hyperopia or anisometropia not apparent on manifest testing, and a cover test identifies strabismus.
Question 6: Which type of esotropia is characterized by a deviation that is controlled by accommodation and fully corrected with the hyperopic glasses prescription?
- Basic esotropia
- Fully accommodative esotropia (Correct answer)
- Partially accommodative esotropia
- Infantile esotropia
Correct answer: Fully accommodative esotropia
Fully accommodative esotropia is completely corrected by the full cycloplegic hyperopic prescription, eliminating the deviation without surgery.
Question 7: When grading the Worth 4-dot test, a patient who reports seeing five dots is demonstrating:
- Normal binocular vision with fusion
- Diplopia — no suppression present (Correct answer)
- Right eye suppression
- Left eye suppression
Correct answer: Diplopia — no suppression present
Seeing five dots means both eyes are open and the images are not fused, indicating uncrossed or crossed diplopia depending on dot positions.
CO Diagnosis & Management of Strabismus and Amblyopia 3
A patient with a right superior oblique palsy will most likely adopt which compensatory head posture?