COT Pupil Assessment 4

Question 1

During a slit-lamp examination, you notice the patient's corneal light reflex is displaced nasally. Which condition does this finding most likely indicate?

Accepted Answer

Esotropia

Answer

A nasally displaced corneal light reflex (Hirschberg test) indicates that the eye is turned outward (the light falls on the nasal cornea when the eye deviates laterally), which corresponds to esotropia — an inward deviation. The reflex displacement is opposite to the direction of the deviation.

Question 2

A 7-year-old child presents with reduced vision in one eye. The cover-uncover test reveals no movement of either eye when covered or uncovered. What does this most likely indicate?

Accepted Answer

Amblyopia without strabismus

Answer

If there is no movement on the cover-uncover test, there is no manifest strabismus (tropia). Amblyopia can exist without strabismus — it may be caused by anisometropia or stimulus deprivation. The absence of eye movement on testing rules out a manifest deviation.

Question 3

When performing retinoscopy on a non-verbal toddler, which technique is most appropriate for controlling accommodation?

Accepted Answer

Cycloplegic drops before retinoscopy

Answer

Cycloplegic drops (such as cyclopentolate or atropine) are essential for retinoscopy in young children because they cannot reliably control their accommodation on command. Cycloplegia relaxes accommodation to reveal the true refractive error, particularly important in detecting hyperopia.

Question 4

A patient is asked to follow a penlight in the six cardinal positions of gaze. In left gaze, the right eye shows limited adduction and the left eye shows nystagmoid movements. Which cranial nerve or structure is most likely affected?

Accepted Answer

Right medial longitudinal fasciculus (MLF)

Answer

Internuclear ophthalmoplegia (INO) is caused by a lesion in the medial longitudinal fasciculus (MLF). A right MLF lesion impairs adduction of the right eye in left gaze, while the contralateral (left) eye shows abducting nystagmus. The MLF connects the CN VI nucleus to the contralateral CN III nucleus.

Question 5

During visual acuity testing, a 5-year-old correctly identifies 4 out of 5 optotypes on the 20/32 line but fails on the 20/25 line. How should this result be recorded?

Accepted Answer

20/32

Answer

Visual acuity is recorded as the last line on which the patient correctly identifies the majority of optotypes (at least 3 out of 5 or 4 out of 5 depending on chart type). Since the child correctly identified 4/5 on 20/32 but failed 20/25, the recorded acuity is 20/32. The '-1' notation is optional but the base line is 20/32.

COT - Certified Ophthalmic Technician Practice Test

COT - Certified Ophthalmic Technician Practice Test

COT Pupil Assessment 4