COT Ocular Motility Testing 4 — Questions and Answers
Question 1: In Duane retraction syndrome type I, which movement is primarily limited?
- Adduction
- Abduction (Correct answer)
- Elevation in adduction
- Depression in adduction
Correct answer: Abduction
Duane type I is characterized by limited or absent abduction due to misfiring of the lateral rectus by the oculomotor nerve.
Question 2: When measuring a horizontal deviation with prisms, base direction for an esotropia should be:
- Base-in before the deviating eye
- Base-out before the deviating eye (Correct answer)
- Base-up before the deviating eye
- Base-down before the deviating eye
Correct answer: Base-out before the deviating eye
For esotropia (eye turned in), base-out prism is placed before the deviating eye to neutralize the inward deviation.
Question 3: A patient reports that diplopia is worst when looking down and to the right, and has a positive head-tilt test to the right shoulder. Which muscle is most likely affected?
- Right superior oblique
- Left superior oblique (Correct answer)
- Right inferior rectus
- Left inferior oblique
Correct answer: Left superior oblique
Worst diplopia in right infraduction plus worsening on right head tilt implicates the left superior oblique by the Parks three-step test logic.
Question 4: The Worth 4-dot test is performed with red and green filters to assess:
- Stereopsis at distance
- Suppression and diplopia (Correct answer)
- Accommodation amplitude
- Convergence near point
Correct answer: Suppression and diplopia
The Worth 4-dot test uses red/green dissociation to detect suppression, diplopia, or fusion by asking the patient how many dots they see.
Question 5: Convergence insufficiency is best characterized by:
- High exophoria at distance and orthophoria at near
- Exophoria greater at near than at distance with remote near point of convergence (Correct answer)
- Esophoria greater at near than at distance
- Constant esotropia at near only
Correct answer: Exophoria greater at near than at distance with remote near point of convergence
Convergence insufficiency presents with exophoria that is greater at near, a receded near point of convergence, and often reduced positive fusional vergence at near.
Question 6: Which of the following describes an A-pattern esotropia?
- Greater esotropia in upgaze compared to downgaze (Correct answer)
- Greater esotropia in downgaze compared to upgaze
- Equal esotropia in all positions of gaze
- Esotropia only in upgaze
Correct answer: Greater esotropia in upgaze compared to downgaze
An A-pattern esotropia has greater convergence (esotropia) in upgaze and less or exotropia in downgaze.
Question 7: The Bielschowsky head tilt test helps differentiate superior oblique palsy from:
- Internuclear ophthalmoplegia
- Contralateral superior rectus palsy (Correct answer)
- Convergence spasm
- Brown syndrome
Correct answer: Contralateral superior rectus palsy
The head tilt test distinguishes a superior oblique palsy from a contralateral superior rectus palsy because each shows opposite hyperdeviation responses to ipsi- vs. contralateral head tilt.
COT Ocular Motility Testing 4
In Duane retraction syndrome type I, which movement is primarily limited?