Introduction; Procedure; Interpretations. 8 4Δ Base Out Test. Introduction; Procedure; Interpretations. 9 Bagolini Glasses. AIM—To introduce the “starlight” test which was devised to check binocular vision in normal conditions of seeing in a rapid, easy, and cost effective manner and. Adjust Striated Bagolini lenses to match pattern ‘A’ above if you are using the trial lens mounted Bagolini’s. Then have the patient look at a point light source.
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Residents and Fellows contest rules International Ophthalmologists bagklini rules. There are a few ways to detect strabismus deviating eyes on a patient depending on their visual acuity and whether or not they are verbal. Eyes can be deviated inward esotropiaoutward exotropiaupward hypertropiadownward hypotropiaintorted incyclotorsionor extorted excylcotorsion. On infants or an bagolino with a poor seeing eye, it is useful to use the Hirschberg Test.
The examiner is looking at the corneal light reflex. If the light reflex is centered in both eyes, the patient does not have a manifest misalignment.
If the light reflex is displaced, it shows a manifest misalignment. Similar to the H test, this test is used when there is a misalignment. For example, the light reflex at the pupillary margin is about 2mm from the center with a normal 4 tsst pupil. If the light reflex is displaced nasally, the patient has an exotropia.
If the light reflex is displaced temporally, the patient is esotropic.
Sensory and Motor Testing – EyeWiki
It is important to note reflex is always slightly nasal, even in an orthophoric patient. It is also important to note that angle kappa can affect light reflex measurements. A positive angle kappa simulates an exotropia, a negative angle kappa simulates an esotropia. A base-in BI prism is used to neutralize an exotropia, a base-out BO prism is used to neutralize an esotropia.
Baglini BU is used to neutralize a hypertropia. Base-down BD is used to neutralize a hypotropia. With patients who have a deviation and are able to fixate on a distance and near target, a cover test is most helpful to the examiner. A cover-uncover test picks up small manifest deviations that are always present. A cover test verifies whether or not eyes are bagooini.
When teet patient has an eye that is constantly deviated, this is called a unilateral tropia. The deviated eye only picks up fixation when the preferred eye is covered. The non-preferred eye when covered and uncovered should not move. When a patient has an alternating tropia, either eye will move to re-fixate when the fellow eye is covered with an occluder.
When a patient is orthophoric, bagllini eye will move because each eye is fixating. Alternate Cover Testing ACT is used to pick up any latent deviation on top of the manifest deviation. Text cover-uncover test is done before moving on to alternate cover testing. After noticing a tropia with cover-uncover testing shifting cover one eye at a timethe alternate cover test shifting cover from eye to eye will bring out the phoric portion.
Prisms are used to neutralize these deviations. It is possible to have “ortho” eyes with cover-uncover and movement of bagolkni on bagolinj cover, these are called phorias. On both of these testing methods, it is important to occlude each eye long enough so the patient has time to take up fixation as the occluder is shifted back and forth.
This is especially true if one eye is amblyopic. An accurate way to measure strabismus correctly is to measure to baglini. These bagoljni are used the most often to quantify stereopsis, it can also be used to detect Batolini abnormal retinal correspondence. The level of dissociation is moderate. This test should be done on all patients who are bi-foveal and can be used as a quick screening to see if the patient is using two eyes together.
One could also use this test to see if the patient is malingering. The patient is directed to put on polarized glasses. They are then shown a book with stereoscopic images 3-dimensional and 2-dimensional images. The patient is asked to identify which pictures are stereoscopic. The book either has a titmus fly or a randot stereogram. The other side of the book has stereoscopic animals and circles. It is typical to ask the patient to identify the animals after the fly or shapes and the circles last.
Some could argue that the titmus fly gives off monocular clues that allow patients with reduced stereo to able to identify the image.
One way to verify if the patient truly has stereopsis is to flip the book at a 90 degree angle, the image should appear 2-dimensional. Falsely good stereopsis is very common when using the titmus fly because it is the most commonly used stereopscopic test.
Bagolini Striated Glasses Test
The purpose of this test is to detect a small central suppression scotoma or foveal suppression. The level of dissociation is mild. It can be used with patients who have decreased stereopsis but are orthophoric on cover testing. This test can also be used on patients with small to intermediate angle deviations, and with patients with Monofixation Syndrome. Instruct the patient to look at a distance target.
A 4-BO prism is quickly placed over the right eye and the examiner observes the movement of the left eye. A sudden displacement of the image onto the parafovea will cause re-fixation if the image is falling on corresponding points on a normal retina. The test is repeated on the left eye and the examiner observes the movement of the right eye. When the test is negative, the patient is considered to be bifoveal.
When the prism is over the right eye, the left eye moves out and in. When the prism is over the left eye the right eye goes out and in.
There are two responses when there is a scotoma microtropia. There is a scotoma on the right eye if the prism is over the right eye and there is no response bilaterally, vice versa for the fellow eye. Bagolini glasses do not have dioptric power but have narrow striations running parallel in one meridian.
This test is used to determine the direction of a pseudofovea, abnormal retinal correspondence ARCand suppression. This test also is able to tell the examiner if the patient has periphery-sensory fusion.
This test is mildly dissociating so it will detect small ARC even in large angle strabismus. The Bagolini glasses also simulate life-like testing conditions, which makes it the least dissociating. A disadvantage to this test is that it is difficult for young children to appreciate because it requires reliable subjective responses. Patient is asked to look at muscle light or pen light. When a patient sees only one line at a time, the patient is suppressing.
You may offset the deviation with a prism and if the patient reports an X this confirms NRC. This test is used to determine the presence of a cyclo deviation.
This test is very dissociating. Clinically, it is useful to use this on patients who have a suspected 4th Nerve Palsy, or Thyroid Eye Disease. Take the two Maddox Rods one red and one whiteand orient them at 90 degrees so the striations are vertical. For a 4th Nerve Tesr, it could bagklini helpful to put the red rod on the eye that is paretic. If the line is completely parallel, there are 0 degrees of cyclotorsion.
The patient should be able use the knob to rotate the line until it is parallel line. If the rod has to be rotated testt, the patient has incyclotorsion. If the rod has to be rotated outward, the patient has excyclotorsion. The trial frame has an axis marked, so the examiner can determine the amount of torsion.
The purpose of this test is used to detect peripheral sensory fusion and foveal suppression. The level of dissociation is high. This test can be used for any verbal child with any angle of strabismus especially with reduced stereopsis. This can be done with the lights on or the lights off depending on what level of dissociation is preferred. With the lights off, the depth of suppression can be measured.
Place the red-green glasses on the patient, with the red glass on tedt right eye. With the right eye patient should see two red lights and with the left eye, patient should see three green lights. The examiner can also measure the boundary of suppression by testing the patient at the end of the room and walking closer to the patient.
The red glass test is used to detect the presence and type of diplopia a patient has. It can also be used to detect suppression, determine retinal correspondence, tset to confirm the type of diplopia a bagolimi has crossed or uncrossed. This is a moderately disassociating test.
Clinically, it is most useful to use this test on adults who complain of trst who seem orthophoric on cover testing. It is also a good way to fit adults with prisms. Testing children with the red filter can be difficult. Ask the patient to fixate on the white circle at the end of the room. The examiner directs the patient bagopini fixate on the white circle. The bagilini will give answers of suppression, fusion, or diplopia.
The patient is suppressing if they report seeing one red circle, however, it can also be a fusion answer. This is why it is important that the patient is able to distinguish the red circle as seen through the filter only as opposed to a red circle on top of a white circle when they are fused. Patients who have alternating suppression should see the red and white light alternating. If the patient sees one red circle and one white circle simultaneously, they are diplopic.