I’m very thankful, with your lessons. This is the first one that confirms me, that even for some one as intelligent and eloquent as you, is hard to explain. The 2nd step was a little confusing when you made the example to the left gaze with an LHT and we started with the RHT. And then the 3rd step is not that clear, like what is it that we are looking for or trying to show. I know it is my way of understanding but with all the respect it’s how I saw this lesson and thank you 🙏. Also I would love to help in sending you, translations and helpful subtitles in Spanish and English. Because it has been hard for me since my first language is Spanish. And translations make it hard some times. Please don’t take my comment the wrong way, you’ve been a light in my residency 👏. Thank you.
Correct me if i’m wrong, during left gaze , primary active muscles should be LSR & LIR since they are out by 23 degrees which is the best action, and the right eye should have RSO & RIO as primary muscles since they are are 55 degrees, but here you said RSR and LIO ?
Can check my understanding? If patient Has right hypertropia, pt either has weak RIR RSO or weak LIO LSR. when look towards left, right hypertropia got worse. This is because LIO RIR which are the normal unaffected muscle will get weaker and unable to compensate for LSR RSO lesion, thus worsening right hypertropia. Therefore we conclude the lesion is RSO and LSR
Ask the patient to depress the eye, as it is attempted the eyes goes into intorsion depicted by movement of 12 clock conjunctival vessels medially I.e inwards
just to clarify, do you mean look for extorsion ? as the person above seems to think otherwise , but SO's action is intorsion so we should expect extorsion in this case?
I don't understand, if there is a RSO affected, shouldn't the patient be more comfortable in right gaze and right tilt? However this patient has more visual disturbances in the right tilt.
As a Physical Therapist I'm having good results with gaze exercises with patients following a laser dot on a wall. They can do it in sitting, standing or supine. Different patterns of eye movement can be educated. It really works and cats love it, too. Laser dots are inexpensive.
Thank you - excellent presentation. at 5:11 you state, "when choosing from a right intorter, [signaling to the RSO] and a left extorter [signaling to the LSR]..." Don't you mean left intorter? I believe the MOA of SR is as an intorter, correct?
