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% Document Info
\author{sannyyy}
\pdfinfo{
  /Title (heterotropia.pdf)
  /Creator (Cheatography)
  /Author (sannyyy)
  /Subject (Heterotropia Cheat Sheet)
}

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\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Heterotropia Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{sannyyy} via \textcolor{DarkBackground}{\uline{cheatography.com/188301/cs/41571/}}}
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\noindent
\begin{multicols}{3}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}sannyyy \\
  \uline{cheatography.com/sannyyy} \\
  \end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 6th December, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\end{multicols}}




\begin{document}
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{What is a Heterotropia?}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Also known as a stabismus, it is a manifest deviation, wherein the eyes are misaligned under normal binocular viewing conditios} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Tropias may be constant or intermittent} \tn 
% Row Count 4 (+ 1)
% Row 2
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\mymulticolumn{1}{x{5.377cm}}{Tropias may affect one eye or alternate between both} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{In early childhood, tropias may cause an amblyopia (lazy eye)} \tn 
% Row Count 8 (+ 2)
% Row 4
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\mymulticolumn{1}{x{5.377cm}}{Tropias may or may not be linked to refractive error} \tn 
% Row Count 10 (+ 2)
% Row 5
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\mymulticolumn{1}{x{5.377cm}}{Tropias may or may not be linked to accommodation and convergence} \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{A comitant heterotropia is one where the angle of deviation remains the same in all directions of gaze, regardless of which eye they use}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Heterotropia Classification}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Esotropia} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Exotropia} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Hyper/Hypotropia} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Cyclotropia} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Microtropia} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Pseudostrabismus}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Patients look like they have a strabismus but they don't} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Common in children with epicanthal folds as it mimics esotropia} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Also patients with a positive angle Kappa, where the corneal light reflex is displaced nasally, can look like they have an exotropia} \tn 
% Row Count 7 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Here, you should perform a cover test to double check} \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{IPE: Accommodative}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Esotropia disappears when the hypermetropia is fully corrected} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Usually arises between 2-5 years} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Amblyopia is uncommon unless the hypermetropia has been uncorrected for a long time. E.g. the problem not picked up at an early age} \tn 
% Row Count 6 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Usually normal BSV with glasses on} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Management - perform cycloplegic refraction and issue a full prescription.  \newline Treat the amblyopia if present. \newline If there's low amounts of hypermetropia and astigmatism, exercises might help to reduce the need to wear glasses as child gets older (over 8) \newline Most patients will always need to wear glasses or contact lenses}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Investigation: Key Things to Note}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Their age - if young, it may be linked to amblyopia and impact their visual development, if a little older, was it acquired?} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{If the tropia is new or longstanding} \tn 
% Row Count 4 (+ 1)
% Row 2
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\mymulticolumn{1}{x{5.377cm}}{Is it causing any symptoms?} \tn 
% Row Count 5 (+ 1)
% Row 3
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\mymulticolumn{1}{x{5.377cm}}{Is it present all the time, why not if not?} \tn 
% Row Count 6 (+ 1)
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\mymulticolumn{1}{x{5.377cm}}{Are any adaptations present?} \tn 
% Row Count 7 (+ 1)
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\mymulticolumn{1}{x{5.377cm}}{Is referral required?} \tn 
% Row Count 8 (+ 1)
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Investigation: Concluding Information}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{The type of test you perform and the expected outcome depends on your preliminary diagnosis} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Usually, if the tropia isn't causing a problem, then it isn't much of a worry. Measurements may be helpful to monitor. Tailor your test to their binocular status and move on} \tn 
% Row Count 6 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{If the tropia is causing a problem and the px is symptomatic, they warrant further investigation} \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{In young children, squints need careful investigation to determine the cause and appropriate management!!} \tn 
% Row Count 11 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{x{1.64772 cm} x{1.23579 cm} x{1.69349 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Esotropia}}  \tn
% Row 0
\SetRowColor{LightBackground}
Primary Esotropia & Secondary Esotropia & Consecutive Esotropia \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Constant: partially accommodative or non accommodative & Results from a loss of vision & Due to a surgical \seqsplit{overcorrection} of an exotropic strabismus \tn 
% Row Count 7 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{5.377cm}}{Intermittent: fully accommodative, convergence excess, relates to fixation distance e.g. at distance or near, non-specific} \tn 
% Row Count 10 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CPE: Non-Accommodative}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Esotropia present all the time and unaffected by the accommodative state} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Deviation may alter between both eyes} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{For example, infantile esotropia. Has an early onset in the first year of life usually before 6 months and is a large angle often \textgreater{}30. Could be an alternating deviation, thus VA good in both eyes Dissociated vertical deviation may be present Not associated with hypermetropia} \tn 
% Row Count 9 (+ 6)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Management - correct the refractive error and treat the amblyopia. May require surgery to align the visual axes and allow normal BSV to develop. Best to perform before they're 2.} \tn 
% Row Count 13 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Investigation: Relevant Clinical Tests}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Case history alongside observing patient} \tn 
% Row Count 1 (+ 1)
% Row 1
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\mymulticolumn{1}{x{5.377cm}}{Visual acuity at both distance and near} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Cover test with and without prism bar} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Refraction} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Ocular motility} \tn 
% Row Count 5 (+ 1)
% Row 5
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\mymulticolumn{1}{x{5.377cm}}{Suppression tests e.g. worth 4 dot test, 4 base out prism} \tn 
% Row Count 7 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Accommodation and Covergence} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Bagolini lenses} \tn 
% Row Count 9 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Patient investigations would depend on whether the tropia is new or longstanding (esp. in an adult), depend on whether patient is a child, and whether the tropia is constant or intermittent}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CPE: Partially Accommodative}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Esotropia present at all time and increases in size when patient accommodates} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Deviation size reduces when the hypermetropia is corrected but it is still present} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Occurs in early childhood (ages 1-3)} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Anomalous retinal correspondence may be present} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Dissociated vertical deviation may be present (different from vertical tropia where only 1 eye deviates upwards)} \tn 
% Row Count 9 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Management: fully correct the refractive error, treat the amblyopia (as they're children!), only refer for surgery in extreme cases} \tn 
% Row Count 12 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
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