24 - visual disturbance and impairment / 26 - red eye

Question 1

Muscles of eye and movements?

Answer 1

Superior rectus: up
Lateral rectus: out
Medial rectus: in
Inferior rectus: down

Superior oblique: internal rotation
Inferior oblique: external rotation

Question 2

Cranial nerve innervation of eye muscles

Answer 2

3rd Oculomotor: everything else.

4th Trochlear: Superior oblique

6th Abducens: lateral rectus (ABDUCTS

Question 3

Most common cause of strabismus?
Ix?
Cure/

Answer 3

Idiopathic is most common, can be secondary to loss of vision or neurological defects.

Detect with corneal reflections

Cure is surgical.

Question 4

Other name for amblyopia?

What happens?

Answer 4

Lazy eye.

Decreased vision in an eye which otherwise appears normal, can occur because of strabismus.

Brain either does not receive visual signals or ‘switches them off’ to avoid diplopia.

Question 5

Sx of amblyopia ? Mx?

Answer 5

Causes poor visual acuity and depth perception.

Treat with eyepatch or atropine.

Question 6

What causes optic neuritis? Key association? sx?

Answer 6

Demyelination of optic nerve. Leads to visual loss. Usually unilateral.

Associated with MS.

Foggy vision and pain on movement of eye. Typically presents with loss of red vision.

Question 7

What happens / sx in macular degeneration?

Answer 7

Blurred or absent vision in central field (macula).

Peripheral field unaffected.

Question 8

Rfs of macular degeneration?

Answer 8

Risks: aging, hypertension, cholesterol disease, obesity and smoking.
Dry or wet.

Question 9

Mx of macular degeneration?

Answer 9

Wet treatment with anti-VEGF medication (ranibizumab, Avastin) or LASER coag.
No treatment for dry.

Question 10

What should you tell people who have macular degeneration

Answer 10

Charles-Bonnet syndrome and assured that it is not a feature of mental illness.

Question 11

What is charles bonnet?

Answer 11

visual hallucinations in those who have lost sight

Question 12

Sx of retinal detachment?

Answer 12

floaters, flashers. If both of these are present do fundoscopy for visual field loss and refer to ophthalmology

Question 13

Rfs of retinal detachmnet?

Answer 13

Amblyopia, previous eye surgery, malignancy

Question 14

Mx of retinal detachment

Answer 14

Surgical - vitrectomy

Question 15

What form of conversion disorder can you get with eye?

What still happens?

Answer 15

hysterical visual loss

Tracking saccade still occurs.
Diagnosis of exclusion

Question 16

What is pailloedema? cause?

Answer 16

Optic disc swelling caused by raised ICP.

Question 17

Features of papilloedema

Answer 17

Loss of venous pulsation, enlarged blind spot.

Question 18

What should you not do with papilloedema ?

Answer 18

LP

Question 19

Mx of papilloedema ?

Answer 19

Many causes that -> raised ICP - Mx those

acetazolamide for IIH

Question 20

Features of cranial nerve palsys 
oculomotor?
trochlear?
abducens? 
Damage to sympathetic trunk?

Answer 20

Oculomotor: down and out with ptosis and mydriasis

Trochlear: verticle double vision

Abducens: esotropion with associated diplopia.

Horner’s: damage to sympathetic trunk. Miosis, prosis, anhydrosis, ptosis.

Question 21

Types of glaucoma?

Answer 21

Closed flow - blockage at iris

Open - further inside

Question 22

Sx of glaucoma?

Answer 22

Painless red eye. Increased cup to disc ratio. Visual field loss. Optic nerve changes.

Question 23

Mx of glaucoma

Answer 23

B blocker

topical prostamide

Question 24

What is uveitis? Sx?

Answer 24

Inflammation of uvea.
Ophthalmic emergency
Redness, photophobia, pain, blurred vision,

Question 25

Cause of uveitis?

Answer 25

infective

commonly associated with autoimmune cause

Question 26

Mx of uveitis?

Answer 26

pred eye drops if non infective

infective - ask micro

Question 27

Sx of conjunctivitis?
Mx?
When to seek help? WHat to do?

Answer 27

Pain, red eye, itchiness
Largely self-limiting, expect remission within 2 weeks.
OTC eyedrops.
If photophobia or decrease in visual acuity develop then seek help
Chloroamphenicol is Abx are required.