Clinical Examination and Signs Flashcards
When inspecting the eye, what things are you looking for?
- Facial asymmetry - VII nerve palsy – upper neuron / lower neuron
- Rashes - rosacea – blepharitis; Malar rash (SLE)– Vasculitis; Shingles - Uveitis
- Lid position abnormalities - ptosis, entropion, ectropion
- Globe position abnormalities - proptosis, enophthalmos
- Pupil asymmetry - anisocoria
- Lumps, bumps, redness/discharge
What is the following?
Ptosis - Droppy eyelid
What is the following?
Entropian - eyelid turns inwards - bottom eyelid is turned inwards in this picture
What is the following?
Ectropian - Eyelid turns outwards
What is the following?
Proptosis - forward displacement of the globe
What is the following?
Enopthalmos - posterior displacement of the globe
What is the following?
Anisocoria - difference in pupil size
What is the following?
Episcleritis - benign, self-limiting inflammatory disease affecting part of the eye called the episclera.
What is the following?
Scleritis - a serious inflammatory disease that affects the white outer coating of the eye, known as the sclera
How would you distinguish between scleritis and episcleritis?
Episcleritis typically presents with little to no pain and is most often idiopathic. It is generally a self-limiting inflammatory process affecting only the conjunctival and superficial episcleral vascular plexuses.
Scleritis manifests as a very painful red eye—but it sometimes suggests that something deeper than the eye is involved.
If you touch sclera and vessels move, this is episcleritis
What is the following?
Subconjunctival haemorrhage - bleeding underneath the conjunctiva. The conjunctiva contains many small, fragile blood vessels that are easily ruptured or broken. When this happens, blood leaks into the space between the conjunctiva and sclera.
What is the following?
Pterygium - growth of the conjunctiva or mucous membrane that covers the white part of your eye over the cornea
What is the following?
Hypopyon - ¨level of inflammatory cells / pus in the AC
What is the following?
Hyphaema - ¨level of blood in the AC
What is the following?
Lens subluxation/dislocation
What is aphakia?
No lens in the eye
What is the following?
Cataracts - a clouding of the lens in the eye which leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes
What field defect would someone have if they had a lesion at 1 (in the following image)/
Blindness - Right uniocular VF defect
What visual field defect would someone have if they had a lesion at 3 (in the attached image)?
Bitemporal hemianopia
What visual field defect would you get in someone with a lesion at 4 (on the attached diagram)?
Left homonimous hemianopia
What visual field defect would be present if there was a lesion at 8 (in the attached diagram)?
Left homonimous hemianopia
What visual field defects would be present in someone with a lesion in the superior optic radiation (F or I in the diagram attached)?
Left inferior homonimous quadrantanopia
When examining the pupils, what is important to look at?
- Iris colour, pupil size and shape in ambient light
- Assess pupil size in light/dark and comment on anisocoria
- Check pupil reactions
- Direct & Consensual response to light
- Response to accommodation
- Relative afferent pupillary defect (RAPD)
What visual field defects would be present in someone with a lesion in the inferior optic radiation (E or J in the diagram attached)?
Left superior homonimous quadrantanopia
If there was a relative afferent pupillary defect, what might this suggest?
An abnormality of the optic nerve or generalised retinal abnormality
What is the following?
Myadriasis - dilation of the pupil
What are central causes of horner’s syndrome?
- MS
- Spondylosis
- SOL
- Syringomyelia
- Stroke/lateral medullary syndrome
What is the following?
Miosis - constriction of the pupil
What are causes of bilateral miosis (pinpoint pupils)?
- Opioid – morphine, heroin
- Senile miosis
- Pontine haemorrhage
- Cholinergic toxicity – organophosphate poisoning
- Upward transtentorial herniation
- Central α-2 agonist – clonidine, dexmedetomidine
- Beta-adrenergic antagonist – carvedilol, timolol
If someone presented with bitemporal hemianopia, where might you suspect the lesion to be?
Optic chiasm lesion e.g. pituitary tumour
If someone presented with blindness in their right eye, where might the lesion causing the VF defect be?
Right optic nerve
Lesions in which locations can cause homonimous hemianopias?
- Optic cortex lesion
- Superior and inferior optic radiations lesion
- LGN, thalamus lesion
- Optic tract lesion (least common)
What is the following?
Chemosis - oedema in the conjunctiva
What is the following?
Blepharitis - inflammed eyelids
What is a scotoma?
Defect causing the part of field of view to go missing
What is strabismus?
Eyes look in different directions - squint
What is papillitis?
Inflammation of the optic nerve head
What is myopia?
Nearsightedness - eye focusses in front of the retina
What is hyperopia?
Farsightedness - Images focus past the retina
What is emmetropia?
Normal refractive index
What is astigmatism?
Condition where the cornea is not perfectly spherical (i.e. more egg/rugby ball shaped) and therefore light is focused in two different focus points which overlap, resulting in blurred vision
What is presbiopia?
Condition where the eye gradually loses its focusing ability for near objects (accommodation) in particular as a result of age (loss of elasticity of crystalline lens capsule and weakening of the ciliary muscles)
What lens would you use to correct the vision of someone who is myopic?
Concave lens
What lens would you use to correct the vision of someone who had hypermetropia?
Convex lens
What is the following?
Synechiae - iris adheres to either the cornea (i.e. anterior synechia) or lens (i.e. posterior synechia)
What is the following?
Dacrocystitis - acute inflammation of the tear sac medial the the medial canthus
How would you remeber when the upper and lower optic radiations are?
TISO
Temporal inferior, Superior Occipital
What are causes of a monocular visual field loss?
Ipsilateral retinal/optic nerve lesion
- Retinal - Central retinal artery/vein occlusion, retinal detachement
- Optic nerve - Optic neuritis, optic atropy, glaucoma
What are causes of a lesion at point C, causing bitemporal hemianopia?
- Pituitary tumour
- Craniopharyngioma
What are causes of a lesion at point D - resulting in homonymous hemianopia?
Middle cerebral artery occlusion
What are causes of a lesion at E - resulting in a Left superior quadrantanopia?
Contralateral Temporal (lower) optic radiation
- Temporal tumour
- MCA occlusion - superior branch
What are causes of a lesion at F - resulting in a Left inferior quadrantanopia?
Contralateral parietal upper optic radiation
- Parietal tumour
- MCA occlusion - inferior branch
What are causes of a lesion at H - resulting in a homonymous hemianopia with macular sparing?
Contralateral occipital visual cortex lesion
- Posterior cerebral artery occlusion
What are pre-ganglionic causes of horner’s syndrome?
- Pancoast tumour
- Cervical rib
- Thyroid carcinoma/goitre
What are post-ganglionic causes of horner’s syndrome?
- Carotid artery dissection
- Radical neck dissection
