Eye Flashcards

1
Q

What this?

A

CN 3 - oculomotor nerve palsy
“Down and out” can’t adduct

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2
Q

What’s this? What could cause?

A

CN3- occulomotor nerve palsy
Down and out
Eye dilated, ptosis, can’t adduct

Causes:
Congenital
Trauma
Mass/ tumour
Demyelination - GBS, MS, neuromyelitis optica spectrum disorders
Vascular e.g. posterior cerebral aneurysm
Hydrochephalus
- Arnold Chiari?
- Mass

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3
Q

What this?
Causes?

A

CN 6 - abducens nerve palsy
“In and stuck”
Can’t abduct

Causes:
Congenital
Trauma
Mass/ tumour
Demyelination - GBS, MS, neuromyelitis optica spectrum disorders
Vascular e.g. posterior cerebral aneurysm
Hydrochephalus
- Arnold Chiari?
- Mass
Infection: VZV

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4
Q

Eye exam Invx

A

Ophthal rv
MRI-B: neoplasm, inflam (eg. GBS), stroke, raised ICP
MR-A: AVM (binasal or bitemporal heminaopia)

Infection: FBC, CRP, VZV PCR, CMV serology

Craniopharyngioma or pituitary adenoma (binasal or bitemporal heminaopia):
- IGF-1, ACTH (dex suppression test), prolactin, LH/FSH, TSH

Optic nerve glioma (NF-1*):
- other signs NF1: 1st degree relative, axillary or inguinal freckling, lisch nodule, XR: distinctive osseous lesions (thinning long bone)

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5
Q

What’s this?

A

Lisch nodules - NF1

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6
Q

What’s this? Causes?

A

No red reflex = leukokoria

Retinoblastoma
Cataracts
Glaucoma (ON damage)

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7
Q

Causes of cataract

A

Idiopathic
TORCH - toxoplasmosis, CMV, rubella, HSV
Trauma
RTx

Syndromes:
- smith-lemli- opitz: cannot make cholesterol, FTT, microceph, ID, syndactyly
- bardet-biedl

Aneuplodies: T21, Turner

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8
Q

Location of CNS lesion
- vertical nystagmus

A

Cerebellar

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9
Q

Location of CNS lesion
- horizontal nystagmus
Can also be caused by?

A

Brainstem

Anticonvulsant medications (phenytoin, carbemazepine, lamotrigine, valproate)

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10
Q

What’s this?

A

Exotropia

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11
Q

Causes of horizontal strabismus (outside of CN palsies)

A

Accommodative
Congenital
Duane syndrome - eye movement disorder characterised by failure of CN6 to develop normally

Exotropia: looks out
Esotropia: looks in

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12
Q

Retinal causes of RAPD

A

Retinal detachment
Ischemic retinal disease
Intraocular tumour: melanoma, metastatic RB
Infection: CMV, HSV

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13
Q

Name visual field defect and causes

A

Complete lesion of optic nerve
- compressive tumour (optic nerve glioma in NF1)
- trauma
- inflammatory: optic neuritis
- IIH
- vasculitis
- anterior ischemic retinopathy

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14
Q

Name visual field defect and causes

A

Quadrantinopia
Involvement of optic radiations
Lesion in contra lateral occipital lobe

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15
Q

Name visual field defect and causes

A

Bitemporal hemianopia
Lesion impinging on optic chiasm
- pituitary adenoma
- craniopharyngioma
- anterior communicating artery aneurysm (rare)

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16
Q

Name visual field defect and causes

A

Homonymous hemianopia
Pressure or lesion on one (left in this example) optic tract
- neoplasm
- AVM
- infection (e.g. encephalitis)
- ischaemia

17
Q

Name visual field defect and causes

A

Nasal hemianopia
Lesion involving perichiasmal area
- tumour
- stroke

18
Q

Eye exam approach

A

IHUGVIDEP
VA
Visual fields
Pupils
EOM
Fundoscopy
Special tests
- motor: lid lag, fatiguability (look up and down repetitively)
- strabismus: cover test
- corneal reflex
- auscultate over eyes for bruits

19
Q

Normal VA at 6 months

A

30/6

20
Q

Normal VA 18 months ?

A

9/6

21
Q

Normal VA 2 years

A

6/6