Eye Abnormality Flashcards
Eye examination
A. Look
- Proptosis/ Ptosis
- Squint
- Unequal pupil size
- Cataract, hazy cornea, Macrocornea
- Bulbar conjunctival haemangioma
Examine:
- Test vision roughly - distant and near and visual field
- Extra-ocular eye muscle function
- Do Fatiguability test ( >1 min vertical gaze)
- Pupil’s reaction to light ? Squint after touch shining in front of eyes
- Offer to look at Fundi and Corneal reflex
Listen for cranial bruit - AVM
Eye changes in Dermatomyositis
- Ptosis
- Proptosis
- Opthalmoplegia
- Uveitis
- Retinopathy and retinal haemorrhage
Eye changes in Sturge Weber Syndrome
- Telangiectasia
- Buphthalmos (sign of infantile glaucoma)
- Glaucoma
- Haemangioma of iris/ choroid
- Retinal vessel angioma
- Retinal detachment
- Fundi - dark red
Unilateral Proptosis causes
Due to SOL in the orbit
1. Primary: Tumor in orbit (Gliomata, Retinoblastoma)
2. Secondary:
Tumor in the orbit - (Neuroblastoma; Leukaemia; Haematoma); Bone origin (Retrobulbar cellulitis; Osteomyelitis of maxilla); Vascular origin (Caverpis sinus thromboiss, AV malformation)
Bilateral Proptosis causes
- Exophthalmos in Thyrotoxicosis
- Craniosynostosis (Crouzon; Aperts)
- Neuroblastoma with metastasis to both orbits
- Periorbital haematoma in fractured base of skull
- Myopic eyes
Steps in examination of proptosis
- Confirm the presence of proptosis (Stand behind the patient and look from above)
- Local examination (test Extraocular eye movements- note any peri-orbital inflammation/ haematoma; and test visual acuity; Ausculate for bruit; Offer to examine fundi
- Examination of:
a. Skull - ? Crouzon (examine the hands and note signs of ICP;
b. Neck of goitre –> Signs of hypothyroidism;
c. Evidence of malignancy—> Lymphadenopathy, hepato- splenomegaly, bleeding tendency and pallor, bone tenderness
Aniridia ddx
- AD
- Iatrogenic - after cataract surgery
- Associated with: Hemi-hypertrophy; Urogenital tract anomaly; Tumor - Wilm’s; adrenal and Rhabdomyosarcoma
Microphthalmia ddx
- Congenital rubella syndrome/ Toxoplasmosis
- Fetal alcohol syndrome
- Patau syndrome
- Septo-optic dysplasia
- Fanconi syndrome
- Apparently small eye in Horner’s syndrome, ptosis and facial nerve palsy
- Idiopathic
Corneal opacity ddx
- Unkown
- Congenital - Rubella, herpes
- Late onset - Down’s; Myotonic Dystrophy; DM
- Early onset - Galactosaemia, LBW, Hurler’s
- Scarring after trauma
Others:
Acute glaucoma
Systemic disease
- Drugs e.g. Chloroquine, vit A
- Metabolic causes - Hurler’s, cystinosis, uraemia
Steps in clinical examination in corneal opacity
Local eye examination - assess degree of
- Visual loss ( ?see object/ finger move/ light only)
- Check light reflex
- Note growth and mentality
- Face- Dysmorphic features –Cushings’s/ Hurler’s
- Skin rash
- Hand - Abnormal crease (down’s), big thumb, no. of fingers, nail candida (DM)
- CVS - murmurs (Down’s)
- Abdo - Hepatosplenomegaly (Hurlers)
Causes of Blue Sclera
- Normal in infancy below 3 months
- Infantile Glaucoma
- Systemic diseases (Osteogenesis imperfecta; Ehler Danlos Syndrome; Rheumatoid arthritis; Marfan’s and Russel Silver syndrome)
Heterochromia ddx
- Waadenbury’s syndrome (white forelock, heterochromia+deafness)
- Horner’s syndrome (present since birth) - lighter colour on the affected side)
- Congenital Heterochromia (AD)
- Eye diseases (Trauma, glaucoma, retinoblastoma, prosthesis)
Large Pupil ddx
- Aniridia
- 3rd Nerve Palsy
- Drugs- Local Atropine eyedrops, Systemic atropine, amphetamines, antihistamine, TCA OD.
- After cataract extraction - pupil is irregular
Pinpoint Pupil ddx
- Horner’s syndrome
- Drugs - Narcotics, cholinergic drugs, Organophosphorus toxicity, diazepam
- Pontine haemorrhage
Papilloedema ddx
A. Local causes:
- Optic nerve diseases - Retrobulbar neuritis
- Central retinal vein thrombosis
- Tumor compression of optic nerve
B. Raised ICP
- SOL in skull
- Pseudotumor cerebri
- Malignant hypertension
