Eye Ears Flashcards
CR Venous Occlusion
Ask in detail about vision loss pattern, associated pain, head ache and systemic symptoms.
Look for :
= Visual acuity
= Field of vision
= Pupils: Size, Direct & Consensual, accomodation
= Fundus
Causes:
= DM, HTN
= Hyperviscosity syndromes
= Myeloma, Waldenstroms
= Glaucoma, CTD’s
Painless Sudden Vision Loss
Amaurosis fugax, TIA
Ischemic Optic Neuropathy
CRVO
Giant cell arteritis
Vitreous Haemorrhage
Retinal Dettachment
Acute angle closure glaucoma
Vision Loss, Gradual
Ocular causes:
= Retinitis pigmentosa
= Open angle glaucoma
= Cataracts
= DM-HTN retinopathy
= Macular degeneration
Neuro-Ophthalmic causes:
= Optic nerve compression any cause
= Nutritional Optic neuropathies
= Toxic Optic neuropathy (methanol)
= Papilloedema of any cause, SOL
Diplopia, monoocular
Cataracts
corneal disease
Lens dislocation
Refractive errors
Macular disease
Visual cortex disease
Diplopia analysis
binocular type: resolves on closing 1 eye.
Image alignment:
- Horizontal diplopia: LR, MR palsy
- Vertical diplopia: SR, IR, SO, IO palsy
- Torsional: 4th nerve palsy (SO4)
Remains same-myasthenia, fatiguability
Image Separation: distance becomes more in progressive diplopia.
= Paretic myopathy: Maximum when gaze if on side of affected muscle - as looking to left in Left LR palsy
= Restrictive myopathy: maximum when gaze to opposite side - ex. IR entrapment in orbital fractures causes diplopia on looking up.
Diplopia in multiple directions: MG, MUCP (cavrnous or Apex) , Graves disease. Is sudden multidirection - suspect Pituitary apolpexy.
Intermittent Diplopia: MG, Graves, Phoria
Diplopia worse on distant vision: LR palsy, and on near vision - MR palsy.
Phoria and Tropia
A phoria (false squint) is a misalignment of the eyes so that their natural resting point is not perfectly aligned. It is only seen when fusion is broken—i.e. one eye is covered or when the two eyes are looking at different targets (accomplished via prism lenses, red/green glasses, or Maddox rod
A tropia is a physical misalignment in one or both eyes that can also be called strabismus. On the other hand, a phoria is a deviation that may only be present when the eyes are not looking at the same object
Peri Orbital Differential
Orbital cellulitis
Peri orbital cellulitis
Blepharitis
Dermatomyositis
Nephrotic syndrome
congestive Heart failure
Myoxedema
Ophthalmopathy in Graves
Optic atrophy causes
Optic neuritis in MS as sequelae
Glaucoma
Eye trauma or radiation
Compressive:
= Papilloedema, Tumors,
= Bony growth
= Thyroid eye disease
= Optic Chiasmal Tumor/Bleed
= Optic sheath meningioma
= Cerebral Lymphoma, Leukemia, Glioma
Vascular Causes:
= Anterior ischemic optic neuropathy
= Vasculitis related AION
= DM related AION
Congenital Causes:
= DIDMOAD syndrome
= Friedrich’s ataxia
= Leber’s Hereditary Optic atrophy
Infectious Causes:
= Lyme disease
= Tuberculosis
= Fungal
= Viral, HIV, Encephalitis
Inflammatory causes:
= Sarcoidosis
= SLE
= Behcet’s disease
= Syphilis, Meningitis
= Orbital cellulitis
Drugs, Toxins, Nutrition, medications
= Ethambutol, Alcohol, Methanol
= Vitamin deficiencies
= Sulfur, Lead, Hydrocarbon contact
Gradual Vision Loss analysis
Unilateral or bilateral
Painful or painless
Sudden or gradual, confirm this
Color vision reduction?
night vision reduction?
Tunnel vision?
Distortion of vision?
Common causes:
Diabetic retinopathy
Hypertensive retinopathy
Glaucoma
Retinitis pigmentosa
Macular degeneration (dm/ cystoid)
Ethambutol, B12, Alcohol, Tobacco
Cocaine use
Retinitis Pigmentosa
family history of blind uncles/ granpa
gradual vision loss, specially in dark
Associations:
1. Bardet Biedl syndrome - RP + polydactyly
2. Usher syndrome - RP + Deafness (Hearing aid ++)
3. Alport Syndrome - RP + Deafness +ESRD (Hearing aids++, Dialysis lines)
4. Refsum Disease: RP + Deafness + P.Neuropathy, Ataxia, thickened nerves + Anosmia + Short toes + Cardiomyopathy, cardiac conduction abnormalities (Phytanic acid accumulation)
5. Kearns Sayre syndrome - RP + ophthalmoplegia + Ataxia + Dysphagia, Cardiac conduction defects - michondrial genetic disorder
6. Mucopolysaccharoidosis - Hurlers
7. Abetalipoproteinemia - fat malabsorption due to MTP deficiency (Microsomal Triglyceride transfer protein)
Fundoscopy in Retinitis pigmentosa
= Peripheral dark bony spicules
= Waxy pallor of the disc
= thin fundal vessels (attenuated)
= Cataracts
= Cystoid macular edema (slit Lamp)
= RAPD in severe vision loss
= constricted vision
Optic atrophy Mimics
Congenital Optic nerve hypoplasia
Tilted Optic disc (congenital)
Myelinated nerve fibers at disc
Myopic crescents
Myopic crescent
A myopic crescent is a moon-shaped feature that can develop at the temporal (lateral) border of disc (it rarely occurs at the nasal border) of myopic eyes. It is primarily caused by atrophic changes that are genetically determined, with a minor contribution from stretching due to elongation of the eyeball.
The myopic crescent is commonly seen in pathological axial myopia. The condition sometimes described erroneously as myopic choroiditis, but myopic crescent is not an inflammatory process and does not run parallel to the degree of myopia. It usually tends to occur after mid adult life. Myopic crescent is often associated with some degree of retinal degeneration and occasionally vitreous degeneration.
Managing Retinitis pigmentosa
Register in Low Vision clinic
#Stop driving, inform DVLA
#RP Society Help
#Vitamin A supplements
Attend other issues if underlying syndromes present
Thyroid Eye symptoms/Signs
Symptoms:
Staring look
peri orbital swelling
grittyness of eyes
Eye pain or discomfort
Changes in visual acuity-color
Signs:
Periorbital edema
Proptosis/Exophthalmous
Lid Lag, Lid retraction
Ophthalmoplegia
Conjunctival edema-chemosis
Keratitis, Corneal ulceration
RAPD due to optic compression in proptosis
Diplopia with Grave’s ophthalmoplegia
Papilloedema
Look for Pretibial myxedema - ulceration-pigementation-atrophy-scarring over shin area
