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Clinical Exam > eye exam > Flashcards

eye exam Flashcards

1
Q

muscle and innervation involved with Ptosis

A

levator palpebrae superioris, supplied by CN3

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2
Q

Causes of Ptosis

A
  1. congenital ptosis
  2. Acquired: myopathies, 3rd cranial nerve palsy and horners.
    Mechanical causes such as orbital cellulitis
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3
Q

Aniridia

A

hypoplasia of the iris, assoc with glaucoma, cataract, corneal opacification.
AD and sporadic (assoc with wilms - WAGR)

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4
Q

Cataract

A

V
I: steroid use
T
A
Metabolic disorders (DM1/2; galactossemia)
I: Hereditary: autosomal, Chromosomal: T21, Malformation syndrome: noonan
N
Congenital: TORCH

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5
Q

Ectopia Lentis

A

Marfan (superiorly, like intellect)
Homocysteinuria (inferiorly, like intellect)

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6
Q

Retinal issues

A

Coloboma
Optic Nerve Hypoplasia
Retinopathy of prematurity

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7
Q

Lens issues

A
  1. Cataract
  2. Ectopia lentis
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8
Q

Colobomata

A

the defect, or lack of can involve any part of the eye
CHARGE syndrome
Cat eye syndrome
T15/T18
Rubenstein Taybi
Marfan
occulocerebrocutaneous
Klippen-feil
Kabuki
Joubert
Walker walburg
Noonan

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9
Q

Optic nerve hypoplasia

A

This can be an isolated anomaly, or be associated with other eye anomalies (microphthalmos, aniridia) and neurological problems such as encephalocele. It is associated with absence of the corpus callosum.

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10
Q

Retinopathy of prematurity

A

Stage 1. Flat white demarcation line between avascular and vascularised retina.

Stage 2. Ridge due to arteriovenous shunting (demarcation line raised into vitreous).

Stage 3. Extraretinal fibrovascular proliferation (new vessels elevated into vitreous).

Stage 4A. Partial retinal detachment, macula attached (visual prognosis still hopeful).

Stage 4B. Partial retinal detachment, macula detached (visual prognosis poor).

Stage 5. Complete retinal detachment.

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11
Q

Strabismus

A

heterotropia
esotropia
exotropia

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12
Q

non paralytic causes of strabismus

A

convergent (esotropia) infantile and accomodative
Divergent (exotropia) intermittent and constant

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13
Q

Paralytic causes of squint

A
  1. Third nerve palsy (frequently congenital; divergent squint, plus downward deviation of eye and ptosis)
  2. Fourth nerve palsy (congenital or acquired from head trauma; accompanying head tilt towards opposite shoulder to eliminate a vertical deviation)
  3. sixth nerve palsy (frequently acquired from head trauma)
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14
Q

introduction to the eye exam

A

Hi my name is Cassie and I’m the paediatric registrar sitting the exam today, thank you for joining us. wash hands

I have been asked to perform an eye examination on you, it shoudn’t cause any pain but if it does let me know and I’ll stop straight away.

I’m just going to start by speaking with the examiners and then we’ll start the examination

xx is well today, is responding well to me and is in no obvious distress. I would like to see her vitals to confirm but I am happy to do blood pressure later on if you would like.

she looks well grown/small for her age but i would like to check this on a growth chart, specifically looking at head circumference, height and weight and a trend over time. [microcephaly - intrauterine infect]

I’m looking around the room for any visual, ambulatory, respiratory or nutritional devices and I can’t see any. xx is/is not wearing glasses. [note any head tilt you see- 4th cranial nerve]

looking at xx, she has some unique features when compared with her mother/father, including x, x and x.
[specifically for malformation syndromes with eye involvement - ][ex premmie]

okay, lets start the exam.

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15
Q
  1. general inspection
A
  1. in front
  2. from the side
  3. from above ?proptosis
    eyebrows, eyelids. cornea, iris, sclera, conjunctivae. examine the glasses
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16
Q
  1. visual acuity
A

large items, to smaller until you get to hundreds and thousands. if no response check for light response. use snellen chart. comment on the need for formal visual testing.

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17
Q

what is it called and where is the lesion?

A

Total left visual loss, damage to Left optic nerve

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18
Q

what is it called and where is the lesion?

A

Bitemporal hemianopia, damage at the level of the optic chiasm

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19
Q

what is it called and where is the lesion?

A

Left homonymous hemianopia and the damage is to the right optic tract.

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20
Q

what is cortical blindness?

A

Cortical blindness (CB) is defined as loss of vision without any ophthalmological causes and with normal pupillary light reflexes due to bilateral lesions of the striate cortex in the occipital lobes. Cortical blindness is a part of cerebral blindness, defined as loss of vision secondary to damage to the visual pathways posterior to the lateral geniculate nuclei.

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21
Q

Causes of cortical blindness

A

ABI to occipital lobe, congenital abnormalities to occipital lobe, perinatal ischaemia.

22
Q

What is the blood supply to the optic tract

A

The anterior choroidal artery and thalamoperforating vessels from the posterior cerebral artery (PCA) supply the optic tract. Optic radiation is supplied by the middle cerebral artery (MCA), and the occipital lobe is primarily supplied by the PCA. The occipital lobe also receives supply from the MCA.

23
Q

how do you differentiate between cortical blindness and cranial nerve blindness?

A

Pupillary light reflex remains intact in cortical blindness, so do the extraocular movements. There is no relative afferent pupil defect (RAPD) in cortical blindness

24
Q

What is it and where is the lesion?

A

right sided impact on lateral tracts of the optic radiation, after the Lateral geniculate nucleus.

25
Q

What is it and where is the lesion?

A

right sided impact on the medial tracts of the optic radiation, after the lateral geniculate nucleus

26
Q

What is it and where is the lesion?

A

right sided homonomys hemianopia (damage to the total left optic radiation)

27
Q

What is it and where is the lesion?

A

Damage to the occipital lobe

28
Q

what does diplopia indicate?

A
29
Q

what can downbeat nystagmys (in primary positiion) mean?

A

cervicomedullary junction; (i.e. arnold-chiari malformation)

30
Q

what can upbeat nystagmys (in primary position) mean?

A

vermis of cerebellum

31
Q

lid lag?

A

thyrotoxicosis

32
Q

fatiguability?

A

myasthenia gravis

33
Q

assymetric optokinetic nystagmys?

A
34
Q

Internuclear opthalmoplegia

A

6th nerve nucleus (pons)
3rd nerve nucleus (midbrain)
via medial longitudinal fasiculus [connecting point]
if you disrupt this, you ill be disconnect MLF
can’t adduct, so you get resulting nystagmys on the left eye (dissociated horizontal nystagmys on the affected eye).

35
Q

causes of Internuclear opthalmoplegia

A

if they can converge that means the 3rd nerve is okay and that means the lesion is probably in the pons, if they can’t converge it might be in the midbrain.

“if the convergence is intact, pick pons”

36
Q

one and a half syndrome?

A

dissociated horizontal nystagmus in the unaffected eye, followed by horizontal gaze palsy.

37
Q

near and far cover test

A

Esophoria and exophoria, also shine a light to detect strabismus

38
Q

pupillary light reflexes

A
39
Q

finding of: papilloedema

A

?RICP, BP, asterixis from hypercapnia

40
Q

Finding: retinopathy of diabetes

A

endocrine and urinalysis

41
Q

finding: nystagmys

A

do a full neurological examination, looking for cerebellar signs if there is horizontal nystagmys

42
Q

unilateral nystagmys - what do you think of first?

A

Tumour until proven otherwise - MRI

43
Q

LOOK OUT FOR INTERNUCLEAR OPTHALMOPLEGIA

A

failure of adduction in the affected eye, while the contralateral eye abducts (hence, ‘looking out’), and develops nystagmus. So this is another cause of apparent ‘unilateral’ nystagmus, although the unilaterality may alternate

44
Q

bilateral horizontal nystagmys?

A

Horizontal conjugate nystagmus in children is most commonly due to anticonvulsant medication, but for children with a negative drug history, cerebellar disease is the most common cause

45
Q

congenital causes of nystagmys

A

visual: Causes include congenital cataracts, high refractive errors, congenital optic atrophy and oculo-cutaneous albinism
pure congenital : congenital nystagmus, labyrinthine disease (peripheral vestibular nystagmus), and periodic alternating nystagmus (which is horizontal jerk nystagmus which intermittently changes direction, and can occur with cervicomedullary junction anomalies, such as Arnold–Chiari malformations).

46
Q

syndromes associated with nystagmys

A

Bardet-Biedl, crouzon, Down, Noonan, occulocutaneoush albinism

47
Q

bilateral, roving eye?s

A

most likely visual impariemtn

48
Q

vertical nystsgmy:

A

visual cause or a brainstem problem

49
Q

see-saw nystagmus

A

parasellar mass with craniopharyngioma, septo-optic dysplasia or occulocutaneous albinism.

50
Q

causes of proptosis?

A

V: haemangioma
I: orbital cellulitis/arachnoid abscess
T: injury to globe
A: Thyroid Eye Disease
M: storage disorder
I: paranasal sinuses/ sarcoidosis
N: sarcoma, rhabdomuosarcoma, retinoblastoma, neuroblastoma, neurofibroma, lymphoma, glioma,
C: craniosynostosis (crouzon, apert)/syndrome/ NF1)

51
Q

bilateral proptosis

A

TED (thyroid eye disease)
craniosynostosis)

Clinical Exam (10 decks)

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