Lisa Quinn revision Flashcards
causes of red eye
types of conjunctivitis
1) Bacterial
2) Viral
3) Allergic
- Antihistamines
- Marcel stabiliser – cromoglycate eye drops
Blephritis
Inflammation of the eyelid margin -> meiobian gland
- Rosea is a risk factor
- Styes (on eyelid margin) and chalazians (away from eyelid margin)
- Warm compress
uveitis
o Steroid eye drops
o Use cycloplegics to relax ciliary bodies to dilate the eye -> iris can get stuck to cornea -> cycloplegics stop this
Corneal Ulcers
- Bacterial infection -> contact lenses
- Fluorescein state
Scleritis
VERY VERY VERY PAINFUL
epscleritis
- Dull ache
- Reassure and discharge
- Phenylephrine added to eye will cause blanching (will go less red)
Endophthalmitis
- Post op
- IV antibiotics
Differentiating red eye
- Painful
- Painless
- Vision
- Normal intraocular pressure or raised? (normal 10-21mmHg)
red eye and pain
red eye and intraocular pressure
history for red eye
- SOCRATES
- Specific
o Type of pain: e.g. gritty
o Itchy
o vision change?
o Contact lense wearer
o History of trauma
o Double vision
o RICP symptoms
Headache
N and vomiting
o Coryzal symptoms - Past medical history
subconjunctival haemorrhage
- Can cause grittiness
- Foreign body sensation
Cause
- Can be spontaneous or coughing
Risk factors
- High blood pressure, blood thinners
horners syndrome
Features: SPAM
* Sympathetic systme
* Ptosis
* Anhidrosis
* Miosis
- Angle closure glaucoma
- > 30mmHg measured using Goldmans tonometry
- Fixed eye- key
- Vision: halo sign
Management
- Timolol
- Pilocarpine
- Acetazolamide (TAP)
- Laser iridotomy
o Works by producing a hole, allowing an alternative hole for the aqueous to flow
pathophysiology of acute angle closure glaucoma
When pupil dilates the iris crumples up to the corner i.e. if you are in a dark room like a cinema -> stops drainage -> can get stuck in this position therefore pupil dilatation
management of glaucoma
- ABC reduce production of aqueous from ciliary body
- PAP -> increases flow through trabecular network
- Mannitol is last resort
Oculomotor nerve palsy
Squints (strabismus) in adults
- CN palsy
- Thyroid eye
- Blow out fracture
Squints in children
- Congenital misalignment
Amblyopia vs strabismus
Strabismus is a problem with eye alignment, in which both eyes do not look at the same place at the same time. Amblyopia is a problem with visual acuity, or eyesight.
cranial nerve examintion
go throught CNs one by one
Olfactory
- Smell
- Causes
o Cribriform plate fracture
o Covid
Optics
- Inspect pupils
- visual acuity
- pupillary reflexes
- colour vision
- visual fields
- fundoscopy
visual acuity
Snellen (6m)
- Cover left eye first and read down to lowest line they can
- Distance from the chart
- Lowest full line that can be read correctly +- additional letters
- E.g. 6/24-1 (would be can reqad the 2 letters on line 24 but not the 3rd
noral visual acuity
- 6/6 is normal (20/20 in feet)
- Driving limit 6/12
pupillary reflexes
1) Direct and indirect
2) Relative afferent pupillary defect (RAPD- diff to indirect)
Relative afferent pupillary defect (RAPD) (different to indirect)
- If one eye not constricting as well as the other (will look way more dilated even if it seemed to constrict on the direct and indirect)
- Swing light between eyes to compare (working CN eye will constrict more than the defective oen)
- Damaged eyes looks like its dilating
colour vision
colour chart
visual fields test
Cranial nerves oculomotor, trochlear , abducens
- Eyelids (CN 3)
- Eye movements
Trigeminal nerve
- Touch – sensory (ophthalmic, maxillary, mandibular division)- cotton wool
- Motor assessment
o Palpating Masseter muscle whilst clenching the teeth - Corneal reflex
Facial nerve
- Sensory assessment
o Anterior 2/3 of tongue - Motor assessment
o Facial expressions
Vestibulocochlear nerve
- Gross hearing assessment
- Rinne and Webers test
Glossopharyngeal and vagus
- Swallow assessment
- Gag reflex
- Ask to cough
Accessory nerve
- Shrug shoulders
- Can you push against my hand on face
Hypoglossal
- Put out tongue
look for direction and fasiculation
uvula
tip of soft palate
o Muscular -> to help move food
o Vagus nerve -> ask them to say ahhh -> opposite direction to CN palsy (can cause nasal regurgitation, hot potato voice)
palatine tonsils
(part of Waldeyeres ring)
o Tonsilitis
o Quinsy – peritonsillar abscess (opening mouth is painful, halitosis, hot potato voice (not neurological just due to physical distortion, systemic symptoms, unilateral distortion of soft palate)
o Stertor -> oropharynx – snoring noise
Oropharyngeal cancer
- Squamous
- Metastasise to lymph nodes
- RF
o Beetle nut gum
o HPV
o Smoking
o Drinking - Presentation
o Lymphadenopathy
o Ulceration
o Hoarseness
o Dysphagia
Lymphadenopathy
- Infection
- Malignancy
- Salivary glands
o Infections and inflammations e.g. parotitis
o Stones
o Cancers- parotid more likely , facial nerve paralysis (ipsilateral facial droop
role of larynx
- Airway protection e.g. close off airway during swallow, coughing
- Speech
Anatomy of the larynx
Epiglottis is anterior -> pointing to the front
1. Aperture (gap)
2. True vocal cords- lighter in colour
3. Piriform fossa
route of the recurrent laryngeal nerves (diff on each side)
Right Recurrent laryngeal nerve – Hooks underneath the right subclavian artery, then ascends towards to the larynx. It innervates the majority of the intrinsic muscles of the larynx.
Left recurrent laryngeal nerve – it hooks under the arch of the aorta, ascending to innervate the majority of the intrinsic muscles of the larynx.
retropharangeal abscess
Infection in the retropharyngeal space is usually secondary to an upper respiratory tract infection (e.g. nasal cavity, nasopharynx, oropharynx) and is most commonly seen in children, usually under the age of 5 years. Infection in this space may
develop into an abscess.
A retropharyngeal abscess can present with a variety of signs and symptoms including a visible bulge on inspection of the oropharynx, sore throat, difficulty swallowing, stridor, reluctance to move their neck and a high temperature. It is important to recognise and treat early.
