Neurology: Clinical - Eyes Flashcards
1
Q
What is the clinical name for short-sightedness?
A
Myopia
2
Q
What is the clinical name for long-sightedness?
A
Hyperopia
3
Q
What is the clinical name for when there is a non-spherical curvature of the cornea (or lens)?
A
Astigmatism
4
Q
What is the clinical name for long-sightedness of old age?
A
Presbyopia
5
Q
What is the clinical name for perfect vision?
A
Emmetropia
6
Q
What is the most common cause for myopia?
A
Eyeball too long
7
Q
In myopia, where is the image formed?
A
In front of the retina - as the eyeball is too long
8
Q
What are the symptoms of myopia?
A
Headaches, complain can’t see whiteboard/distant objects, divergent squint
9
Q
What is a sign of myopia in infants/preverbal children?
A
Divergent squint
10
Q
What is the most common cause for hyperopia?
A
Eyeball too short or cornea and lens too flat
11
Q
In hyperopia, where is the image formed?
A
Behind the retina - eyeball too short
12
Q
What are the symptoms of hyperopia?
A
Eyestrain after reading/computer, convergent squint in children
13
Q
What type of lens does myopia usually require?
A
Biconcave lenses
14
Q
What is a sign of hyperopia in children and how is it corrected?
A
Convergent squint
Glasses/lenses to prevent a ‘lazy eye’
15
Q
What type of lens does hyperopia usually require?
A
Biconvex lenses
16
Q
What appears hazy in astigmatism?
A
Everything
17
Q
Why does presbyopia occur?
A
With age the lens gets less mobile/elastic
18
Q
What is phototransduction?
A
Conversion of light energy to an electrochemical response by the photoreceptors (rods and cones)
19
Q
What happens after the rods and cones are phototransduced?
A
Need to activate optic nerve neurons to generate an AP
20
Q
What is the visual pigment in rods called?
A
Rhodopsin
21
Q
How does bleaching of the visual pigment result in phototransduction?
A
Phototransduction cascade
22
Q
What role does vitamin A play in the visual pigment?
A
Visual pigment regeneration
23
Q
What can physical symptoms can occur if there is vitamin A deficiency?
A
Bitot’s spots in conjunctiva
Corneal ulceration
Corneal melting
24
Q
What is classed as your visual field?
A
Everything you see with one eye including in the periphery
25
What are the clinical tests for the visual field?
Confrontation test
| Automated perimetry
26
Which fibres cross at the optic chiasm?
Medial (nasal) fibres
27
Where do fibres from the optic tract synapse?
Lateral geniculate body (LGB) of the thalamus
28
Where do the optic radiations run between?
LGB of thalamus and primary visual cortex
29
What would you expect if the right optic nerve was damaged?
Blindness in right eye
30
What would you expect if the optic chiasma was disrupted in the middle?
Bitemporal hemianopia
31
What would you expect if the right optic tract was damaged?
Contralateral homonymous hemianopia (right)
32
What would you expect if the optic radiation was damaged?
Contralateral homonymous hemianopia
33
Which muscles elevate/depress when the eye is adducted?
Obliques
34
Which muscles elevate/depress when the eye is abducted?
Superior and inferior rectus
35
What is the primary action of the superior oblique muscle?
Intorsion
36
What is the primary action of the inferior oblique muscle?
Extorsion
37
What is the clinical term for an eye squint?
Strabismus
38
What misalignment of the eyes manifests as a convergent squint?
Esotropia
39
What misalignment of the eyes manifests as a divergent squint?
Exotropia
40
What is the clinical term a lazy eye?
Amblyopia
41
What is the clinical term for double vision?
Diplopia
42
Where does the pupillary light reflex go in the brain?
Edinger-Westphal nucleus (EWN) - part of the CNIII nucleus
43
Where does the constrictor papillae receive it's parasympathetic fibres from?
Edinger_Westphal nucleus (EWN) - part of the CNIII nucleus
44
What is the clinical term when pupils are of different sizes?
Anisocoria
45
In what syndrome might you find someone with anisocoria?
Horner's syndrome
46
What are some of the signs of Horner's syndrome?
Miosis (a constricted pupil)
Anisocoria
Ptosis
Anhidrosis (decreased sweating)
47
How is Horner's syndrome caused?
A deficiency of sympathetic activity due to the sympathetic trunk being damaged. Signs and symptoms happen on ipsilateral side of lesion.
48
What are some common causes of absent/abnormal pupillary reflexes?
Any abnormality of the afferent limb/centre/efferent limb of the reflex:
Diseases of the retina - detachment/degeneration/dystrophies
Diseases of the optic nerve - such as optic neuritis (MS)
Diseases of CNIII which is efferent limb
49
How does diabetes cause CNIII palsy?
Usually due to diabetic peripheral neuropathy - damage to small blood vessels that supply the nerve
50
What would you suspect of a patient with CNIII palsy with an absent pupillary reflex?
Cerebral artery aneurysm (emergency)
51
What is the common characteristic of a complete oculomotor nerve palsy?
'Down and out' position of affected eye
52
How might a Pancoast tumour of the lungs present?
Horner's syndrome
53
How do postganglionic sympathetic fibres travel in the head and neck?
Postganlionic sympathetic fibres travel along with blood vessels in head and neck
54
How does nuclear sclerosis affect vision?
Makes objects appear less clear and see more of the red spectrum
55
What is conjunctivitis?
Self-limiting bacterial or viral infective of the conjunctiva
56
What are the symptoms of conjunctivitis?
Red, watering eyes
Discharge
No loss of vision as long as infection does not spread to cornea
57
What is the treatment for conjunctivitis?
Antibiotic eye drops if likely to be bacterial
58
If a stye is external what does it affect?
The sebaceous glands of an eyelash
59
If a stye is internal what does it affect?
Meibomian glands
60
What is an inflammatory condition of the cornea?
Corneal ulcers
61
What is a non-inflammatory condition of the cornea?
Dystrophy
62
What do corneal pathologies frequently lead to?
Opacification of the cornea
63
Pharmcologically, which group of compounds would be used to dilate the pupils?
Sympathetic eye drops
64
How does glaucoma arise?
Increase in intraocular pressure, aqueous humour is not draining out enough
65
What are the triad of signs for diagnosing glaucoma?
1. Raised IOP
2. Visual field defects
3. Optic disc changes on ophthalmoscopy
66
What are the management options for glaucoma?
Eye drops to decrease IOP
Laser trabeculopasty
Trabeculectomy surgery
67
What are the eye drops that could be used to decrease IOP?
Prostaglandin analogues
Beta-blockers
Carbonic anhydrase inhibitors
68
Why does the angle close in angle closure glaucoma?
1. Functional block - large lens
| 2. Iris obstructs angle for drainage
69
What is the management for acute episode of angle closure glaucoma?
Decrease IOP: IV infusion, analgesics, antiemetics, constrictor eye drops, beta-blocker drops, steroid eyedrops
Iridotomy (laser) to both eyes to bypass blockage
70
What are the main differences between open angle and angle closure glaucoma?
Open angle: drainage through trabecular meshwork is blocker, leads to gradual, painless buildup of IOP
Angle closure: peripheral iris blocks the angle and therefore aqueous fluid can't drain, increase in IOP is sudden leading to red eye and severe pain = emergency
71
What is uveitis?
Inflammation of the uvea
72
What examinations would you do for an acute red eye?
Best corrected visual acuity
Snellen chart
Ophthalmoscopy
Slit lamp and volks lens
73
What questions would you ask in a history about loss of vision?
Unilateral/bilateral?
Onset: sudden/gradual/over what time?
Type: blurred/distorted/black?
Associated symptoms: pain/redness/discharge?
74
What extra examinations or investigations could you do for loss of vision?
```
Amsler chart
Colour vision - ischihara plates
Visual field assessment
Flurescein angiography
Optical coherence tomography
```
75
What are potential diagnoses for sudden complete loss of vision?
Central retinal artery occlusion
| Anterior ischaemic optic neuropathy
76
What are drusen?
Yellow deposits under the retina
77
What does intravitreal anti-VEGF do?
Stop the abnormal blood vessels leaking, growing and then bleeding under the retina
78
What is intravitreal anti-VEGF a treatment for?
Age related macular degeneration
79
What diagnosis does the appearance of distorted lines on an Amsler chart suggest?
Macular degeneration
80
What is the commonest cause of vision loss when using a Humphrey's visual field analyser?
Glaucoma
81
What type of visual field defect is commonly caused by a stroke?
Homonymous hemianopia
82
What does the VEGF stand for in anti-VEGF?
Vascular endothelial growth factor
83
Why proptosis in Grave's disease?
Hyperthyroidism causes orbital fat hypertrophy
84
What can cause cavernous sinus thrombosis?
Bacterial infection from face or scalp (e.g. infected hair follicle) which pass through emissary veins into cavernous sinus
85
What would happen to the eye in a sixth nerve palsy?
Inability for lateral rectus to adduct the eye and so would result in a convergent squint of the affected eye
86
There is a convergent squint of the right eye, what could be the potential diagnosis?
6th nerve palsy
87
What would happen to the eye in a third nerve palsy?
Abnormal, drooping (ptosis), eye deviated outward, most movements lacking (down and out characteristic)
88
There is ptosis of the right eye, the eye is deviated outwards and most movements are lacking, what could be the potential diagnosis?
3rd nerve palsy
89
What would happen to the eye in a fourth nerve palsy?
Superior oblique affected (intortion and depression)
| If SO doesn't work, LO overworks eye shoots up when ask person to look at nose
90
The left eye shoots up when you ask the person to look at their nose, what could be a potential diagnosis?
4th nerve palsy
91
54yo male presented with headaches, sudden onset of double vision and drooping eyelid on left side.
O/E: L ptosis, LE was in down and out position, with other movements restricted. Pupil enlarged non-reactive.
Likely diagnosis?
3rd nerve palsy with possible aneurysm as absence of pupillary reflex
92
What embryological anomaly leads to a coloboma?
COME BACK TO********
93
What is a coloboma?
A congenital malformation of the eye causing a hole in the lens, iris, or retina
94
What might cause the appearance of a drooping eyelid?
LPS muscle -> CNIII problem
95
Which might cause the inability to close the eyelid?
Facial nerve palsy
