Ojos! Flashcards
Ischemic abducens palsy
Diabetic palsy, awake w/ eye pain, then get horizontal diplopia. Eye cannot abduct. Infarct w good prognosis, diplopia worse at a distance b/c have to abduct slightly
Pituitary Apoplexy
SHEEHAN! Severe headache and BP drop postpartum, pit explodes, get adrenal insufficiecy
Cataract
Pt can’t see out, you can’t see in, cataracts from corticoid long term use are common
Cluster headache
More common in men! Assoc w/ horner’s sx , same time each night, red teary eye w/ ptosis/miosis. worry about cartoid dissection first time
Amblyopia ex anopia
Poor vision due to disuse of the eye (aka lazy eye), dind’t develop stereoscopic vision
Internuclear Opthalmoplegia
INO! Medial Longitudinal Fasciulus is involved, get sudden double vision, worst on a lateral gaze. Eyes move conjugately one way, but other way, get nystagmus and lack of adduction!
Affected eye can’t adduct properly (so if R eye hit, see double when look left)
Think MS in young people, think PPP vessel stroke in older
Optic Neuritis
Pain on eye mvt w/ central scotoma. Normal fundus w/ poor vision!
Polymyalgia Rheumatica compx?
Hip/shoulder neck pain for a whle and then…Giant Cell Arteritis! Central Retinal Artery occlusion! Get one sided headache and blurred vision!
Dx w/ Elevated ESR and then temp artery biopsy!
(Diff than central retinal vein occlusion (w/ congested veins, swollen disc, polycythemia)
Basilar Migraine
Dizziness, slurred speech, double vision for 15 min, then severe headache and vomiting
Posterior communicating artery aneurysm
Painful third nerve palsy! Collapse and vomit, hold neck rigid and dilated left pupil, drooping Lid, eye abducted!
Dx: Ct, LP, MRA/arteriography! Think abt herniation
IF aneurysm coiled and then deterioration, probs VASOSPAM, give nimodipine (CCB)
Acute Angle Closure Glaucoma
Eye pain, h/a, red eye, cloudy cornea, dilated pupil, poor rxn to light
Angle closure from neuro drugs like topamax!
Muscular entrapment
trauma + diplopia only in one plane of gaze, ie:
mvt of vertical gaze in full adduction of right eye = Inferior Oblique issue!
Meyers Loop
Neoplasm in R temporal lobe hits optic radiations subserving superior visual fields swinging forward…=> increased muscle stretch reflexes and homonymous L superior quadrant defect
Tunnel vision!
Functional visual loss- as test screen is move further away, area perceived should enlarged…this is MALINGERING!!!
Monocular vision loss
Lesion anterior to chiasm (eye or optic nerve)
If can improve visual acuity w/ pinhole, means refractive/ocular problem
Gradual loss of vision means ocular disease like cancer, catarct, or retinal disorder
Optic nerve glioma in NFM type I
Papiledema vision loss?
ICP increase initially causes transient visual obscurations (TVOs) and pulsatile tinnitus,
blind spot enlarges, and then nasal step of field loss, then concentric peripheral constriction (like tunnel vision)
Optic neuritis
Swinging flashlight test shows APD, fundus normal for a while, down visual acuitivy, red desaturation, no color plates!
RPLS
Post transplant chemotx and immunosup like cyclospor and tacrolimus make you aggitated, confused, and blind- so cortical blindness but pupillary response normal!
Ischemic Optic Neuropathy
Most common optic neuorpath in pts over 50- either anterior ION or posterior b/c retina has dual supply…Ciliary/choroidal circ for choroid/outer layers/optic nerve head, central retinal supplies inner
AION = optic nerve head w/ disc edema
PION = retrobulbar (rare), normal disc!
ION from temp arteritis = emergency!
Painless loss of vision over hours/days, blurred vision, altitudinal field defect…remains stable!
Why? Small optic cup? HTn? DM?
PION post spinal surg..irreversible!
Drugs causing it = amiodarone, INF-A, decongestatns, PDE inhib!
Post Cerebral Artery Stroke
Homonymous hemianopia! Maybe can see macular sparing b/c of MCA vasc supply to that area too!
