Ophthalmic Shingles and Pupil Problems Flashcards
Where is the most common locations for shingles to occur?
Shingles typically occurs in those over 50. The two most common locations for it to occur are in the thoracic dermatomes and the ophthalmic branch of the trigeminal nerve.
What are the risk factors for ophthalmic shingles?
Increasing age
Trauma
Immunocompromised
What are the clinical features of ophthalmic shingles?
Pain and neuralgia in the ophthalmic trigeminal nerve dermatome
Blistering inflamed rash
Erythema
Globe affected in 50% of cases (nose tip involvement makes this more likely – nasociliary branch of trigeminal nerve which also supplied the orbit – Hutchinson’s sign)
How should ophthalmic shingles be investigated?
Visual acuity
Slit lamp to check for anterior uveitis
How is ophthalmic shingles managed?
Oral antivirals (must given within 72 hours) – aciclovir usually used for 7-10 days. IV antivirals if severe infection Prolonged steroid eyedrops may be required Avoid contact with pregnant women
What is Aniscoria?
Term used to describe unequal pupils. Should be investigated in case of some sort of cerebrovascular event. However, could also just be normal for that person. Important to check old photos or videos and ask about previous eye injury or surgery.
If not normal need to determine whether there is a pupil that’s not constricting properly or one that’s not dilating properly which can be done with a pen torch.
How will pupils appear if there are sympathetic vs parasympathetic lesions?
Sympathetic lesions cause a pin point pupil Parasympathetic lesions (CNIII) cause a blown pupil
What is an Argyll robertson pupil?
This occurs in neurosyphilis and diabetes. There is a bilateral miosis, poor pupillary dilation, pupil irregularity, and light near dissociation (meaning accommodation reflex present but pupillary reflex absent). Also known as prostitute’s pupil. Usually as a result of a lesion to fibres that inhibit the Edinger Westphal nucleus which stimulates the parasympathetic neurons.
What is a Holmes Adie pupil?
Benign tonically dilated pupil that will not respond to light but will constrict to accommodate very slowly. Once the pupil has constricted it remains small for an abnormally long time. This occurs due to damage of the postganglionic fibres of the parasympathetic nerves due to a viral or bacterial infection.
What is Holmes adie syndrome?
Commonly this is seen in females with absent knee or ankle jerks and impaired sweating in which case its known as Holmes Adie syndrome.
What is Horner’s syndrome?
This is due to disruption of sympathetic fibres causing a miotic pupil, partial ptosis. If also a unilateral facial anhidrosis then the lesion must be more proximal to the spine prior to the common carotid artery bifurcation.
What can cause Horner’s with unilateral facial anhidrosis?
Causes of Horner’s with unilateral Anhidrosis • Pancoast’s tumour • Thyroidectomy or thyroid malignancies • Trauma • Cervical Rib • Mediastinal masses • Aortic Aneurysms
What can cause Horner’s without Unilateral anhidrosis?
Causes of Horner’s without Anhidrosis
• Cavernous sinus thrombosis
• Common carotid dissection/aneurysm
• Cluster Headache
What can cause Horner’s with unilateral anhidrosis of the face, arm and trunk?
Causes of Horner’s With Anhidrosis of the face, arm, and trunk
• Stroke (typically lateral medullary syndrome)
• Syringomyelia
• Multiple sclerosis
• Tumour – gliomas
• Encephalitis
• Hypothalamic lesions
