Opthalmology Flashcards
If a patient presents with Diplopia, what is it important to test?
Eye movements, examine for ptosis and pupils
If patient reports monocular visual loss what should you think about and examine?
Monocular= in front of the chiasm.
Examine acuity, colour vision and fundoscopy.
Optic atrophy secondary to MS, glaucoma etc.
If patient presents with binocular visual loss, what should you think about and examine?
Sudden=ischaemia
Gradual= inherited conditionsc metabolic, toxic Optic neuropathy, Retinopathy caused by diabetes, HTN, vasculitis. Age related Macular degeneration.
Examine fundoscopy, visual fields and acuity.
Is a patient presents with central visual loss (difficulty reading/seeing faces), what should you consider?
Diabetic retinopathy
Optic disease
Cataracts
If a patient reports difficulty with peripheral vision then what should you consider?
Retinal pathology (retinal artery occlusion, retinitis pigmentosa) or stroke/chiasmal lesion Glaucoma
In a third and fourth nerve palsy suggest an aetiology.
Midbrain (carvernous sinus) pathology- stroke, SOL, demyelination
What causes INO?
Typically MS or brainstem infarction affecting the medial longitudinal fascilus.
Name 4 causes of complex opthalmoplegia? (4 subtypes)
Nerves ie. mononeuritis multiplex (diabetes, small vessel disease), demyelination
NMJ ie. MG
Muscles ie. Thyrotoxicosis
Rare ie. Miller Fisher
What is altitudinal hemianopia and what causes it?
Loss of half the vision in the horizontal plane. Usually caused by ischaemic optic neuropathy.
What would be important to ask a patient about their visual loss? (6)
1) Onset of symptoms (including history of trauma)
2) Rate of progression of symptoms?
3) Monocular or binocular?
4) Associated pain or systemic symptoms?
5) Constant or intermittent/variable throughout the day?
6) Affects on AoDL?
How does optic neuritis usually present
Deterioration in vision (particularly colour vision) over a few days and usually painful.
Differentials for diplopia? (4)
CN lesion of 3,4 or 6
INO in MS
Complex ophthalmoplegia in MG or thyroid disease
On examining the eyes (not testing reflex) equal pupils indicate a defect where and unequal pupils indicate a defect where?
Equal= sensory defect (afferent) Unequal= motor defer (efferent)
When would you urgently refer a patient to opthalmology with diabetic eye changes?
Pre-proliferative retinopathy or beyond.
What would you see in background diabetic retinopathy?
Hard exudate
Blot haemorrhage
Microaneurysm
