OPTHALMOLOGY Flashcards
Diplopia worse walking down the stairs
fourth nerve palsy
headache + ptosis + miosis
aka Painful Horner’s syndrome
–> due to internal carotid dissection
Progressive headache 6/10, ptosis and right dilated unreactive eye
3rd nerve palsy described possibly due to posterior communicating artery aneurysm
Obese lady on COCP develops morning headaches which are worse on coughing and diploplia. What’s causing double vision?
sixth nerve palsy duue to benign intercranial hypertension
Retro-orbital boring pain 10/10 lasting 20 minutes. 10 episodes per week.
Cluster headache
A 30-year-old female presented with double vision and ataxia. Three years earlier she had an episode where she lost vision in her left eye for two weeks. On exam, she was mildly ataxic, with brisk reflexes, and both horizontal and vertical nystagmus. What is the most likely diagnosis?
Multiple sclerosis
What are the two parts of the pupillary light reflex?
AFFERENT - optic nerve
EFFERENT - oculomotor nerve
Give signs of optic nerve dysfunction
Decrease in visual acuity (VA).
Dyschromatopsia: visual colour impairment.
Visual field defects.
Diminished contrast sensitivity.
Relative afferent pupillary defect (RAPD).
What condition can cause optic neuritis?
MS
Give clinical features of MS
- sensory loss
- muscle cramping and weakness
- bladder, bowel + sexual dysfunction
- Charcot’s triad (tremor +dysarthria + ataxia)
What is l’hermitte sign?
a clinical feature of MS - electrical shock on neck flexion
What is Uhthoff phenomenon?
worsening of MS symptoms due to increase in temperature
Features of optic neuritis
unilateral pain exacerbated by eye movements, decreased VA visual field defect (central scotoma), dyschromatopsia and RAPD.
How do you investigate MS?
MRI - demyelinating plaques
Lumbar puncture - oligoclonal bands in CSF
Treat optic neuritis
IV methylprednisolone then oral prednisolone
Horner’s syndrome features
ptosis (due to muller muscle dysfunction), miosis (causing anisocoria) and ipsilateral anhydrosis (if lesion below superior cervical ganglion).
What is Adie’s pupil?
affected pupil is dilated with absent light reflex due to damage to ciliary ganglion
What is Holmes-Adie syndrome?
diminished/absent deep tendon reflexes of lower limbs + Adie’s pupil +/- orthostatic hypotension
What is Argyll Robertson (prostitute’s) pupil?
bilateral, irregular small pupils that dont react but do accomodate
- due to diabetes or syphilis
Clinical features of 3rd nerve palsy
ptosis
down and out eye
dilated pupil with abnormal accomodation
Clinical features of 6th nerve palsy
horizontal double vision, esotropia (inwards) and limited abduction
What is mysathenia gravis?
autoimmune disease of AcH receptors at post-synaptic neuromuscular junctions
Clinical features of myasthenia gravis
bilateral ptosis
lid twitch elicited by looking down then up
diplopia
opthalmoplegia
weakness of muscles of facial expression and proximal limbs
Investigate myasthenia gravis
- ptosis improves after 2min of ice
- anti-ACh receptor antibody and anti-muscle specific kinase
- electromyography and muscle biopsy
- image throax for thymoma
management of myasthenia gravis
Pyridostigmine (anticholinesterase), steroids and immunomodulators.
Surgery if thymoma is present (thymectomy).
What is myotonic dystrophy?
AD condition due to tri-nucleotide repeat on chromosome 19.
Causes delayed muscle reaction and wasting
Give the ocular features of myotonic dystrophy
- early onset cataracts
- ptosis
- hypermetropia (long sighted)
- opthalmoplegia
Lateral optic nerve lesion immediately anterior to the chiasma would result in which vision defect?
junctional scomatoma
optic tract lesion
homonymous hemianopia of opposite side
Damage to the optic radiation will cause which visual defect?
bilateral quadrantopia
