Random - pupil stuff / eyelid Flashcards
What is the pathway of pupil reflex
Afferent
- Retinal
- Optic nerve
- Mid brain
Efferent
- Midbrain
- Oculomotor nerve
What can be affected at retina
Detachment
Degeneration
What can affect optic nerve
Optic neuritis
What can affect oculomotor and how does it present
Damage to parasympathetic fibres
- Ptosis
- Dilated non reactive pupil
- Divergent squint - down and out
How does microvascular cause affect 3rd nerve palsy and what is microvascular
DM Hyeprtension Ischaemia Usually just affects motor Parasympathetic fibres usually fine so pupil is spared
IF REFLEX ABSENT WHAT SHOULD YOU SUSPECT
Compression of the whole nerve Cerebral artery aneurysm - do CT to rule out Cavernous sinus thrombosis Tumour Trauma Raised ICP
What causes Argyll robertson pupil
DM
Syphillis
What happens
Pupil reflex absent
Accomodation present
Small irregular pupil
NO response to light
What is Holmes Adie Pupil
Unilateral dilated pupil then constricts
Slow accomodation / sluggish
Absent knee + ankle reflex
Other causes of dilated pupil
Causes of constricted pupil
Dilated Cocaine / amphetamine Trauma Phaeochromocytoma Anti-cholinergic Topical mydriatics 3rd nerve palsy Raised ICP
Constricted Horner Cluster Argyll Robertson Opiates Nictoine
What causes Marcus Gunn pupil
Lesion anterior to optic chiasma
Retinal detachment
Optic neuritis - must rule out MS
What does it lead to
Afferent pupil defect
Eye dilates when light shone instead of constrict
What is Horner’s
Any disruption of sympahhetic innervation of eye
Sympathetic arise from spinal cord - preganglion
Enter sympathetic ganglion at base of neck
Exit as post ganglion nerve which travel to head alongside ICA
What are the signs
Miosis - small pupil
Ptosis - drooping
Enophthalmos - sunken eye
Anhidrosis - loss of sweating
What causes Horner’s if anhidrosis if of face / arm and trunk
Central lesions - 4S Stroke Syringomyelia MS Swelling from tumour Encephalitis
What causes Horner’s if anhidrosis of face
Pre-ganglionic lesions - 4T’s
Pancoast tumour
Thyroidectomy
Trauma
If no anhidrosis
Post ganglionic lesion - 4C's Carotid artery dissection Carotid aneurysm Cluster headache Cavernous sinus thrombosis
How is sweat glands innervated
Sympathetic
Ach on muscarininc fibres
What causes miosis
Sympa usually = Na on A1 = dilatation
If broken get excessive constriction
What can cause optic neuritis
MS DM Syphillis / Lyme's/ herpes Neuromyelitis Sarcoid / SLE Drugs
What are the symptoms
Unilateral decrease in visual acuity over hours to days Poor colour - red sats Pain worse on eye movement Afferent pupil defect Swollen optic disc
How do you Dx
MRI to look for signs of MS
How do you Rx
High dose steroid
What causes optic neuropathy
Stroke
Atherosclerosis
GCA
Hypotension
Symptoms
Unilateral decreased vision
Little warning
What is papilloedema
Optic disc swelling due to raised ICP
What causes
SOL Malignant hypertension Intracranial hypertension Hydrocephaus Hypercapnia Hypo PTH / hypo Ca
What is seen on fundoscopy
Venous engorgement = 1st sign
Loss of venous pulsation
Blurring optic disc
Elevation of disc / loss of optic cup
What causes nasolacrimal duct obstruction
Imperforate membrane
What does it lead too
Most common reason for persistent watery eye in infancy
How do you Rx
Massage duct
Usually resolves by 1
What is Herpes Zoster Ophthalmicus
Reactivaiton of VZV in V1 of trigeminal
What do you get
Vesicular rash around eye
If rash near tip of nose suggest eye involvement ‘ Hutchinson’
How do you treat
Anti-viral
IV if severe / immunocompromsied
Topical steroid if secondary inflammation
Ophthalmology review
What are complications
Eye involvement - COnjunctvitis - Keraitits - Episcleritis - Uveitis - Ptosis Post hepatic neuralgia Optic atrophy
What is Blephairitis
Inflammation of eyelid
What causes
Meibonium gland dysfunction = common
Seborrheic dermatitis
Staph infection
What are symptoms
Bilateral Gritty eye Discomfor Sticky eyes Red eyelid Swelling if staph
How do you treat
Hot compress
Remove debris
Aritifical tears
Complications
Stye
Chalzions
Secondary conjunctivitis
What is a stye
Infection of sebaceous glands of eyelid
Pain
What type of stye
External
Internal
What does enternal affect
Usually staph infection of serum or sweat production
What does internal affect
Infection of Meibomian gland
How do you Rx
Hot compress
Analgesia
Ax if conjunctivitis
What may be left
Chalazion (cyst)
What is a Chalazion
Meibomian cyst Firm painless lump in the eyelid Hot compress and analegsia Ax if acutely inflamed May need surgical Rx
What is ectropion / entropion and what are risks
Entropion = in turning - Tape eyelid to prevent - Will need lubricant eyedrops - Surgery = definite Ectropion = out turning Can be painful Risk of corneal ulceration / damage
What is GCA
Large vessel vasculitis affecting temporal artery
Overlaps with PMR
EMERGENCY
What are the symptoms of GCA
Typically >60 Rapid onset <1 month Headache Jaw claudication Visual distubrance Tender palpable temporal artery Features of PMR
What causes visual disturbance
2 to ischaemic optic neuropathy
Cotton wool spots
Can go blind
What are features of PMR
Ach Stiffness Lethargy Depression Low grade fever Anorexia Night sweats
How do you Dx
FBC + ESR + CRP = Raised inflammatory
- Monitor with this
Fluroscein angiography / doppler = most common
Temporal artery biopsy
What will be normal
CK and EMG
How do you treat
High dose prednisolone + PPI
IV if sight threatening
Monitor BP and BG
Urgent ophthalmology review as visual damage = irreversible
What is issue with biopsy
Often skip lesions so may miss
What is loss of vision + headache till proven otherwise
GCA
How do you differentiate GCA from non-arteritis optic neuropathy
PMR features
Raised ESR
Swollen pale disc
What does non-arteritis have
Features of HTN / DM
Swollen pale disc
ESR <40
What causes optic nerve swelling <50
Optic neuritis
What causes optic nerve swelling >50
GCA
Optic neuropathy
