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Specific Symptoms
• Central vision………….A macula B cornea
• Knife like pain…………A iritis b neuralgia
• Jaw pain/headache …
• A Giant Cell arteritis B corneal ulcer
• Numbness/pins & needles
• A CMV virus B Herpes Zoster
• Recurrent, patterns of lights…A conjunctivitis B migraine
• Dull vision/loss of red vision…A cornea B optic nerve
Specific Symptoms
• Central vision………….A macula B cornea
Specific Symptoms
• Knife like pain…………A iritis b neuralgia
Specific Symptoms
• Jaw pain/headache …
• A Giant Cell arteritis B corneal ulcer
Specific Symptoms
• Numbness/pins & needles
• A CMV virus B Herpes Zoster
Specific Symptoms
• Recurrent, patterns of lights…A conjunctivitis B migraine
Specific Symptoms
• Dull vision/loss of red vision…A cornea B optic nerve
Specific Symptoms
• Central vision………….macula
• Knife like pain…………neuralgia, shingles
• Jaw pain/headache ……giant cell arteritis
• Numbness/pins & needles……shingles
• Recurrent, patterns of lights…..migraine
• Dull vision/loss of red vision…optic nerve
Eye general health: case 1, age 20y
• history– Vomiting– Nausea– Stomach not tender– Headache?
healthy
Papilloedema
Refer to RMO/neurosurgeon
(swollen disc, sight GOOD)
• Loss of sight 2 days ago, one eye• Headaches 1 week• Shoulder pains months• Weight loss months• unwell months• Test needed:• ESR• Giant cell arteritis• (if eye OK, refer to RMO)• Systemic steroids
Eye general health: case 2, age 80y
Ischaemic optic neuropathy
(swollen disc AND loss of sight)
Eye general health: general
Zoster–IV antiviral if immunosuppressed
zoster
scleritis
episcleritis
Diabetic retinopathy
Eye & major trauma in pairs 1 minute
Draw an eye, illustrating the possible injuries
Draw an orbit, illustrating the possible injuries
Eye & major trauma
Eye & major trauma
Birmingham (UK generally) is increasingly violent. A careful check will exclude problems. Sometimes the eye is impossible to examine (as lids are shut). Refer/ask on-call eye SPR to assess.
Fist, glass bottle, car windscreen
Perforating injury
Blunt injury…hyphaema
hyphaema
Blowout fracture
Floor of orbit fracture; inferior rectus trapped/damaged, so eye cannot look upAnaesthesia over cheek: assault, cricket/squash ball
Eye & previous eye surgery
There are many possible problems after ocular surgery: refer, sometimes urgently
Visual acuity
TNCEN
OTNC
LOXEWTYURNG
TYURNG
TYURNG
6/606/36
6/24
6/18
6/12
6/9
6/6
6/5
Visual fields
paper
paper
Pupils
• Pupils (needs Flash player installed)
Red reflex
Check red reflex from 10 cm, focusing on iris
‘white’ reflex
www.occhioallaretina.it/Immagini/leucocoria.JPG
http://oftalmologo.bravepages.com/Leucocoria%201.jpg
?retinoblastoma
Visual symptoms: quiz, in pairs, 2 minutes, what are the causes……….
Misty vision Aches…………
No ache…………………
Sudden onset visual loss ………………….
Specific symptoms Give examples……………………….
Loss of sight on one side What may be going on?………….…………………………………….
Episodes of visual loss ………………………………….Clues…………………………..
Blurred vision with flashes and floaters
……………………………….
Visual symptoms: quiz, in pairs, 2 minutes, what are the causes……….
Misty vision
If eye aches, acute glaucoma/uveitis
No ache, cataract/retinal disease etc
Sudden onset visual loss
vascular
Specific symptoms
E.g. GCA, optic neuritis, central vision
Loss of sight on one side Differentiate eg right side of BOTH eyes (CVA), or ONE eye alone (eye disease)
Episodes of visual loss
TIAs: occur suddenly, resolves over minutes
Blurred vision with flashes and floaters
retinal detachment/vitreous haemorrhage
Visual symptoms: pattern recognition
Neuro-ophthalmology
• Dilated pupil/ptosis/divergent eye= 3rd n palsy = ?post.com.art.aneurysm
• Vertical diplopia = 4th nerve palsy• One eye convergent = 6th nerve palsy• Dilated pupil/normal sight = adies pupil • Dim vision one eye = optic neuritis
(rarely tumour)• 7th nerve palsy
3rd nerve palsy
3rd nerve palsy
3rd nerve palsy
3rd nerve palsy