Specific Symptoms

1
Specific Symptoms

• Central vision.A macula B cornea
• Knife like painA 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 lightsA
  conjunctivitis B migraine
• Dull vision/loss of red visionA cornea
  B optic nerve

2
Specific Symptoms

• Central vision.A macula B cornea

3
Specific Symptoms

• Knife like painA iritis b neuralgia

4
Specific Symptoms

• Jaw pain/headache
• A Giant Cell arteritis B corneal ulcer
  

5
Specific Symptoms

• Numbness/pins needles
• A CMV virus B Herpes Zoster

6
Specific Symptoms

• Recurrent, patterns of lightsA
  conjunctivitis B migraine

7
Specific Symptoms

• Dull vision/loss of red visionA cornea
  B optic nerve

8
Specific Symptoms

• Central vision.macula
• Knife like painneuralgia, shingles
• Jaw pain/headache giant cell arteritis
• Numbness/pins needlesshingles
• Recurrent, patterns of lights..migraine
• Dull vision/loss of red visionoptic nerve

9
Eye general health case 1, age 20y

• history
• Vomiting
• Nausea
• Stomach not tender
• Headache?

• Papilloedema
• Refer to RMO/neurosurgeon
• (swollen disc, sight GOOD)

healthy
10
Eye general health case 2, age 80y

• 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

Ischaemic optic neuropathy (swollen disc AND loss
of sight)
11
Eye general health general
12
Diabetic retinopathy
13
Eye major trauma in pairs 1 minute

• Draw an eye, illustrating the possible injuries
• Draw an orbit, illustrating the possible injuries

14
Eye major trauma
15
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

16
Perforating injury
17
Blunt injuryhyphaema
hyphaema
18
Blowout fracture
Floor of orbit fracture inferior rectus
trapped/damaged, so eye cannot look
up Anaesthesia over cheek assault,
cricket/squash ball
19
Eye previous eye surgery

• There are many possible problems after ocular
  surgery refer, sometimes urgently

20
Visual acuity
T NC EN OTNC LOXEW TYURNGTYURNGTYURNG
6/60 6/36 6/24 6/18 6/12 6/9 6/6 6/5
21
Visual fields
22
(No Transcript)
23
Pupils

• Pupils (needs Flash player installed)

24
Red reflex


Check red reflex from 10 cm, focusing on iris
25
white reflex
?retinoblastoma
26
(No Transcript)
27
(No Transcript)
28
(No Transcript)
29
Visual symptoms quiz, in pairs, 2 minutes, what
are the causes.
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 .
30
Visual symptoms pattern recognition
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
31
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

32
3rd nerve palsy
3rd nerve palsy
33
3rd nerve palsy
3rd nerve palsy