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