Transcript The Eye in Casualty David Kinshuck, with photos from www

Specific Symptoms
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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
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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
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Vomiting
Nausea
Stomach not tender
Headache?
Papilloedema
healthy
Refer to RMO/neurosurgeon
(swollen disc, sight GOOD)
Eye general health: case 2, age 80y
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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)
Eye general health: general
episcleritis
scleritis
Zoster
–IV antiviral if
immunosuppressed
zoster
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 up
Anaesthesia over cheek: assault, cricket/squash ball
Eye & previous eye surgery
There are many possible problems after ocular
surgery: refer, sometimes urgently
Visual acuity
T
6/60
NC
6/36
EN
6/24
OTNC
6/18
LOXEW
6/12
TYURNG
6/9
TYURNG
TYURNG
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
?retinoblastoma
www.occhioallaretina.it/Immagini/leucocoria.JPG
http://oftalmologo.bravepages.com/Leucocoria%201.jpg
Visual symptoms: quiz, in pairs, 2 minutes, what are the causes……….
Misty vision
Aches…………
No ache…………………
Sudden onset visual loss
………………….
Visual
symptoms: quiz, inGive
pairs,examples……………………….
2 minutes, what are the
Specific
symptoms
causes……….
What may be going on?………….
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Episodes of visual loss
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Clues…………………………..
Blurred vision with flashes ……………………………….
and floaters
Loss of sight on one side
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
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