Random - pupil stuff / eyelid

Question 1

What is the pathway of pupil reflex

Answer 1

Afferent

• Retinal
• Optic nerve
• Mid brain

Efferent

• Midbrain
• Oculomotor nerve

Question 2

What can be affected at retina

Answer 2

Detachment

Degeneration

Question 3

What can affect optic nerve

Answer 3

Optic neuritis

Question 4

What can affect oculomotor and how does it present

Answer 4

Damage to parasympathetic fibres

• Ptosis
• Dilated non reactive pupil
• Divergent squint - down and out

Question 5

How does microvascular cause affect 3rd nerve palsy and what is microvascular

Answer 5

DM 
Hyeprtension
Ischaemia 
Usually just affects motor
Parasympathetic fibres usually fine so pupil is spared

Question 6

IF REFLEX ABSENT WHAT SHOULD YOU SUSPECT

Answer 6

Compression of the whole nerve 
Cerebral artery aneurysm - do CT to rule out
Cavernous sinus thrombosis 
Tumour
Trauma
Raised ICP

Question 7

What causes Argyll robertson pupil

Answer 7

DM

Syphillis

Question 8

What happens

Answer 8

Pupil reflex absent
Accomodation present
Small irregular pupil
NO response to light

Question 9

What is Holmes Adie Pupil

Answer 9

Unilateral dilated pupil then constricts
Slow accomodation / sluggish
Absent knee + ankle reflex

Question 10

Other causes of dilated pupil

Causes of constricted pupil

Answer 10

Dilated 
Cocaine / amphetamine
Trauma
Phaeochromocytoma
Anti-cholinergic 
Topical mydriatics 
3rd nerve palsy
Raised ICP 

Constricted 
Horner
Cluster
Argyll Robertson
Opiates
Nictoine

Question 11

What causes Marcus Gunn pupil

Answer 11

Lesion anterior to optic chiasma
Retinal detachment
Optic neuritis - must rule out MS

Question 12

What does it lead to

Answer 12

Afferent pupil defect

Eye dilates when light shone instead of constrict

Question 13

What is Horner’s

Answer 13

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

Question 14

What are the signs

Answer 14

Miosis - small pupil
Ptosis - drooping
Enophthalmos - sunken eye
Anhidrosis - loss of sweating

Question 15

What causes Horner’s if anhidrosis if of face / arm and trunk

Answer 15

Central lesions  - 4S
Stroke
Syringomyelia
MS
Swelling from tumour
Encephalitis

Question 16

What causes Horner’s if anhidrosis of face

Answer 16

Pre-ganglionic lesions - 4T’s
Pancoast tumour
Thyroidectomy
Trauma

Question 17

If no anhidrosis

Answer 17

Post ganglionic lesion - 4C's 
Carotid artery dissection 
Carotid aneurysm 
Cluster headache
Cavernous sinus thrombosis

Question 18

How is sweat glands innervated

Answer 18

Sympathetic

Ach on muscarininc fibres

Question 19

What causes miosis

Answer 19

Sympa usually = Na on A1 = dilatation

If broken get excessive constriction

Question 20

What can cause optic neuritis

Answer 20

MS
DM
Syphillis / Lyme's/ herpes
Neuromyelitis 
Sarcoid / SLE
Drugs

Question 21

What are the symptoms

Answer 21

Unilateral decrease in visual acuity over hours to days
Poor colour - red sats 
Pain worse on eye movement
Afferent pupil defect
Swollen optic disc

Question 22

How do you Dx

Answer 22

MRI to look for signs of MS

Question 23

How do you Rx

Answer 23

High dose steroid

Question 24

What causes optic neuropathy

Answer 24

Stroke
Atherosclerosis
GCA
Hypotension

Question 25

Symptoms

Answer 25

Unilateral decreased vision | Little warning

Question 26

What is papilloedema

Answer 26

Optic disc swelling due to raised ICP

Question 27

What causes

Answer 27

``` SOL Malignant hypertension Intracranial hypertension Hydrocephaus Hypercapnia Hypo PTH / hypo Ca ```

Question 28

What is seen on fundoscopy

Answer 28

Venous engorgement = 1st sign Loss of venous pulsation Blurring optic disc Elevation of disc / loss of optic cup

Question 29

What causes nasolacrimal duct obstruction

Answer 29

Imperforate membrane

Question 30

What does it lead too

Answer 30

Most common reason for persistent watery eye in infancy

Question 31

How do you Rx

Answer 31

Massage duct | Usually resolves by 1

Question 32

What is Herpes Zoster Ophthalmicus

Answer 32

Reactivaiton of VZV in V1 of trigeminal

Question 33

What do you get

Answer 33

Vesicular rash around eye | If rash near tip of nose suggest eye involvement ' Hutchinson'

Question 34

How do you treat

Answer 34

Anti-viral IV if severe / immunocompromsied Topical steroid if secondary inflammation Ophthalmology review

Question 35

What are complications

Answer 35

``` Eye involvement - COnjunctvitis - Keraitits - Episcleritis - Uveitis - Ptosis Post hepatic neuralgia Optic atrophy ```

Question 36

What is Blephairitis

Answer 36

Inflammation of eyelid

Question 37

What causes

Answer 37

Meibonium gland dysfunction = common Seborrheic dermatitis Staph infection

Question 38

What are symptoms

Answer 38

``` Bilateral Gritty eye Discomfor Sticky eyes Red eyelid Swelling if staph ```

Question 39

How do you treat

Answer 39

Hot compress Remove debris Aritifical tears

Question 40

Complications

Answer 40

Stye Chalzions Secondary conjunctivitis

Question 41

What is a stye

Answer 41

Infection of sebaceous glands of eyelid | Pain

Question 42

What type of stye

Answer 42

External | Internal

Question 43

What does enternal affect

Answer 43

Usually staph infection of serum or sweat production

Question 44

What does internal affect

Answer 44

Infection of Meibomian gland

Question 45

How do you Rx

Answer 45

Hot compress Analgesia Ax if conjunctivitis

Question 46

What may be left

Answer 46

Chalazion (cyst)

Question 47

What is a Chalazion

Answer 47

``` Meibomian cyst Firm painless lump in the eyelid Hot compress and analegsia Ax if acutely inflamed May need surgical Rx ```

Question 48

What is ectropion / entropion and what are risks

Answer 48

``` Entropion = in turning - Tape eyelid to prevent - Will need lubricant eyedrops - Surgery = definite Ectropion = out turning Can be painful Risk of corneal ulceration / damage ```

Question 49

What is GCA

Answer 49

Large vessel vasculitis affecting temporal artery Overlaps with PMR EMERGENCY

Question 50

What are the symptoms of GCA

Answer 50

``` Typically >60 Rapid onset <1 month Headache Jaw claudication Visual distubrance Tender palpable temporal artery Features of PMR ```

Question 51

What causes visual disturbance

Answer 51

2 to ischaemic optic neuropathy Cotton wool spots Can go blind

Question 52

What are features of PMR

Answer 52

``` Ach Stiffness Lethargy Depression Low grade fever Anorexia Night sweats ```

Question 53

How do you Dx

Answer 53

FBC + ESR + CRP = Raised inflammatory - Monitor with this Fluroscein angiography / doppler = most common Temporal artery biopsy

Question 54

What will be normal

Answer 54

CK and EMG

Question 55

How do you treat

Answer 55

High dose prednisolone + PPI IV if sight threatening Monitor BP and BG Urgent ophthalmology review as visual damage = irreversible

Question 56

What is issue with biopsy

Answer 56

Often skip lesions so may miss

Question 57

What is loss of vision + headache till proven otherwise

Answer 57

GCA

Question 58

How do you differentiate GCA from non-arteritis optic neuropathy

Answer 58

PMR features Raised ESR Swollen pale disc

Question 59

What does non-arteritis have

Answer 59

Features of HTN / DM Swollen pale disc ESR <40

Question 60

What causes optic nerve swelling <50

Answer 60

Optic neuritis

Question 61

What causes optic nerve swelling >50

Answer 61

GCA | Optic neuropathy