Random - pupil stuff / eyelid Flashcards Preview

Ophthalmology > Random - pupil stuff / eyelid > Flashcards

Flashcards in Random - pupil stuff / eyelid Deck (61)
Loading flashcards...
1

What is the pathway of pupil reflex

Afferent
- Retinal
- Optic nerve
- Mid brain

Efferent
- Midbrain
- Oculomotor nerve

2

What can be affected at retina

Detachment
Degeneration

3

What can affect optic nerve

Optic neuritis

4

What can affect oculomotor and how does it present

Damage to parasympathetic fibres
- Ptosis
- Dilated non reactive pupil
- Divergent squint - down and out

5

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

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

6

IF REFLEX ABSENT WHAT SHOULD YOU SUSPECT

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

7

What causes Argyll robertson pupil

DM
Syphillis

8

What happens

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

9

What is Holmes Adie Pupil

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

10

Other causes of dilated pupil

Causes of constricted pupil

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

Constricted
Horner
Cluster
Argyll Robertson
Opiates
Nictoine

11

What causes Marcus Gunn pupil

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

12

What does it lead to

Afferent pupil defect
Eye dilates when light shone instead of constrict

13

What is Horner's

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

14

What are the signs

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

15

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

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

16

What causes Horner's if anhidrosis of face

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

17

If no anhidrosis

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

18

How is sweat glands innervated

Sympathetic
Ach on muscarininc fibres

19

What causes miosis

Sympa usually = Na on A1 = dilatation
If broken get excessive constriction

20

What can cause optic neuritis

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

21

What are the symptoms

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

22

How do you Dx

MRI to look for signs of MS

23

How do you Rx

High dose steroid

24

What causes optic neuropathy

Stroke
Atherosclerosis
GCA
Hypotension

25

Symptoms

Unilateral decreased vision
Little warning

26

What is papilloedema

Optic disc swelling due to raised ICP

27

What causes

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

28

What is seen on fundoscopy

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

29

What causes nasolacrimal duct obstruction

Imperforate membrane

30

What does it lead too

Most common reason for persistent watery eye in infancy