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

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 NC EN OTNC LOXEW TYURNG TYURNG TYURNG 6/60 6/36 6/24 6/18 6/12 6/9 6/6 6/5

Visual fields

Pupils Pupils (needs Flash player installed)Pupils

Red reflex Check red reflex from 10 cm, focusing on iris

‘white’ reflex ?retinoblastoma

Visual symptoms: quiz, in pairs, 2 minutes, what are the causes………. Misty visionAches………… No ache………………… Sudden onset visual loss…………………. Specific symptomsGive examples………………………. Loss of sight on one sideWhat 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 sideDifferentiate 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 = 3 rd n palsy = ?post.com.art.aneurysm Vertical diplopia = 4 th nerve palsy One eye convergent = 6 th nerve palsy Dilated pupil/normal sight = adies pupil Dim vision one eye = optic neuritis (rarely tumour) 7 th nerve palsy

3 rd nerve palsy