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Specific Symptoms

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

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Specific Symptoms

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  1. 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

  2. Specific Symptoms • Central vision………….A macula B cornea

  3. Specific Symptoms • Knife like pain…………A iritis b neuralgia

  4. Specific Symptoms • Jaw pain/headache … • A Giant Cell arteritis B corneal ulcer

  5. Specific Symptoms • Numbness/pins & needles • A CMV virus B Herpes Zoster

  6. Specific Symptoms • Recurrent, patterns of lights…A conjunctivitis B migraine

  7. Specific Symptoms • Dull vision/loss of red vision…A cornea B optic nerve

  8. 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

  9. Eye general health: case 1, age 20y • history • Vomiting • Nausea • Stomach not tender • Headache? • Papilloedema • Refer to RMO/neurosurgeon • (swollen disc, sight GOOD) healthy

  10. Eye general health: case 2, age 80y • 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)

  11. episcleritis scleritis • Zoster • IV antiviral if immunosuppressed zoster Eye general health: general

  12. Diabetic retinopathy

  13. Eye & major trauma in pairs 1 minute Draw an eye, illustrating the possible injuries Draw an orbit, illustrating the possible injuries

  14. Eye & major trauma

  15. 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

  16. Perforating injury

  17. Blunt injury…hyphaema hyphaema

  18. Blowout fracture Floor of orbit fracture; inferior rectus trapped/damaged, so eye cannot look up Anaesthesia over cheek: assault, cricket/squash ball

  19. Eye & previous eye surgery There are many possible problems after ocular surgery: refer, sometimes urgently

  20. Visual acuity T NC EN OTNC LOXEW TYURNGTYURNGTYURNG 6/60 6/36 6/24 6/18 6/12 6/9 6/6 6/5

  21. Visual fields

  22. Pupils • Pupils(needs Flash player installed)

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

  24. www.occhioallaretina.it/Immagini/leucocoria.JPG http://oftalmologo.bravepages.com/Leucocoria%201.jpg ‘white’ reflex ?retinoblastoma

  25. Visual symptoms: quiz, in pairs, 2 minutes, what are the causes………. Visual symptoms: quiz, in pairs, 2 minutes, what are the causes……….

  26. Visual symptoms: pattern recognition

  27. 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

  28. 3rd nerve palsy 3rd nerve palsy

  29. 3rd nerve palsy 3rd nerve palsy

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