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Eye Movements

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Superior Rectus: Abduction and elevation Lateral Rectus: Abduction Inferior Rectus Abduction and depression Inferior Oblique: Adduction and elevation Medial Rectus: Adduction Superior Oblique: Adduction and depression

Sudden Painless Loss of Vision
Causes 1. 2. 3. 4. 5. 6. 7. 8. Retinal detachment Vitreous haemorrhage Retinal vein occlusion Retinal artery occlusion Wet age related macular degeneration Anterior ischemic optic neuropathy Optic neuritis Cerebrovascular accident

Retinal detachment
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sudden painless loss of vision preceded by flashing lights (photopia), floaters, visual field defects macula involved = Central vision loss macula NOT involved = peripheral field loss and visual acuity maybe normal Relative Afferent Pupillary Defect – (affected eye pupil dilates in response to light)

Ophthalmoscope
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abnormal red reflex detached retina –grey and wrinkled normal examination does not exclude diagnosis

Management

glaucoma due to RBC occluding trabecular meshwork Vascular occlusion Central Vein Occlusion   sudden painless loss of vision if severe = RAPD Ophthalmoscope   hyperaemic retina with engorged vines multiple haemorrhages .g. laser to retinal hole/ retinal surgery +/.vitrectomy Vitreous haemorrhage   sudden painless loss of vision (extent of loss depends on degree of haemorrhage) o large haemorrhage = TOTAL visual loss o small haemorrhage = presents as floaters and normal/slight reduced visual acuity sudden appearance of black spots/ cobwebs/ haze in vision Ophthalmoscope   decreased red reflex RBC in anterior vitreous Causes     Proliferative diabetic retinopathy Retinal detachment Trauma Age related macular detachment Management   Refer to ophthalmologist and determine cause Mange complications – e.

diabetes. Carotids – bruits? .  cotton wool spots ‘stormy sunset’ Causes    Raised intraocular pressure (chronic glaucoma. Pulse – AF?. valvular heart disease. hypertension) Hyperviscosity syndromes (polycythemia) Vessel wall disease (e. HT) Management  Check . AF Temporal Arteritis à high ESR! Vasculitis (polyarteritis nodosa) Artherosclerotic process (diabetes.BP. sarcoidosis) Management  CRVO associated with arteriosclerosis à check BP Central retinal artery occlusion    sudden painless loss of vision à Unilateral RAPD Visual acuity markedly reduced Ophthalmoscope  Pale retina with cherry red spot (macula is spared as receives branches from posterior ciliary artery) Cause      very high intraocular pressure Arterial embolus from diseased carotid. Heart – murmur? .g.

artherosclerosis) Ophthalmoscope  normal/ swollen optic disc . Acute optic neuropathy      rapid progressive loss of vision maybe decreased colour vision decreased visual acuity RAPD symptoms of underlying disease (MS. sudden blurring of vision decrease visual acuity with CENTRAL SCOTOMA Ophthalmoscope      drusen subretinal haemorrhages hard exudates macular oedema All occur at macula as new abnormal vessels under it leak fluid and bleed. nerve ischemia.Wet Age-related macular degeneration     occurs in the elderly sudden distortion à straight lines seem curved and central blank patch of vision or.

. suprasellar meningioma After the optic chiasm . Multiple sclerosis Fig 2 – lesion at optic chiasm – Can be caused by a pituitary tumour.lesion at the right optic tract gives a left homonymous hemianopia. Fig 3 . craniopharyngioma.The visual loss is seen on the opposite (contralateral) side of the lesion because the optic nerves have already crossed over at the optic chiasm. cerebral tumour.The visual field loss is seen on the same (ipsilateral) side as the lesion.Can be caused by – trauma. Fig 1 – lesion of right optic nerve gives a Right Monocular loss .Before the Optic chiasm . Can be caused by vascular disease. head injury.

Can be caused by stroke in posterior circulation Quick Summary Table Defect Loss of vision in one eye Bitemporal Hemianopia Binasal hemianopia Left homonymous hemianopia Right homonymous hemianopia Homonymous quadrantopia Location Ipsilateral Optic Nerve Optic chiasm Optic chiasm Right optic tract / radiation Left optic tract / radiation Contralateral optic radiation   Upper – temporal region Lower – parietal region Scotoma Occipital region . Fig 4 . The lesion is of the left temporal radiation (remember that Temporal produces a Top quadrantanopia). Space occupying lesions Each eye has a left and right visual field.Each eye has a left and a right visual field. Gives a left homonymous hemianopia with macular/ central vision sparring. In a right upper homonymous quadrantanopia the right visual field of both the right eye and left eye is lost. Can be caused by stroke. Fig 5 .lesion at the left optic radiation gives a right upper homonymous quadrantanopia.lesion of the parietal radiation will result in a lower homonymous quadrantanopia. Fig 6 – Lesion at the right occipital lobe/pole. In a left homonymous hemianopia the left visual field of both the right eye and left eye is lost but the lesion is of the right optic tract.