Royal Australasian College of Physicians Examinations/Resources/Clinical Exam/Short Cases/Neurology/The Eye Examination

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Examination of the Eye[edit]

Procedure[edit]

  • General Appearance:
    • Thyroid stare ± goitre
  • Eyelids
    • xanthelasma
    • Ptosis
    • Exophthalmos
      • Thyroid Stare (goitre)
      • Mass lesion
      • bilateral
      • Eaton-Lambert myaesthenic syndrome
      • Botulism
      • Muscular dystropy
      • Mitochondrial myopathy
  • Cornea:
    • Arcus senilus
    • Kaiser-Fleischer Rings
  • Sclera
    • Jaundice
    • Pallor
    • Blue
      • Osteogenesis Imperfecta
      • Ehlers-Danos
      • Marfan's Syndrome
  • Orbits
    • Palpate for Tenderness
    • Brow sweating for Horner's
  • Neurological:
    • II
      • acuity
      • fields
      • fundoscopy
    • II & III
      • pupils
      • light reflex (direct / consensual)
      • afferent pupillary defect
      • accommodation reflex
    • III IV VI
      • diplopia
      • nystagmus
      • gaze palsies
    • V VII
      • corneal reflex
  • Gaze Fatigue – Myaesthenia
  • Central Blindness:
    • Hemianopia
    • Bitemporal
    • Homonymous

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Patterns of Eye Movement Disorders[edit]

  • III only
    • orbital
    • brainstem
      • pupil involved – eg posterior communicating artery aneurysm
      • pupil spared – eg infarct, hypertension, diabetic palsy
  • III, IV, VI
    • superior orbital fissure lesion
  • III, IV, V, VI
    • cavernous sinus pathology
    • check internal carotid
  • III + contralateral hemiparesis – midbrain stroke
  • III + movement disorder - red nucleus lesion

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