Optic Chiasm Lesions
• Pituitary = UPPER quadrant bitemporal
hemianopia
• Craniopharyngioma = LOWER bitemporal
hemianopia
- can result in diabetes insipidus
Ophthalmology
, ACUTE ANGLE-CLOSURE GLAUCOMA
> atropine precipitates by causing mydriasis
use : AACE
narrowing the to prevent
> early
-
+
cataract
surgery recurrence
Risk Factors angle iridocorneal obstructing aqueous flow -
Management
,
• Hypermetropia (long-sightedness)
• Pupillary dilation • Emergency and urgent referral
• Lens growth associated with age
Combination of eye drops:
Features • Pilocarpine - causes contraction of ciliary muscle ->
• Severe pain - may be ocular or headahce open trabecular meshwork -> increase drainage
• Decreased visual acuity • B-blocker = timolol - decreases aqueous production
• Hard, red eye • Alpha-2-agonist = apraclonidine -> decrease
• Haloes around lights production and increase drainage
• Semi-dilated non-reacting pupil
• Corneal oedema -> dull or hazy cornea • IV acetazolamide - reduces aqueous secretions
• Systemic upset - N&V, abdo pain
Definitive management:
Investigations • Laser peripheral iridotomy
• Tonometry - assess elevated IOP ·
- Hole in peripheral iris so aqueous humour drains
• Gonioscopy - special lens normal-10-21mmthy
↳ , > 30 T risk
t mmHg =
optic heuritis
Family Hx = annual screening from 40
, PRIMARY OPEN-ANGLE GLAUCOMA
Risk Factors Management
• Increasing age • 360 selective laser trabeculoplasty = 1ST LINE if IOP > 24mmHg
• Genetics - 1st degree relatives • 2nd line = prostaglandin analogues
• Afro-Caribbean ethnicity • 3rd line = B-blocker, carbonic anhydrase inhibitors
• Myopia • Surgery
• HTN
• Diabetes mellitus
• Corticosteroids
Features
• Peripheral visual field loss
• Decreased visual acuity
Normal = 01 - 0
.
.
Fundoscopy Signs
• Optic disc cupping - cup:disc ratio > 0.7 SEs = ocular
allergy ,
mild systemic hypotension
• Optic disc pallor 3rd line
• Bayonetting of vessels - vessels break
• Additional features - cup notching, disc haemorrhages
Investigations
• Automated perimetry - assess visual field
• Slit lamp examination
• Application tonometry - measure IOP
• Pituitary = UPPER quadrant bitemporal
hemianopia
• Craniopharyngioma = LOWER bitemporal
hemianopia
- can result in diabetes insipidus
Ophthalmology
, ACUTE ANGLE-CLOSURE GLAUCOMA
> atropine precipitates by causing mydriasis
use : AACE
narrowing the to prevent
> early
-
+
cataract
surgery recurrence
Risk Factors angle iridocorneal obstructing aqueous flow -
Management
,
• Hypermetropia (long-sightedness)
• Pupillary dilation • Emergency and urgent referral
• Lens growth associated with age
Combination of eye drops:
Features • Pilocarpine - causes contraction of ciliary muscle ->
• Severe pain - may be ocular or headahce open trabecular meshwork -> increase drainage
• Decreased visual acuity • B-blocker = timolol - decreases aqueous production
• Hard, red eye • Alpha-2-agonist = apraclonidine -> decrease
• Haloes around lights production and increase drainage
• Semi-dilated non-reacting pupil
• Corneal oedema -> dull or hazy cornea • IV acetazolamide - reduces aqueous secretions
• Systemic upset - N&V, abdo pain
Definitive management:
Investigations • Laser peripheral iridotomy
• Tonometry - assess elevated IOP ·
- Hole in peripheral iris so aqueous humour drains
• Gonioscopy - special lens normal-10-21mmthy
↳ , > 30 T risk
t mmHg =
optic heuritis
Family Hx = annual screening from 40
, PRIMARY OPEN-ANGLE GLAUCOMA
Risk Factors Management
• Increasing age • 360 selective laser trabeculoplasty = 1ST LINE if IOP > 24mmHg
• Genetics - 1st degree relatives • 2nd line = prostaglandin analogues
• Afro-Caribbean ethnicity • 3rd line = B-blocker, carbonic anhydrase inhibitors
• Myopia • Surgery
• HTN
• Diabetes mellitus
• Corticosteroids
Features
• Peripheral visual field loss
• Decreased visual acuity
Normal = 01 - 0
.
.
Fundoscopy Signs
• Optic disc cupping - cup:disc ratio > 0.7 SEs = ocular
allergy ,
mild systemic hypotension
• Optic disc pallor 3rd line
• Bayonetting of vessels - vessels break
• Additional features - cup notching, disc haemorrhages
Investigations
• Automated perimetry - assess visual field
• Slit lamp examination
• Application tonometry - measure IOP
