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

=Examination of the Eye=

Procedure

 * General Appearance:
 * Thyroid stare ± goitre


 * Eyelids
 * xanthelasma
 * Ptosis
 * unilateral
 * III palsy (Examination procedure / Sample Case)
 * Horner's Sx
 * Pupil changes
 * Sweating
 * bilateral
 * myaesthenia
 * myotonic dystrophy
 * 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

 * 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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