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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