OPHTHALMOLOGICAL ASSESSMENT

Ophthalmological Assessment & Retinography
Ophthalmology is quite a post-graduate specialty but a basic knowledge is required for the final exams, particularly with respect to examination.

Also - please note there is an 'h' at the start of 'ophthalmology'!!!
 
This includes - the muscles of the eye, cranial nerves, Snellen’s test and use of an ophthalmoscope, optic neuropathy and basic interpretation of retinography.
 
With respect to retinography to see retinal problems – you should really know the signs of retinopathy causes by diabetes and hypertension. Further to this, you really should know what papilloedema looks like and its etiology. In my final MBBS paper, there was a slide of a retinal photograph and we were expected to identify signs in it and formulate a diagnosis; this was seen as quite unexpected at the time and a short time spent looking at some typical pictures would have helped greatly. 
 
PAIN BEHIND THE EYE WITH DECREASED VISUAL ACUITY IS NEVER MIGRAINE UNTIL OTHER CAUSES ARE EXCLUDED.
 
Examination
1.    Inspection
2.    Visual acuity in each eye
3.    Fields
4.    External ocular movements
5.    Fundi
6.    Pupils including swinging torch test
 
Visual Field Defects – 
·      In front of chiasm – optic nerve/central scotoma
·      At chiasm – bitemporal hemianopia
·      Behind chiasm – homonymous hemianopia
 
Papilloedema Causes:
·      Optic neuritis
·      Raised ICP due to tumour
·      Essential intracranial hypertension – obese middle age women
·      Malignant hypertension
·      Hypercapnia (T2RF) with a veiny prominence

Optic Neuritis
·      Painful
·      Retro and intraorbital pain
·      Optic Neuropathy – all types of damage
o   CRAAP! Central scotoma, Red colour loss, Acuity reduced, Afferent defect, Pale disc.
o   Caused by: MS, trauma, compression (tumour), diabetes, toxic (ethambutol etc), 2nd to papilloedema.
·      Optic Neuritis – demyelination – bulbar (20%) or retrobulbar (80%)
·      Optic Atrophy – Appearance of the disc (6 weeks later!)