Painless sudden loss of vision = central retinal artery occlusion/thrombosis Tests – BP, cholesterol, glucose Patient would be a vascularpath Pupil abnormality is relative afferent pupillary defect, as retina not able to detect light
2 – right eye loss of vision 3 – bitemporal hemianopia “tunnel vision” 5 – right homonymous hemianopia 8 – right homonymous hemianopia 9 – right homonymous hemianopia with central sparing
Using the direct ophthalmoscope…
You will find a word at each of the points indicated by the boxes…
A patient standing six metres from a standard Snellen Chart can
only see the top line. How is this recorded in snellen notation?
5 minutes of arc: 6/6 acuity
10 minutes: 6/12
20 minutes: 6/24
30 minutes: 6/36
E 50 minutes of arc: 6/60 acuity
The human eye is just able to discern separate objects if the angle between
them is 30 seconds of arc.
The test distance
An average eye would see this line at 12
What abnormality does this photo show, and what is the
surgical procedure called which corrects it?
What is this abnormality called, and what is the main symptom it
What stain has been used, and what abnormality is shown?
What abnormality is shown here?
Suggest two important differential diagnoses
Suggest two useful investigations
This patient suddenly lost all useful vision in her
right eye a few hours before the photo was taken.
What is the diagnosis?
What tests would you perform
What is the commonest accompanying systemic
What pupil abnormality would be present?
Name three abnormalities shown here
Give the diagnosis
Suggest a cause
Medial Rectus Third nerve
Muscle: Nerve supply:
• Slide 11 - Painless sudden loss of vision =
central retinal artery occlusion/thrombosis.
Tests – BP, cholesterol, glucose. Patient would
be a vascularpath. Pupil abnormality is relative
afferent pupillary defect, as retina not able to
• Slide 13 – Complete ptosis, “down & out” eye,
dilated pupil = 3rd
nerve palsy. Possible cause =
posterior communicating artery aneurysm
pressing on nerve, or vascualr occlusion along
the length of the 3rd
• Slide 15
– 2 – right eye loss of vision
– 3 – bitemporal hemianopia “tunnel vision”
– 5 – right homonymous hemianopia
– 8 – right homonymous hemianopia
– 9 – right homonymous hemianopia with central
• Slide 17 – Horners, see partial ptosis,
constricted pupil & decreased sweating. Causes
anything along the length of the sympathetic
chain, e.g. tumour, vascular origin
• Slide 24 – central retinal vein occlusion,
see multiple haemorrhages
• Slide 25 – internal carotid artery atheroma
and consequent embolus seen on retina
• Slide 26 – diagnosis = diabetic retinopathy
• Slide 28 – Stevens Johnson with
decreased tear production & scarring
• Slide 29 – areas of depigmentation of
• Slide 30 – RA and see deterioration of the
sclera called scleromalacia perforans
• Slide 31 – sturge weber syndrome
• Slide 32 – inverting eye lid with cotton bud