Accident and Emergency
Nagi Giumma Barakat in Get Through, 2006
Concomitant strabismus is most common in children. The angle of deviation will remain the same wherever the eye moves. There are many unknown causes of strabismus, but it is important in any refractory error or neurological problem. Incomitant strabismus is usually caused by neurological or mechanical problems, such as VIth nerve palsy or orbital trauma. Half of the patients referred for orthoptistic assessment for strabismus are normal. The covered-eye test can be performed. GPs can be trained to do this - it is very easy. A light is shined into the eyes, where one looks for the pupillary reflex. If it is centred in both eyes, this is normal. In case one is temporally situated, cover it centrally. If the abnormality becomes central, the child has strabismus. If the child is not yet 10 years of age, there could be a latent squint or an underlying neurological problem, and a full neurological examination is required.
Case 74: Red eye and photosensitivity
Eamon Shamil, Praful Ravi, Dipak Mistry, Janice Rymer in 100 Cases in Emergency Medicine and Critical Care, 2018
Physical examination is difficult to perform, as the patient is reluctant to open his right eye under usual room lighting. Visual acuity is 6/6 in the left eye, and 6/12 that improves to 6/6 with pinhole in the right eye. The pupillary reflex is normal with no relative apparent pupillary defect (RAPD). Slit lamp examination shows an injected conjunctiva with an increased marginal tear film. There is a 1 mm reflective metallic flake with a brown halo on the cornea at the 6 o-clock position.
Brain death and ethical issues
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Anesthesia for Neurotrauma, 2018
The pupillary light reflex assesses the function of the II and III cranial nerves. Pupillary reflex must be tested in each eye separately and consensual responses has to be evaluated.16,17 Initially, the medical professional checks that the patient’s pupils are the same size. Then the medical professional shines the light on each pupil and checks to see that both pupils have constricted to the same size.
Neuroretinitis Secondary to Bartonella Henselae in a Patient with Myelinated Retinal Nerve Fibers: Diagnostic Dilemmas and Treatment
Published in Ocular Immunology and Inflammation, 2019
Victoria Toumanidou, Anna Dastiridou, Nikolaos Kourtis, Sofia Androudi
An otherwise healthy 56-year-old man presented for a consultation, because he realized that visual acuity was decreased from his right eye. Onset was unclear and the patient was not sure if this was a new symptom. On examination, best-corrected visual acuity (BCVA) was 20/80 in the right eye and 20/20 in the left eye. The pupillary reflex was normal. A fundus examination revealed optic nerve and peripapillary myelinated nerve fibers without any other abnormal findings. For this reason, we did not run any additional tests or imaging, but we instructed the patient to return for a follow-up. Two weeks later, the patient returned complaining of vision deterioration since his previous visit, which now was at the level of 20/160 in the right eye and 20/20 in the left eye. Indirect ophthalmoscopy of the right eye revealed signs of neuroretinitis including subretinal fluid and retinal exudates (Figure 1a).
Apraxia of eyelid opening secondary to possible progressive supranuclear palsy: a case report
Published in International Journal of Neuroscience, 2021
Wei Jiang, Lin Gan, Yang Sun, Ming Dong, Peng Yu
Neurological examination revealed upward gaze palsy with no nystagmus. Bilateral pupillary reflex was normal and symmetrical. Bradykinesia and cogwheeling tone were observed; however, there were no resting tremors. Deep tendon reflexes in the upper limbs were normal, while those in the lower limbs were diminished. Rapid alternating movements were slower than normal. He had a medical history of hepatitis B and indulged in moderate smoking and occasional alcohol intake. Brain magnetic resonance imaging, laboratory tests for anti-muscle-specific tyrosine kinase and anti-acetylcholine receptor antibodies, and single-fiber electromyography were unremarkable. Brain positron emission tomography (PET) revealed a reduction in glucose metabolism in the left part of the medial frontal lobe, basal ganglia, and temporal, occipital, and cingulate cortex. According to the diagnostic criteria of the National Institute of Neurological Disorders and Stroke and the Society for Progressive Supranuclear Palsy (NINDS-SPSP), the patient was diagnosed with possible progressive supranuclear palsy (PSP) [1]. Here, we present a video showing AEO in this patient in order to provide a better understanding of the clinical manifestation of this rare condition (Supplementary Video).
Syphilis at age 15 years
Published in Baylor University Medical Center Proceedings, 2018
Jacqueline Kaufman, Bogar Garcia, Shawn Horrall
A 15-year-old female presented with worsening nonpruritic rash on her palms and soles for 1-month duration. She denied any fever, pain, pruritus, dysuria, vaginal discharge, or previous vaginal sores. In the past year, she had been treated in the emergency department for gonorrhea/chlamydia and then again for trichomonas. She reported a total of 8 sexual partners since the age of 14 with occasional use of barrier protection. She is on Nexplanon for birth control and is up-to-date on her vaccinations. On exam, the rash is limited to palms and soles as shown in (Figure 1). Her ocular exam revealed a weak pupillary reflex to light with normal accommodation. The remaining neurological exam was unremarkable, including proprioception and Romberg's test. Pelvic exam did not reveal any lesions, lymphadenopathy, or discharge. A venereal disease research laboratory test was positive and confirmed by positive Treponema pallidum antibody test. Penicillin G intravenous was initiated due to concern for neurosyphilis. Ophthalmology's ocular exam did not reveal ocular findings of syphilis. A lumbar puncture was performed and was negative for neurosyphilis. Intravenous penicillin was then changed to intramuscular. She was then discharged with improvement at her 4-week follow-up.
Related Knowledge Centers
- Accommodation Reflex
- Ciliary Muscle
- Fovea Centralis
- Pupillary Response
- Reflex
- Refraction
- Retina
- Pupillary Light Reflex
- Lens