CLINICAL APPROACH AND DIFFERENTIAL DIAGNOSIS
Patients presenting with visual impairment require a systematic examination, not only of vision, but also of the pupillary response, eye movements, and, unless the cause clearly lies within the globe, a full neurological examination.
An isolated homonymous hemianopia--------
usually indicates an occipital lesion
Refractive errors are excluded by testing visual acuity through a pinhole or by correcting a lens deformity (page 9).
Four types of refractive error exist:
If this examination is normal, then the lesion lies in the retina, visual pathways or visual cortex.
Examine the globe and anterior chamber
The findings aid localisation of the lesion, e.g.
Impairment of vision + impaired pupil response indicates a lesion anterior to the lateral geniculate -body
A homonymous hemianopia + sensory and cognitive deficit indicates a parieto-temporal -lesion
Red, painful eye Excessive lacrimation Photophobia Acute visual loss
Corneal surface inflamed and ulcerated
Inflammation of iris -
and ciliary body, small pupil
Misty cornea, -
ciliary congestion, dilated pupil, increased ocular tension
Involvement of the vitreous, uvea and retina;-ENDOPHTHALMITIS
pus and debris present in the anterior chamber.
Examine the lens with an ophthalmoscope
130 Opacification indicates CATARACT.
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