Impairment Of Vision

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

PRESBYOPIA - failure of accommodation with age HYPERMETROPIA (long sightedness) - short eyeball MYOPIA (short sightedness) - long eyeball ASTIGMATISM - variation in corneal curvature

Red, painful eye Excessive lacrimation Photophobia Acute visual loss

Corneal surface inflamed and ulcerated

KERATITIS

Inflammation of iris -

and ciliary body, small pupil

UVEITIS

Misty cornea, -

ciliary congestion, dilated pupil, increased ocular tension

ACUTE GLAUCOMA

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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