1. olfactory, S
- Hx of rhinitis
- nasal patency and discharge
-smell three times ( soap , toothpaste) by closing eyes , one nostril at a time
Avoid irritating and pungent like NH3 ( trigeminal is also stimulated)
- Anosmia (acruired , congemnital ) - sinusitis , head injury , meningitis, subfrontal meningioma, parkinsons disease
- Parosmia - perversion of sense of smell Head trauma , sinus infection
- Cacosmia - foul order that doesn't exist
2.Optic nerve,S
- inner half ( nasal) fibres decussate , outer half ( Temporal ) fibers remains same
-reach superior colliculus , some parts Edinger-Westphal nucleus ( LIGHT REFLEX)
- remaining to lateral geniculate body , form optic radiation which pass posteriorly through retrolenticular part of internal capsule and end to visual cortex( Area 17)
- upper & lower lip of calcarine sulcus , medial surface
- Visual acuity ( distant & near vision)
Distant
- 6 m , snellens chart , one eye at a time
- If not 6/60 , bring closer to 5,4,3.....1m
- If not , use fingers
- If not , Hand movement (HM)
Near
- 1 foot away , Jaegars chart
- One eye at a time
Cause refractive errors ,pappilitis , retrobulbar neuritis , primary occular disorder ( Iridocyclitis , corneal opacities , cataract, vitreous opacities, retinal detachment , glaucoma)
Pin Hole Test
If patient able to see better through a pin Hole, refractive error
- Visual Field
- Confrontation test
- Color Vision
- Ishihara's chart
- Fundus examination
- Opthamoscope - papilloedema (oedema of optic disk >3 Diopters
Causes
- Raised ICP , increased Proteins (GBS)
- Hematilocal -anemia , leukaemia
- Venous cause - central retinal vein occlusion , cavernous sinus thrombosis
- Arterial causes - malignant HTN, vasculitis
- Endocrine causes-Hypoparathyroidism, Grave's disease with severe exophthalmose
- Pseudotumour cerebri ( Benign intracranial HTN ) - idiopathic ( headache , papilloedema, 6th nerve palsy)
- Drugs- nalidixic acid , tetracycline ,hypervitaminosis A , OCP,glucocorticoid
3. Occulomotor (3), trochlear(4) ,abducent(6)
- Occulomotor nucleus complex - midbrain at the level of Superior colliculus
- Nucleus of trochlea(4)in midbrain just caudal to 3rd nerve nucleus ( level of inf. Colliculus)
- 6th nucleus in pons , long intracranial course , affected by Increased IC lesion , false localising sign
| 6 Abdu6ent | Lateral rectus |
| 4 Trochlear | Superior oblique ( depression , internal rotation) |
| 3 occulomotor (outward & downward) | IO ( @2E - elevation , external rotation) |
| SR (elevation) | |
IR(Depression) MR ( adduction) |
3rd nerve - ciliary muscle , iris ( pupillary ) , levator palpebraeb Superioris ( upper eyelid elevation)
Examination
- Check for extra-ocular movement
- Unilocular - duction ( follow finger without moving head )
- Upwards ( supraduction)
- Downwards (infraduction)
- Outwards (Abduction)
- Inwards (Adduction)
- Inward rotation(Intortion / incycloduction)
- Outward rotation(extortion/excycloduction)
- Binoculars- vergence , version
H
3rd nerve palsy
- Dilated and unreactive pupils
- Ptosis
- Eyeball turned outwards and downward
- Ptosis, squint
- Ptosis - drooping upper eyelid cover >2 cm of cornea
Cause
- 3rd nerve palsy( weakness of levator palpebrae Superioris)
- Horner's syndrome
- Mysthenia gravis
- Ocular myopathy
2. Squint
- 6th nerve palsy - failure of Abduction of Eyes , convergent squint
- Nystagmus
# Involuntary , rhythmic oscillatory ( to & fro ) movement of eyes
Abnorma
- Pupils
- Size , shape ,symmetry
- Reaction to light
Direct light reflex
- Elicit in dark room
- Gaze on a distant object
- Bring a torch light from side , observe constriction of pupil on same eye
Consensual light response
- Bring a partition ( card board) betn two eyes
- Do the same as mentioned above
- Look in the opposite eye
RAPD
- Relative afferent pupilary defect
-marcus gun pupil
BLINK TO THREAT
- for facial and optic
Light reflex pathway
Accomodations Reflex
- first look distant , then to a pen or fingern, brought up close to eye
Triple response appreciated ( pupil constriction , convergence pf eyes
FUNDUSCOPY
- pale , cupped ,
- bruises , cotton woo
- microhemor
SHARE THIS PAGE LINK AND SUPPORT