Describe Conjunctiva

Conjunctiva is translucent and clear. The pink color of palpebral conjunctiva is due to underlying vascular bed. White Sclera is seen through bulbar conjunctiva

Note conjunctival reflection

Note anterior and posterior chamber. Note ciliary body and lens connection

Diagnosis

Sub conjunctival hemorrhage. Sharply demarcated.

Afferent pathway for visual acuity?

Retina-Optic nerve-Optic chiasma-Optic radiation-Occiptal lobe visual cortex.

Note fovea as center for visual field. Locate site for blind spot in retina

Center of optic disc has no retinal receptors and leads to blind spot.

Pathway for light reflex?

Afferent: Retina-optic nerve-mid brain Efferent: Both oculo motor nerves

Note direct and consensual light reflex

Sorry the pupillary contraction on right is not visible

Note the pathway for pupillary contraction

Direct reflex on right Consensual reflex on left

Note the pathway for light reflex

Is this light reflex normal?

Yes. Note direct and consensual light reflex

Is this light reflex normal?

Afferent path on left eye is abnormal.

Which muscles are in action?

Right lateral rectus and left medial rectus. Gaze is conjugate.

Which nerves are in action?

Right abducens (right lateral rectus) and left oculomotor nerve (left medial rectus). Gaze is conjugate.

Which nerves are in action

Oculomotor nerves. Superior rectus in action. Gaze is conjugate.

Which cranial nerves are in action?

Both oculomotor nerves Inferior recti in action

Identify the ocular muscles

Levator palpabrae supreioris Superior rectus Inferior recrtus

Appreciate position of ocular muscles

Superior oblique: Trochlear nerve Lateral rectus: Abducens nerve Oculomotor supplies the rest

Ocular muscles influenced by sympathetic system

Levator palpabrae superioris Iris muscle Muscle in floor of orbit

Is the technique appropriate?

No. You should look at left fundus with your left eye.

Identify artery and vein

Artery is narrow with light reflex Vein is thicker than artery and is red

Diagnosis

Leukemic infiltration

Diagnosis

Macroglobunemia

Source for tears?

Lacrimal gland Meibonian glands Conjunctival glands Drained by puncta into lacrimal sac and on to nasolacrimal duct into nose.

Note pathway for aqueous humor

Your right eye compared to subject’s left eye

Normal mono-ocular field of vision

80-90 degrees temporal. 45 degrees medial. Limited by nose Eye brows limit upward field

Anticipate the visual field defects with lesions marked.

Blind rught eye Bitempral hemianopsia Homonymous hemianopsia

Describe and locate the lesion for each visual field defect

Left upper retna Left optic nerve Chiasma Right optic tract Right optic radiation