PANCE Blueprint EENT (7%)

Neuro-ophthalmologic disorders (PEARLS)

NCCPA™ PANCE Eyes, Ears, Nose, and Throat Content Blueprint eye disorders ⇒ neuro-ophthalmologic disorders

Nystagmus (ReelDx)
ReelDx Virtual Rounds (Nystagmus)
Patient will present as → a 46-year-old male with an involuntary, rapid, and repetitive movement of both eyes side to side.

Involuntary, jerking movements of the eyes

DX: Caloric reflex test in which one ear canal is irrigated with warm or cold water or air. The temperature gradient provokes the stimulation of the horizontal semicircular canal and the consequent nystagmus.

TX: medications baclofen and gabapentin

  • Several therapeutic approaches, such as contact lenses, surgery, and low-vision rehabilitation, have also been proposed
  • Surgery: tenotomy
  • Physical therapy
Optic neuritis (ReelDx)
ReelDx Virtual Rounds (Optic neuritis )
Patient will present as → a 47-year-old school teacher with a cough, hemoptysis, fever, chills, and weight loss that has persisted since he returned from a summer trip to China. A chest radiograph is concerning for infection, and a sputum culture is positive for acid-fast organisms. Treatment for this patient’s condition is begun. Three weeks later, the patient returns to the clinic with decreased visual acuity for one day in his right eye. He also reports pain in the eye with movement but no other symptoms. The patient has a family history of glaucoma, diabetes mellitus, factor V Leiden, and stroke. On physical examination, when a penlight is shined into the affected eye, there is no pupillary constriction in either eye. 

Acute inflammation and demyelination of the optic nerve leading to acute monocular vision loss/blurriness and pain on extraocular movements

  • Typically occurs over hours or days
  • Multiple sclerosis is the most common cause, and optic neuritis is often the initial presenting symptom
  • Optic neuritis is associated with the use of ethambutol (a common board question) 

DX: Fundoscopy ⇒ inflammation of the optic disc

  • MRI will confirm demyelination

TX: IV corticosteroids

  • Refer to neurology for evaluation of Multiple Sclerosis

Papilledema (ReelDx)
ReelDx Virtual Rounds (Papilledema)
Patient will present as → a 57-year-old male with a history of hypertension who complains of an acute onset of intermittent headaches and blurred vision of the right eye.

Papilledema is optic disc swelling that is caused by increased intracranial pressure. The swelling is usually bilateral and can occur over a period of hours to weeks

DX: Diagnosis is by ophthalmoscopy with further tests, usually brain imaging and sometimes subsequent lumbar puncture, to determine the cause

  • MRI or CT scan of the head looking for a cause. Focus on finding intracranial pathology = tumor or bleed, cerebral edema, CSF outflow obstruction, or overproduction
  • Increased opening pressure with lumbar puncture confirms increased intracranial pressure

TX: Treat underlying cause

Hordeolum (ReelDx + Lecture) (Prev Lesson)
(Next Lesson) Nystagmus (ReelDx)
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