Comments on: What's wrong with my eyeballs.

Question: What's wrong with my eyeballs.

pilibeen — Mon, 31 Mar 2008 16:57:54 -0800

What was this doctor talking about while checking my eyes?

A couple of years ago I was at the hospital with a broken nose. The doc was surrounded by some interns, and did this test where he held his finger up and had me follow it w/ my eyes while he moved it back and forth . When he moved quickly from one side to the other, he turned to his interns and said something along the lines of, "..you see that? that's what I was talking about earlier.". The interns looked genuinely excited to see it, so I'm guessing it's not all that common?

I'm guessing some people's eyes do something strange, maybe some kind of "jump", to follow something quickly from one side to another? I know this is sparse on details...but I figured I'd try. I should've asked the doc when I was there, but I was a bit out of it.

By: -harlequin-

-harlequin- — Mon, 31 Mar 2008 17:06:01 -0800

If it helps, an on-the-spot test for inebriation is to do that - if sober, your eyes will follow the finger rapidly, if drunk, they will follow in a noticeably more jump-pause-jump manner.
Perhaps there are things that cause this that might be relevant to your scenario - pain? painkillers?

By: jmnugent

jmnugent — Mon, 31 Mar 2008 17:11:19 -0800

Harelquin is referring to the nystagmus effect.

By: pilibeen

pilibeen — Mon, 31 Mar 2008 17:13:03 -0800

I was in pain...but didn't take any other painkillers besides some tylenol before going in. That's interesting though...could drowsiness alone cause that?

By: RobotHeart

RobotHeart — Mon, 31 Mar 2008 17:42:07 -0800

Could you perhaps have mild amblyopia? I had it and as a child when I was drowsy and not concentrating one of my eyes would "wander out" slightly, but it wouldn't really be noticeable except to a medical professional or my parents, trained for what to look for. I sometimes experienced double vision as that happened.

If this is what your doctor saw, it would have nothing to do with the broken nose, from my understanding. It might just be that he never had a person with amblyopia to show his interns before. But it may have been more pronounced that usual from your pain and drowsiness making you a little zoned out.

By: RobotHeart

RobotHeart — Mon, 31 Mar 2008 17:42:34 -0800

*than. blah

By: ikkyu2

ikkyu2 — Mon, 31 Mar 2008 17:53:53 -0800

Hard to know exactly what the doc was seeing.

He was checking your extraocular muscles or eye movements, in other words examining the functions of cranial nerves number three, four and six, and the two most common abnormalities I see when examining folks are nystagmus and saccadic pursuit (instead of smooth pursuit, the normal finding). So that may help with your Googling.

In the case of a fractured nose, one likes to rule out intraorbital damage, especially to those abovementioned cranial nerves, as well as mechanical restriction of the eye or its muscles due to orbital fracture. I'm sure that's why he was examining your eye movements, but I don't know what he saw that was of interest to his interns.

By: sideshow

sideshow — Mon, 31 Mar 2008 18:01:03 -0800

Speaking of eye doctors not telling you about your problems.....

I had an eye exam and I was given a test where I had a pattern of lines presented to each eye. I was asked to pick which lines were closer, the horizontal or vertical lines. The looked the same so I said "neither". The doctor pressed me to pick one of them and said "eh, horizontal".

My dad was getting an exam immediately after me and while he was getting the test the doctor asks, "Do you know your son has no depth perception?".

Turns out that the test I failed presented to slightly different sets of lines to each eye, and if a person's brain can successfully analyze the differences a certain set appears closer.

I have since learned that there are many ways for my brain to judge depth (object in front of another is closer than the one it's in front of, a VW Beetle is a certain size so if it looks this small it's that far away, etc) so I'm not totally handicapped. In fact, I didn't know I had any problems at all. But, if it's worth mentioning to my father, why not mention it to me?

By: a robot made out of meat

a robot made out of meat — Mon, 31 Mar 2008 18:01:44 -0800

I got yelled at about this by an ER attending the other day, so I suspect that it may have been the teaching point if it wasn't the ones that ikkyu2 already hit. When checking the pupils, you look to see if they react when focus changes. It's kind of a subtle finding, and some newish people will automatically write "pupils equal, round, reactive to light and accommodation" even if they have no idea what "reactive to accommodation" really looks like.

By: ikkyu2

ikkyu2 — Mon, 31 Mar 2008 20:19:41 -0800

meatrobot: Light-near dissociation is the hallmark of the Argyll-Robertson pupil, which is seen in syphilis. It can also be seen, however, in the Adie pupil that is associated with a heritable peripheral neuropathy.

In 15 years as a neurologist, I have seen 1 case of Argyll-Robertson pupil, and 1 Adie pupil - the AR pupil, I saw as a med student - so I can't imagine yelling at anyone about it. Given the fact that the pathophysiology of the AR pupil isn't even known - the pathways responsible for accommodation aren't well-described - it's a teaching point that has little utility in neurology as we practice it.

By: a robot made out of meat

a robot made out of meat — Tue, 01 Apr 2008 05:00:14 -0800

ikkyu2: Yeah. I think ERJerk's point was that not being a neurologist and not having seen the pathology ever I didn't really know what to look for, and therefore should not write PERRLA. His claim was that one day I would be on the stand with LawyerJerk asking "DR. MEAT, WHAT ELSE IN THIS REPORT IS A LIE?!" I think he was annoyed by a fresh crop of medical students writing PERRLA since the example case write-ups here do.