Diplopia

Question 1

cause of paralytic squint?

Answer 1

damage to one or more of the 3 cranial nerves supplying the eye muscles

Question 2

strabismus is

Answer 2

misalignment of the eyes

Question 3

what life threatening condition is a cause for 6th nerve palsy which must be ruled out?

Answer 3

cavernous sinus thrombosis

Question 4

5 other causes of 6th nerve palsy

Answer 4

• microvascular infarct
• raised ICP
• demyelinating disease
• direct pressure e.g. tumour + middle ear infections
• microvascular infarct

Question 5

sudden onset of horizontal diplopia when asked to look towards the affected side

Answer 5

6th nerve palsy

Question 6

management of 6th nerve palsy

Answer 6

temporary plastic prism fitted to the patients glasses to reduce the squion and double vision

Question 7

injections that can be considered to manage 6th nerve palsy

Answer 7

botox injections into medial rectus muscle

Question 8

what does a botox injection into medial rectus muscle cause

Answer 8

prevent shortening and contracting of the medial rectus

Question 9

which nerve palsy causes: defective depression of the eye in attempted adduction, and which muscle does it innervate

Answer 9

trochlear nerve

superior oblique

Question 10

which nerve palsy causes vertical double vision, particularly when reading or going down the stairs

Answer 10

trochlear nerve

Question 11

positioning of eye and features of eye in 3rd nerve palsy?

Answer 11

down and out position

ptosis

dilated pupil

Question 12

Strabismus is …

Answer 12

when one eye is looking directly at the object being viewed whilst the other eye is misaligned inwards/outwards/upwards or downwards

Question 13

Amblyopia is …

Answer 13

visual developmental disorder where one eye fails to achieve normal visual acuity

Question 14

management of Amblyopia?

Answer 14

patching of the non ambylopic eye to improve vision in the ambylopic eye

Question 15

How does intranuclear ophthalmoplegia manifest?

Answer 15

reduced adduction
and
contralateral nystagmus in the the abducting eye

Question 16

where is the lesion in intranuclear ophthalmoplegia?

Answer 16

medial longitudinal fasiculus

Question 17

causes of intranuclear ophthalmoplegia (2)

Answer 17

MS

Stroke

Question 18

Anisocoria is

Answer 18

one pupil larger than the other

Question 19

Eye appearing: sunken, lots of bruising + swelling following trauma to the eye

• investigation
• diagnosis

Answer 19

CT scan

Inferior orbital floor fracture

Question 20

Management of inferior orbital floor fracture (3)

Answer 20

1. Urgent maxillofacial surgery
2. advice patient not to blow their nose due to the communication between the sinuses + orbit
3. Broad spec Abx

Question 21

gradual onset of diplopia, variable throughout the day with progressive eyelid drooping on examination

• investigations
• diagnosis

Answer 21

1. Blood test for anti-acetylcholinesterase ab
2. CT/MRI
3. Chest imaging - to look for a thyoma

Myasthenia gravis

Question 22

what can be added to glasses for patients with diplopia

Answer 22

temporary prism - fresnel prism