Eye Examination and Structure

Question 1

What does a relative afferent pupillary defect indicate?

Answer 1

• A lesion of the retina or optic nerve

Question 2

A patient presents with down-and-out gaze and ptosis. What would cause this? What must be excluded?

Answer 2

• CNIII palsy
• Posterior communicating artery aneurysm (exclude with CTA-COW/MRI)

Question 3

What are the characteristic presenting features of someone with Horner’s syndrome and common causes? What might someone with congenital Horner’s syndrome also have?

Answer 3

• Ptosis, miosis and anhidrosis
• Carotid dissection, Pancoast (apical lung) tumour
• Congenital Horner’s - heterochromia

Question 4

Which cranial nerve will first be affected by raised ICP? Why, and what will its palsy cause?

Answer 4

• CNVI
• Longest course - more stretch
• Palsy - inability to adduct the eye

Question 5

What are the three tests that must be done before referral to an ophthalmologist?

Answer 5

FBE, ESR, CRP (exclude temporal arteritis)