Eye Movement Problems

Question 1

What eye movements does the superior oblique do?

Answer 1

Down and out (and rotation)

Question 2

What position will the eye be in a 3rd nerve palsy and what other signs will there be?

Answer 2

Down and out (unopposed superior oblique and lateral rectus)
Ptosis (eye lid droop)
Fixed dilated pupil

Question 3

What position will the eye be in a 4th nerve palsy?

Answer 3

Up and in (no superior oblique function)

Question 4

What position will the eye be in a 6th nerve palsy?

Answer 4

Unable to adduct

Question 5

What are the causes of a third nerve palsy?

Answer 5

Cavernous sinus lesion (varied causes including tumour, vascular lesions and trauma)
Superior orbital fissure syndrome (trauma, tumour, inflammation)
Posterior communicating artery aneurysm
Diabetes
Hypertension

Question 6

How to tell is vascular (diabetes,hypertension) cause of 3rd nerve palsy?

Answer 6

Pupil often spared

Question 7

What happens to the pupil in 3rd nerve palsy due to compression by tumour and aneurysm and why?

Answer 7

Affected first
Pupillary fibres are on outside of 3rd nerve

Question 8

Causes of 4th nerve palsy

Answer 8

Trauma
Diabetes
Tumour
Idiopathic

Question 9

Causes of 6th nerve palsy

Answer 9

Tumour causing raised ICP
Base of skull trauma
Vascular incl diabetes
MS