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2nd year > Eye movements in health and disease > Flashcards

Eye movements in health and disease Flashcards

1
Q

what are the extraocular muscles of the eye?

A 
superior rectus
inferior rectus
medial rectus
lateral rectus
superior oblique
inferior oblique
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2
Q

what are the extraocular muscles of the eye?

A 
superior rectus
inferior rectus
medial rectus
lateral rectus
superior oblique
inferior oblique
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3
Q

Rectus muscles

A

originate from common tendinous ring and attach to anterior sclera

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4
Q

superior rectus

A

elevates eye
adduction
medial rotation
innervated by oculomotor nerve

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5
Q

inferior rectus

A

depresses eye
adduction
lateral rotation
innervated by oculomotor nerve

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6
Q

medial rectus

A

adduction

innervated by oculomotor nerve

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7
Q

lateral rectus

A

abduction

innervated by abducens nerve

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8
Q

oblique muscles

A

attach to posterior sclera

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9
Q

superior oblique

A

depresses eye in adduction
medial rotation/ intorsion
innervated by trochlear nerve

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10
Q

inferior oblique

A

elevates eye when in adduction
lateral rotation/ extorsion
innervated by oculomotor nerve

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11
Q

what happens when the superior tract is damaged?

A

inferior vision affected

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12
Q

what happens when the inferior tract is damaged?

A

superior vision affected

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13
Q

lesion at optic chiasm

A

tunnel vision

non-homonymous bitemporal hemianopia

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14
Q

what happens when there is a lesion in the primary visual cortex?

A

macular sparing

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15
Q

efferent visual pathway

A

upper motor neurone from fronto-parietal cortex to brainstem then lower motor neurone - cranial nerve to muscles of the eye
travel through cavernous sinus to orbit

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16
Q

motor pathway to eye

A

conjugated eye movement requires modification to the basic primary motor pathways to achieve convergence and conjugation

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17
Q

what is convergence?

A

alignment as objects become closer together

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18
Q

what is conjugation?

A

simultaneous tracking of objects

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19
Q

how to test superior rectus?

A

look laterally and upwards

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20
Q

how to test inferior rectus?

A

look laterally and downwards

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21
Q

how to test medial rectus?

A

look medially

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22
Q

how to test lateral rectus?

A

look laterally

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23
Q

how to test inferior oblique?

A

look medially and upwards

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24
Q

how to test superior oblique?

A

look medially and downwards

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25
what are the components of MS?
inflammation - autoimmune mediation demyelination axonal loss
26
efferent opthalmic manifestations of MS
``` extraocular muscle palsy internuclear opthalmoplegia nystagmus saccadic abnormalities uveitis oscillopsia diplopia ```
27
afferent opthalmic manifestations of MS
demyelinating optic neuritis
28
visual field defects
prechiasmal chiasmal post-chiasmal
29
pre-chiasmal defects
optic neuritis
30
chiasmal defects
junctional scotoma | bitemporal hemianopia defect - rare
31
post-chiasmal defects
optic tract | geniculocalcarine pathway
32
what is optic neuritis?
common early presentation of MS - 20% | acute demyelination of optic nerve
33
clinical features of optic neuritis
``` more commonly unilateral than bilateral pain on eye movement loss of vision blurred vision partial/ complete typically central reduced visual acuity central scotoma loss of colour vision pale disc relative afferent pupil defect no fundoscopy findings ```
34
potential fundoscopy findings
can develop papillitis - blurred margins caused by swollen disc on fundoscopy
35
what is central scotoma?
blurred spot in centre of vision
36
what is a relative afferent pupillary defect?
pupils don't send impulse back to brain to cause dilation or constriction of pupil
37
clinical features of a relative afferent pupillary defect
affected eye will dilate when light shone in swinging torch test because of the consensual reflex from when light shone in unaffected eye is removed and there is dilation but the light is not detected by the affected eye so no constriction can occur
38
prognosis for optic neuritis
often self-resolves in 2-3 weeks 5-10% will not recover fully can get recurrent attacks
39
treatment for optic neuritis
oral steroids have no long-term improvement but can speed recovery IV steroids - methyprednisolone has been shown to reduce progression of MS
40
Rectus muscles
originate from common tendinous ring and attach to anterior sclera
41
superior rectus
elevates eye adduction medial rotation innervated by oculomotor nerve
42
inferior rectus
depresses eye adduction lateral rotation innervated by oculomotor nerve
43
medial rectus
adduction | innervated by oculomotor nerve
44
lateral rectus
abduction | innervated by abducens nerve
45
oblique muscles
attach to posterior sclera
46
superior oblique
depresses eye in adduction medial rotation/ intorsion innervated by trochlear nerve
47
inferior oblique
elevates eye when in adduction lateral rotation/ extorsion innervated by oculomotor nerve
48
what happens when the superior tract is damaged?
inferior vision affected
49
what happens when the inferior tract is damaged?
superior vision affected
50
lesion at optic chiasm
tunnel vision | non-homonymous bitemporal hemianopia
51
what happens when there is a lesion in the primary visual cortex?
macular sparing
52
efferent visual pathway
upper motor neurone from fronto-parietal cortex to brainstem then lower motor neurone - cranial nerve to muscles of the eye travel through cavernous sinus to orbit
53
motor pathway to eye
conjugated eye movement requires modification to the basic primary motor pathways to achieve convergence and conjugation
54
what is convergence?
alignment as objects become closer together
55
what is conjugation?
simultaneous tracking of objects
56
how to test superior rectus?
look laterally and upwards
57
how to test inferior rectus?
look laterally and downwards
58
how to test medial rectus?
look medially
59
how to test lateral rectus?
look laterally
60
how to test inferior oblique?
look medially and upwards
61
how to test superior oblique?
look medially and downwards
62
what are the components of MS?
inflammation - autoimmune mediation demyelination axonal loss
63
efferent opthalmic manifestations of MS
``` extraocular muscle palsy internuclear opthalmoplegia nystagmus saccadic abnormalities uveitis oscillopsia diplopia ```
64
afferent opthalmic manifestations of MS
demyelinating optic neuritis
65
visual field defects
prechiasmal chiasmal post-chiasmal
66
pre-chiasmal defects
optic neuritis
67
chiasmal defects
junctional scotoma | bitemporal hemianopia defect - rare
68
post-chiasmal defects
optic tract | geniculocalcarine pathway
69
what is optic neuritis?
common early presentation of MS - 20% | acute demyelination of optic nerve
70
clinical features of optic neuritis
``` more commonly unilateral than bilateral pain on eye movement loss of vision blurred vision partial/ complete typically central reduced visual acuity central scotoma loss of colour vision pale disc relative afferent pupil defect no fundoscopy findings ```
71
potential fundoscopy findings
can develop papillitis - blurred margins caused by swollen disc on fundoscopy
72
what is central scotoma?
blurred spot in centre of vision
73
what is a relative afferent pupillary defect?
pupils don't send impulse back to brain to cause dilation or constriction of pupil
74
clinical features of a relative afferent pupillary defect
affected eye will dilate when light shone in swinging torch test because of the consensual reflex from when light shone in unaffected eye is removed and there is dilation but the light is not detected by the affected eye so no constriction can occur
75
prognosis for optic neuritis
often self-resolves in 2-3 weeks 5-10% will not recover fully can get recurrent attacks
76
treatment for optic neuritis
oral steroids have no long-term improvement but can speed recovery IV steroids - methyprednisolone has been shown to reduce progression of MS
77
what are the types of nystagmus?
``` unilateral bilateral purely downward purely torsional pendular is most common ```
78
oculomotor nerve palsy
eye moves down and out ptosis pupil involvement diplopia
79
why does an oculomotor palsy cause diplopia?
no conjugation of eyes
80
why does an oculomotor palsy cause pupil involvement?
carries parasympathetic fibres to sphincter and ciliary muscles
81
causes of oculomotor nerve palsies
``` posterior circulation aneurysm brainstem lesions microvascular ischaemia cavernous sinus disease strokes ```
82
abducens nerve palsy
limited abduction most common nerve palsy of eye esotropia head turn for compensation
83
what is esotropia?
eye turned inwards
84
causes of abducens nerve palsy
``` trauma space occupying lesion raised ICp ischaemia inflammation cavernous sinus disease ```
85
why is abducens nerve palsy the most common?
most superficial/ on the outside
86
trochlear nerve palsy
head tilt to compensate torsional diplopia worse on downward gaze cannot look down
87
causes of trochlear nerve palsy
trauma aneurysm cavernous sinus disease space occupying lesion
88
internuclear opthalmoplegia
most common abnormality in MS | often bilateral
89
causes of internuclear opthalmoplegia
cerebrovascular disease | lesion in medial longitudinal fasciculus
90
clinical features of internuclear opthalmoplegia
disorder of conjugate lateral gaze adduction deficit in ipsilateral affected eye pendular nystagmus in abducting contralateral eye patients present with horizontal nystagmus
91
what is cavernous sinus thrombosis?
blood clot in cavernous sinus | can be life-threatening
92
causes of cavernous sinus thrombosis
- oral contraceptives - pregnancy - blood clotting disorders - haematological diseases - malignancies - head trauma - neurosurgical procedures - IBS - collagen vascular diseases - blood vessel disorders - hyperhomocysteineamia - haematological conditions - nephrotic syndrome - dehydration - infections
93
what infections can cause cavernous sinus thrombosis?
In paranasal region - rhinogenic infections - mid-facial infections - dental infections - otogenic infections - meningitis - pharyngitis - tonsillitis - orbital and periorbital cellulitis
94
what is the pathophysiology of cavernous sinus thrombosis?
thrombogenesis occurs in vertebral venous system decreases cerebral drainage, increasing ICP oxygenated blood in brain decreases causes cerebral oedema and infarcts/ strokes
95
clinical features of cavernous sinus thrombosis
- symptoms depend on the size and location of thrombosis - non-specific symptoms - raised ICP - cerebral ischaemia - headache – acute, subacute or chronic and may progress in severity over days/ weeks - bilateral papilloedema - vision impairment – diplopia/ vision loss - nausea and vomiting - impaired consciousness - seizures – focal or generalised - cranial nerve dysfunction – diplopia, tinnitus, unilateral deafness, facial palsy - paralysis - aphasia - behavioural changes - delirium - amnesia - progressive and slow development of symptoms
96
diagnosis of cavernous sinus thrombosis
neuroimaging | lab tests
97
neuroimaging for cavernous sinus thrombosis
MRI with venography, if not CT with venography
98
neuroimaging findings in cavernous sinus thrombosis
``` absence of flow intraluminal venous thrombus focal oedema secondary to ischaemia intraparenchymal haemorrhage empty delta sign ```
99
lab tests for cavernous sinus thrombosis
``` D-dimer - elevated in acute disease FBC coagulation studies baseline renal function tests prior to starting treatment CRP blood cultures lumbar puncture ESR antibody studies LFTs thrombophilia screening EEG ```
100
treatment for cavernous sinus thrombosis
general stabilisation treat raised ICP treat underlying cause anticoagulation antimicrobial therapy if infection present surgical intervention if no improvement with medical therapy or if anticoagulation is contraindicated
101
medical management of cavernous sinus thrombosis - anticoagulation
1st line = LMW heparin 2nd line = unfractionated heparin long-term = vitamin K antagonists (warfarin) for 3-12 months
102
antimicrobial therapy for cavernous sinus thrombosis
vancomycin 3rd/4th generation cephalosporin metronidazole for 3-4 weeks rarely caused by fungal infection but if the case = immunosuppression, amphotericin B
103
other medical managements of cavernous sinus thrombosis
``` fluids neuroprotective measures ICP management anticonvulsants if seizures present corticosteroids in certain conditions ```
104
invasive procedures for cavernous sinus thrombosis
endovascular thrombolysis | catheter thrombectomy
105
surgery for cavernous sinus thrombosis
decompressive hemicraniectomy haematoma evacuation shunt placement abscess drainage

2nd year (48 decks)

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