Neuro-ophthalmic Disease Flashcards
What are the cardinal clinical feature of neuro-ophthalmic disease?
Eye movement defects
Double vision
Visual defect/field loss/decreased acuity
What is the most common cause of neuro-ophthalmic disease? List some others too
Vascular disease = most common
Also tumours, trauma, nerve damage, inflammation/infection
Which cranial nerves are associated with eye movement?
III
IV
VI
CN VI palsy affects which intra-ocular muscle?
What happens to the eye as a result?
Lateral rectus
Eye is pulled inwards/medially (adduction)
CN IV palsy affects which intra-ocular muscle?
What happens to the eye as a result?
Superior oblique
Eye is pulled up/superiorly + inwards/medially
What are the main causes of CN IV palsy?
Congenital
Microvascular
Tumour
Trauma
CN III palsy affects which intra-ocular muscles?
Recti
Inferior oblique
Levator palpebrae superioris
Sphincter pupillae
What happens to the eye as a result of CN III palsy?
Eye is pulled downwards/inferiorly + outwards/laterally (“down and out”)
Ptosis
Dilated pupil
What must be suspected with a painful CN III palsy?
Aneurysm
What must be suspected with a CN VI palsy?
Increased cranial pressure
What is inter-nuclear ophthalmoplegia?
Impairment of horizontal eye movement (failure of adduction of affected eye)
e.g. looking left, the left eye abducts with nystagmus but right eye cannot adduct pass the midline
What is the medial longitudinal fasciculus and how does it relate to inter-nuclear ophthalmoplegia?
Connection between 3rd and 6th CN, allowing communication
In INO this is damaged
List the order of the optic pathway
Optic nerve Optic chiasma Optic tracts Optic radiations Cortex
What is the major cause of inter-nuclear ophthalmoplegia?
Multiple sclerosis
A defect of the left optic nerve will only cause visual loss in the left eye. True/False?
True
