Neuro-ophthalmic Disease

Question 1

What are the cardinal clinical feature of neuro-ophthalmic disease?

Answer 1

Eye movement defects
Double vision
Visual defect/field loss/decreased acuity

Question 2

What is the most common cause of neuro-ophthalmic disease? List some others too

Answer 2

Vascular disease = most common

Also tumours, trauma, nerve damage, inflammation/infection

Question 3

Which cranial nerves are associated with eye movement?

Answer 3

III
IV
VI

Question 4

CN VI palsy affects which intra-ocular muscle?

What happens to the eye as a result?

Answer 4

Lateral rectus

Eye is pulled inwards/medially (adduction)

Question 5

CN IV palsy affects which intra-ocular muscle?

What happens to the eye as a result?

Answer 5

Superior oblique
Eye is pulled up/superiorly + inwards/medially
Typically causes the head to tilt

Question 6

What are the main causes of CN IV palsy?

Answer 6

Congenital
Microvascular
Tumour
Trauma (closed head)

Question 7

CN III palsy affects which intra-ocular muscles?

Answer 7

Recti (medial, inferior, superior)
Inferior oblique
Levator palpebrae superioris
Sphincter pupillae

Question 8

What happens to the eye as a result of CN III palsy?

Answer 8

Eye is pulled downwards/inferiorly + outwards/laterally (“down and out”)
Ptosis
Dilated pupil

Question 9

What must be suspected with a painful CN III palsy? What are the other causes?

Answer 9

Aneurysm (PAINFUL)

Microvascular, tumour, MS, congenital

Question 10

What must be suspected with a CN VI palsy? What are the other causes?

Answer 10

Increased cranial pressure

Microvascular, tumour, congenital

Question 11

What is inter-nuclear ophthalmoplegia?

Answer 11

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

Question 12

What is the medial longitudinal fasciculus and how does it relate to inter-nuclear ophthalmoplegia?

Answer 12

Connection between 3rd and 6th CN, allowing communication

In INO this is damaged

Question 13

List the order of the optic pathway

List the main causes of defects in the optic pathway

Answer 13

Optic nerve
Optic chiasma
Optic tracts
Optic radiations
Cortex

CVA, SOL, MS, trauma

Question 14

What is the major cause of inter-nuclear ophthalmoplegia?

Answer 14

Multiple sclerosis

Question 15

A defect of the left optic nerve will only cause visual loss in the left eye. True/False?

Answer 15

True - causes monocular blindness

Question 16

A defect in the optic chiasma will cause what type of visual loss?

Answer 16

Bitemporal hemianopia

Question 17

Describe visual loss caused by a defect of the left optic tract

Answer 17

IPSILATERAL HOMONYMOUS HAEMANOPIA
Nasal visual loss of left eye
Temporal visual loss of right eye

Question 18

Describe visual loss caused by a defect of the left optic radiation

Answer 18

Superonasal visual loss of left eye

Superotemporal visual loss of right eye

Question 19

Describe visual loss caused by a defect of the left cerebral cortex (occipital)

Answer 19

Nasal visual loss of left eye
Temporal visual loss of right eye
N.B. macula-sparing

Question 20

List the main causes of optic nerve damage

Answer 20

Optic neuropathy
Optic neuritis
Tumours

Question 21

How is neuro-ophthalmic disease typically treated?

Answer 21

Temporary prism/ patch for 6-8 weeks

Question 22

List clinical signs of optic neuritis

Answer 22

Progressive unilateral LOV
Pain behind eye on movement
Colour desaturation
Central scotoma