Neuro-Ophthalmology Flashcards
The optic nerve is formed by the convergence of which cells?
Retinal ganglion cells
The optic tract connects which two structures?
Optic chiasm and lateral geniculate nuclei
The optic tract conveys signals from the contralateral nasal retina and ipsilateral temporal retina. True/false?
True
The optic radiations connect which structures?
Lateral geniculate nuclei and visual cortex
Superior optic radiations pass through the temporal lobe and inferior optic radiations pass through through the parietal lobe. True/false?
False - superior optic radiations pass through parietal lobe and inferior optic radiations pass through temporal lobe
The oculomotor nerve is accompanied by parasympathetic fibres that innervate what?
Sphincter papillae
Ciliary muscles
Where are the trochlear nuclei located?
Midbrain
Where is the abducens nucleus located?
Pontine tegmentum
What nerves supply the afferent and efferent limbs of the pupillary light reflex?
Afferent limb - CN II
Efferent limb - CN III
Light projected along the eye is projected to which nuclei?
Edinger-Westphal
Where do parasympathetic fibres from the Edinger-Westphal nuclei synapse?
Ciliary ganglion
Parasympathetic fibres are carried from short ciliary nerves to innervate which structures?
Ciliary muscle
Sphincter pupillae
What causes lens curvature to increase in the accommodation reflex?
Ciliary muscle contracts causing relaxation of suspensory lens ligaments
What are the main signs of CN II dysfunction?
Decreased VA Dyschromatopsia Visual field defects Diminished contact sensitivity RAPD
What is optic neuritis?
Inflammation of the optic nerve
Give some ophthalmic clinical features of MS
Optic neuritis
Internuclear ophthalmoplegia
Nystagmus
How is optic neuritis treated?
IV methylprednisolone
What is neuromyelitis optica?
Demyelinating disorder with bilateral optic neuritis and transverse myelitis
What occurs in anterior ischaemic optic neuropathy?
Damage to CN II due to ischaemia
What is papilloedema?
Optic disc swelling secondary to elevated ICP
Give some clinical features of papilloedema
Headache N + V Transient visual loss Enlarged blind spot Blurred optic disc margins Splinter haemorrhages
What are the clinical features of Horner’s syndrome?
Ptosis (drooping eyelid)
Miosis (constriction)
Ipsilateral anhidrosis
What can be used to confirm Horner’s pupil?
Apraclonidine
What occurs in lateral medullary syndrome?
Ischaemia to lateral part of medulla
What can be affected in lateral medullary syndrome?
Vestibular nucleus
Descending sympathetic system
Spinal trigeminal tract
Spinothalamic tract
What is the cause of Adie’s pupil?
Loss of postganglionic parasymapthetic innervation to iris sphincter and ciliary muscle
Give some clinical features of Adie’s pupil
Anisocoria
absent light reflex
Absent deep tendon reflex of lower limbs
How can Adie’s pupil be investigated?
Slit lamp Topical pilocarpine (Adie's pupil constricts)
Describe an Argyll-Robertson pupil
Bilateral, irregular and small
A chiasmatic optic nerve lesion causes which visual defect?
Bitemporal hemianopia
An optic tract lesion causes which visual defect?
Contralateral homonymous hemianopia
A temporal radiation lesion causes which visual defect?
Contralateral superior homonymous quadrantanopia
A parietal radiation lesion causes which visual defect?
Contralateral inferior homonymous quadrantopia
A lesion of the main optic radiations causes which visual defect?
Contralateral homonymous hemianopia
An occipital cortex lesion causes which visual field defect?
Contralateral homonymous hemianopia with macular sparing
Give some clinical features of a third nerve palsy
Ptosis
Abduction and depression of eye
Dilated pupil
Give some clinical features of a fourth nerve palsy
Vertical diplopia
Hypertropia
Limited eye depression
Compensatory head tilt
Give some clinical features of a sixth nerve palsy
Horizontal double vision
Esotropia
Limited abduction
Give some ocular features of myasthenia gravis
Ptosis (typically bilateral)
Diplopia
Ophthalmoplegia
Give some ocular features of myotonic dystrophy
Early onset cataract
Ptosis
Hypermetropia
Ophthalmoplegia
Give some ophthalmic features of neurofibromatosis type I
Optic nerve glioma
Bilateral Lisch nodules
“Bag of worm” sensation
What is benign essential belpharospasm?
An idiopathic condition with involuntary contraction of orbicularis oculi muscle
What is the treatment for benign essential blepharospasm?
Artificial tears
Botulinum injection
Give some clinical features of cavernous sinus syndrome
Ptosis and ophthalmoplegia Loss of corneal reflex Maxillary sensory loss Horner's syndrome Proptosis and periorbital swelling
Give some causes of cavernous sinus syndrome
Infection
Tumours
Internal carotid aneurysms
