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CP2 Opthalmology > Neuro-opthalmology > Flashcards

Neuro-opthalmology Flashcards

1
Q

List the important causes of optic disc swelling?

A
  • Malignant hypertension
  • Papilloedema
  • Optic neuritis
  • Non arteretic ant. ischaemiac optic neuropathy
  • (AION) AION (temporal arteritis)

My pet ostrich never ages

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2
Q

Describe the symptoms and important points regarding optic neuritis?

A

Symptoms:

  • Retrobulbar pain worse on movement.
  • Globe tenderness.
  • Central scotoma (black spot in the centre of their vision)

Signs on examination:

  • Optic disc is not always swollen.
  • Will have red desaturation (see’s red colour as less bright more pink)
  • RAPD
  • May have other neuro signs

Note: Associated with risk of developing MS

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3
Q

Describe the symptoms and important points regarding papilloedema?

A

Symptoms:

  • (must be bilateral)
  • Transiently obscured vision

Signs on examination:

  • Gradually progressive field loss
  • Splinter haemorrhages.

On fundoscopy:

  • -exudates
  • -cotton wool spots
  • -retinal folds near the disc
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4
Q

Describe the symptoms and important points regarding of AAION (temporal arteritis)?

A

(Arteric Anterior ischemic optic neuropathy)

  • Severe temporal headache.
  • Scalp tenderness.
  • Jaw claudication
  • Visual loss caused by ischaemia from inflammation of arteries in the head called temporal arteritis. (posterior ciliary aa?).

Investogations:

  • Raised ESR and C reactive protein
  • Treat with steroids ~2years
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5
Q

Describe the symptoms and important points regarding of non arteric AION?

A
  • Non inflamatory disease of the small arteries
  • Infarction of the post. ciliary aa.
  • 50% of patients are hypertensive.
  • ESR will not be rasied and there are no systemic symptoms.
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6
Q

Which muscles control the iris and which nervous systems are they each controlled by?

A
  • Dilator pupillae:- sympathetic
  • Constrictor pupillae:- parasympathetic
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7
Q

What are the 3 physiological influences on the pupil?

A
  • Light
  • Strong emotion (fight or flight causes pupil dilation)
  • Accommodation.
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8
Q

Outline the 3 things which occur in the accommodation reflex?

A
  • Pupils constrict.
  • Eyes converge (contraction of medial rectus)
  • Ciliary muscles contract, relaxing the zonules and thickening the lens increasing the refractive power of the lens.
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9
Q

Outline the pupillary light reflex pathway.

A
  • Afferent: Light–> optic nn —> chiasm —> tract —> pre tectal nuclei
  • At this point 2 (one for each eye) edinger westphal nuclei are recruited. Reason for consensual response.
  • Efferent: Signal travels along pathway of CNIII —> ciliary ganglion —> constrictor pupillae
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10
Q

Outline the pupillary sympathetic pathway.

A

For example:

fearful stimulus Hypothalamus —> 1st order neuron synapse in spinal cord at level T1

2nd order neuron —> synpases in superior cervical ganglion fibres travel around the internal carotid and split up into seperate fibres supplying:

  • -sweat glands to the forehead and to supply the levator palpebrae superioiris (elevated eyelid)
  • -dilator pupillae
  • -sweat glands in the face

When thinking what it supplys think HORNERS

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11
Q

Define the term anisocorea?

A

Unequal pupil size >1mm

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12
Q

What are the potential causes of anisocorea?

A
  • Horner’s syndrome
  • CN III palsy
  • Adie’s pupil
  • Traumatic mydriasis
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13
Q

Describe the clinical features of Horner’s syndrome?

A

Sympathetic chain damage pressure causing:

  • -Partial ptosis (levator palpebrae superioiris)
  • -Meiosis (unopposed action of constrictor pupillae as no sympathetic input)
  • -Anhydriasis.
  • -Apparent enopthalamus (sunken eyelid)
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14
Q

What are the potential causes of Horner’s syndrome? Think about the different order neurons.

A

1st order neuron causes:

  • -CNS disease (SOL, infection, CVA, demyelination)
  • -Cervical region compression (tumor) or injuries

2nd order neuron causes:

Sympathetic chain compression from:

  • -Cervical rib
  • -Pancos tumour
  • -Aneurysms
  • -Lypathendopathy
  • Apical TB
  • Neck trauma (surgery)

3rd order neuron causes:

  • -ICA aneurysm (suspect if also complaining of neck pain)
  • -Migraines and cluster headaches
  • -Idiopathic
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15
Q

Describe the presentation of CNIII palsy?

A
  • Full ptosis
  • Eye will be pointing down and out due to the unopposed actions of the lateral rectus and superior oblique
  • Efferent pupil defect (anisocorea) as nn fibres which control constrictor pupillae travel with CNIII. Mydriasis.
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16
Q

What are the causes of CNIII palsy?

A
  • Vascular III nn palsy: Diabetes/hypertension pupil usually spared. Self limiting.
  • Brainstem injury: Tumour, CVA, demyelination.
  • Cavernous sinus: Carotid cavernous fistula Tumour
  • Inflammation Skull Pain: Post communicating aa aneurysm Extradural haematoma
  • Orbit: Trauma, Inflammation, Tumour. Infiltrative lymphomas.
17
Q

Describe the clinical features of Adie’s pupil?

A
  • Light reflex is absent.
  • Accommodation pupil reflex is normal/slow. AKA enlarged dilated pupil.
  • May be associated with reduced tendon reflexes (Holmes ad syndrome)
  • Usually affect young women, idiopathic cause but thought to be post infective.
  • uses Pilocarpine (cholinergic) to determine diagnosis, by constricted affected pupil
18
Q

Describe the symptoms of traumatic mydriasis?

A
  • Mydriasis
  • Photophobia
  • Eye ache
  • Watering
  • Usually caused by blunt trauma damaging the the iris sphincter muscle.
  • Usually reversible.
19
Q

In a pupil examination what should you do if you find anisocrea?

A

Turn off the light.

20
Q

What are the differentials for an abnormal small/large pupil?

A

Small pupil:

  • Horner’s syndrome
  • Pharmacological
  • Previous synechia (post. surface of the iris is adhered to the lens.

Large pupil:

  • Adie’s pupil
  • CN III palsy
  • Traumatic mydriasis
21
Q

Which medications can affect pupil size?

A

Dilate:

  • TCA’s
  • Phenylephirine chloride
  • Cocaine
  • Amphetamines

Constricts:

  • Opiods
22
Q

Anisocorea Flow Chart

A

CP2 Opthalmology (16 decks)

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