Ocular Motility/ Visual Field Defects

Question 1

ocular motility defects are due to …

Answer 1

CN 3,4,6 palsies

Question 2

how does 6th nerve palsy present

Answer 2

no lateral rectus so…
medial deviation of eye
A: microvascular, raised ICP*, tumour, congenital, papilloedema

Question 3

4th nerve palsy presentation

Answer 3

no superior oblique so…
up and middle
A: microvascular, trauma

Question 4

what causes bilateral 4th nerve palsy

Answer 4

blunt head trauma

Question 5

3rd nerve palsy presentation

Answer 5

down and out gaze with dilated pupil, ptosis

A: microvascular (no pupil change), tumour, aneurysm*, cavernous sinus thrombosis, raised ICP, MS

Question 6

what is the main eye condition associated with MS

Answer 6

inter-nuclear ophthalmoplegia: eyes cannot work together- double vision, divergent squint, nystagmus

Question 7

visual field defects occur as 4 areas are affected- what are these

Answer 7

optic nerve, optic chiasma, optic tracts, occipital cortex

Question 8

optic nerve pathology is…

Answer 8

optic neuropathy, optic neuritis, tumours

Question 9

t/f: optic nerve pathology means defect is usually not precise

Answer 9

F: usually precise

Question 10

what is optic neuritis

Answer 10

progressive unilateral visual loss, pain behind eye- especially on movement, central scotoma*, colour deficits

Question 11

proptosis is a tell tale sing of….

Answer 11

haemangioma

Question 12

optic chiasma pathology is and classic presentation

Answer 12

pituitary tumour, craniopharyngioma, meningioma

bi-temporal hemianopia

Question 13

optic tract pathology and s/s

Answer 13

tumours, demyelination, vascular anomalies e.g. stroke

s/s: homonymous defects, precise, macula not spared, quadrantanopia, incongruous

Question 14

s/s of occipital visual field defects

Answer 14

macula spared so image is congruous, homonymous defect

Question 15

what is Horner’s syndrome

Answer 15

characteristic facial appearance caused by damage to sympathetic facial supply

Question 16

hornet’s can have different locations, this is dependent on if the event/lesion is at…

Answer 16

central, pre-ganglionic, post-ganglionic

Question 17

aetiology of central

Answer 17

4Sentral: stroke, multiple sclerosis, swelling, syringomyelia (cyst in SC)

Question 18

aetiology for pre-ganglionic

Answer 18

4Torso: tumour (Pancoasts), trauma, thyroidectomy, top rib (rib above 1st rib)

Question 19

aetiology for post-ganglionic

Answer 19

4Cervical: carotid aneurysm, carotid artery dissection, cavernous sinus thrombosis, cluster headache

Question 20

what is the main sign of congenital Horner’s

Answer 20

heterochromia

Question 21

triad of Horner’s

Answer 21

ptosis, miosis anhidrosis

Question 22

ix for Horner’s

Answer 22

adrenalin drops (+ve test= pupil dilation), cocaine drops (+ve test= no reaction)

Question 23

what is Holmes-Adie Pupil

Answer 23

unnatural dilated pupil that is sluggish to react to light

Question 24

cause of Holmes-Adie

Answer 24

damage to post-ganglionic parasympathetic fibres

Question 25

s/s of holmes-adie

Answer 25

slow dilation of pupil following contraction reaction to light

Question 26

what is Holmes-Adie syndrome

Answer 26

pupil + absent ankle and knee reflexes

Question 27

what is Argyll-Robinson Pupil

Answer 27

pupil that doesn’t react to light- neurosyphilis symptom. often irregular shaped