The eye in systemic disease

Question 1

What are the cardinal features of neurophthalmic disease?

Answer 1

1. eye movement defects

2. visual defects

Question 2

What is the gold standard imagine for identifying cause

Answer 2

MRI

Question 3

Which secondary preventative measures should be taken?

Answer 3

BP and cholesterol

Question 4

What does a IIIrd nerve palsy cause?

Answer 4

paralysis;
medial rectus
inferior rectus
superior rectus
inferior oblique
sphincter pupillae
levator palpebrae superioris

Question 5

What will the ocular position be in a IIIrd nerve palsy?

Answer 5

down and out

Question 6

What can cause a IIIrd nerve palsy?

Answer 6

-microvascular
(more likely if it is pupil sparing)
-tumour
-aneurysm
(especially if involving pupil= get MRI/angiogram)
-MS
-congenital

Question 7

What will the ocular position be in a IVth nerve palsy?

Answer 7

eye sits higher and cannot turn inwards

Question 8

What will the eye not be able to to with a trochlear nerve palsy?

Answer 8

Cannot squeeze downwards in adduction- eye will lift up as no intorsion

Question 9

What compensation may be seen in a IVth nerve palsy?

Answer 9

Head tilt

Question 10

What can cause a trochlear nerve palsy?

Answer 10

-congenital decompensated
-microvascular
-tumour
-bilateral-closed head trauma
longes cranial nerve- comes out posterior brainstem

Question 11

What will be limited in a VIth nerve palsy?

Answer 11

Abduction of the globe

Question 12

What muscular condition can cause VIth nerve palsy?

Answer 12

Myositis

Question 13

What can cause a VIth nerve palsy

Answer 13

Microvascular
Raised ICP
Tumour
Congenital

Question 14

Why is the abducens nerve susceptible to impingement?

Answer 14

When it passes over petrous tip

Question 15

List the 3 main causes of CNIII palsy?

Answer 15

Vasculopathic
Tumour
Aneurysm

Question 16

List the 4 main causes of CNIV palsy?

Answer 16

Vasculopathic
Tumour
Congenital
Trauma

Question 17

List the 3 main causes of CNVI palsy?

Answer 17

Vasculopathic
Tumour
Cranial pressure

Question 18

What is an inter-nuclear pathology?

Answer 18

Problem is in nucleus itself, problem with grey matter pathways and brainstem

Question 19

What is seen in inter-nuclear pathology?

Answer 19

Eye coordination problems

Nystagmus

Question 20

Describe nystagmus

Answer 20

still firing at nuclei level but eye doesn’t move

Question 21

What are the causes of inter-nuclear pathology?

Answer 21

MS

Vascular

Question 22

What is seen on MRI in MS?

Answer 22

Intensity at lateral ventricles = plaques= hallmark of MS

Question 23

What is a supra-nuclear pathology?

Answer 23

Problem in frontal lobe or frontal eye field, initiation of eye movement is broken before it reaches nucleus

Question 24

What can cause a optic nerve defect?

Answer 24

Ischaemic optic neuropathy
Optic neuritis
Tumours

Question 25

What is optic neuritis

Answer 25

Commonly seen in MS

Progressive unilateral visual loss

Pain behind eye, on movement

Can cause atrophy

Central scotoma

Question 26

Which tumours can cause an optic nerve defect?

Answer 26

Meningioma
Glioma
Haemangioma

Question 27

What are the causes of a problem at the optic chiasm

Answer 27

Pituitary tumour
Craniopharyngioma
Meningioma

Question 28

What can cause problems at the optic tract and radiations?

Answer 28

Tumours
Demyelination
Vascular anomalies

Question 29

Where is the pathology in quadrantanopia?

Answer 29

Behind lateral geniculate

Question 30

What do symmetrical defects suggest?

Answer 30

Problem towards the occipital lobe