Vision and Eye Movements

Question 1

The most frequent visual disorder in children is ______. In adults, it’s ________.

Answer 1

Myopia (nearsigtedness)

Hyperopia (farsightedness)

Question 2

On CN III, why does a fixed and dilated pupil present earlier than a “down and out” motor palsy with a compressive lesion?

Answer 2

parasympathetics are located peripherally on the nerve, motor is central

Question 3

What causes pinpoint pupils?

Answer 3

pontine lesion causing loss of sympathetic input (from the hypothalamus to the superior cervical ganglion) resulting in unapposed sympathetic tone

Question 4

What defines an Argyll Robertson pupil?

Answer 4

reacts to accomodation and not light

Question 5

What is Adie’s tonic pupil? What causes it? What’s the treatment?

Answer 5

mydriasis and blurry vision that occurs at 20 to 40 years with female predominance from degeneration of the ciliary ganglion (parasympathetics)

eyes respond to accomodation and not light

no treatment needed

Question 6

What nerve brings sympathetic fibers to Muller’s muscle in the eyelid? What does this cause?

Answer 6

long ciliary nerve

ptosis (such as in Horner’s syndrome)

Question 7

What is pilocarpine? How does it affect pupils?

Answer 7

ACh agonist

should constrict any pupil unless dilated by atropine

Question 8

The region in the retina responsible for high acuity vision is called the ________ and the central portion of it is called ________.

Answer 8

macula

fovea

Question 9

The macula contains (rods/cones) while the fovea contains (rods/cones).

Answer 9

rods and cones

rods

Question 10

What is Terson’s syndrome?

Answer 10

vitreous hemorrhage associated with SAH/ICH

is associated with more severe SAH/ICH

Question 11

What are Roth’s spots? What are they associated with?

Answer 11

a pale spot in the retina from the accumulation of white blood cells and fibrin

Associated with subacute bacterial endocarditis or embolic plaques

Question 12

What percent of people with optic neuritis develop MS?

Answer 12

75%

Question 13

What percent of optic neuritis cases are bilateral?

Answer 13

10%

Question 14

What percentage of optic neuritis patients completely recover their vision? What symptoms often lingers?

Answer 14

30%

color blindness (dyschromatopsia)

Question 15

What can be seen on fundoscopic exam with ischemic optic neuropathy?

Answer 15

flame hemorrhages and edema w/ disc atrophy

Question 16

Toxic and nutritional optic neuropathies cause what kind of visual loss?

Answer 16

bilateral, symmetric central, or centrocecal scotomas

(unlike demyelinating disease) with normal peripheral fields

Question 17

What is the most common type of glaucoma?

Answer 17

open angle glaucoma

Question 18

What is the visual loss in gluacoma?

Answer 18

arcuate defect in the upper and lower nasal fields

Question 19

What causes floaters?

Answer 19

opacities in the vitreous humor

Question 20

A sudden increase in floaters with a bright flash of light is a concern for what?

Answer 20

retinal detachment

Question 21

Uveitis accounts for what percent of blindness in the US?

Answer 21

10%

Question 22

What is the inheritance of Leber’s hereditary optic neuropathy?

Answer 22

mitochondrial

Question 23

What is the clinical picture of Lever’s hereditary optic neuropathy?

Answer 23

optic atrophy with painless vision loss in one eye before the other

Question 24

What is the affected chromosome in Retinitis pigmentosa?

Answer 24

Ch 3

Question 25

What occurs in Retinitis pigmentosa?

Answer 25

b/l degeneration of all layers of the retina with foveal sparing

Question 26

What occurs in Stargardst disease?

Answer 26

b/l degneration of the macula and fovea (opposite of retinitis pigmentosa)

Question 27

What is a junctional scotoma? What causes it?

Answer 27

ipsilateral monocular blindness and contralateral superotemporal quadrantanopia

optic nerve/chiasm junction (think von Willebrand’s knee)

Question 28

What ischemic stroke causes macular sparing? Why?

Answer 28

PCA strokes

macula represented by occipital poles which is supplied by MCA collaterals

Question 29

What and where is the vertical gaze center?

Answer 29

rostral interstitial nucleus of the medial longitudinal fasciculas (riMLF) located at the junction of the midbrain and thalamus

Question 30

What nucleus assists in maintaining vertical gaze?

Answer 30

interstitial nucleus of Cajal

Question 31

What comprises the horizontal gaze center?

Answer 31

paramedian pontine reticular formation (PPRF) and CN VI nuclei

Question 32

Damage to one CN VI nucleus causes what clinical findings? Why?

Answer 32

failure of abduction of the ipsilateral eye and adduction (medial rectus) of the contralateral eye

CN VI nerve fibers cross to the contralateral CN III to innervate the medial rectus

Question 33

What midbrain nucleus is responsible for the accommodation reflex?

Answer 33

Perlia’s nucleus

Question 34

Superior colliculus is responsible for coordinating what eye movement?

Answer 34

contralateral horizontal

Question 35

What composes Parinaud’s syndrome?

Answer 35

• impaired gaze
• impaired convergence
• mydriasis
• convergence nystagmus
• lid retraction (Collier’s sign)

Question 36

Decreased downgaze is seen in what pathology?

Answer 36

progressive supranuclear palsy

Question 37

Downward eye deviation can by caused by what hemorrhage location?

Answer 37

thalamic hemorrhages

Question 38

What causes intranuclear opthalmoplegia?

Answer 38

lesion of the ipsilateral MLF rostral to the abducens nerve

Question 39

What is the clinical picture of patients with INO?

Answer 39

ipsilateral eye cannot adduct completely while contralateral eye has nystagmus as it abducts

Question 40

What is the most common cause of INO in the young?

Answer 40

MS