Eye movement disorders

Question 1

What could horizontal gaze suggest?

Answer 1

Palsy looking away from hemisphere lesion (cant look away)

Palsy looking toward brain stem lesion (cant look to)

Question 2

What is key when assessing diplopia?

Answer 2

Does it occur when one eye is closed?

If not - neurological eg, nerve palsy, brain stem, NMJ

IS so - eye problem eg refractive error, cataract etc

Question 3

What is intra nucleur opthalmoplegia?

How do you assess?

Answer 3

Weakness in adduction causing nystagmus in contralateral eye on lateral gaze

Assess by quick movements

Question 4

What is the Medial Longitudinal fasciculus?

Answer 4

It links eye nerves and damage manifests in intra nucleur opthalmoplegia

Question 5

What does intra nucleur opthalmoplegia suggest?

Answer 5

MS

Question 6

What is a CN3 palsy until proven otherwise?

What else can it be?

Answer 6

Posterior communicating artery stroke

Can be:

SOL

MS

Question 7

How do you tell which side the double vision is?

What causes horizontal diplopia

What causes vertical diplopia?

What causes torsional diplopia?

What causes near/far diplopia?

Answer 7

It is worse when looking to that side - looking toward affected muscle

Horizontal - lateral or medial rectus

Vertical - Superior or inferior rectus

Torsional - oblique

Near - Medial

Far - Lateral