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Ophthalmology > Neuro-ophthalmology | > Flashcards

Neuro-ophthalmology | Flashcards

1
Q

What are 5 important causes of a swollen optic disc?

A
  1. Optic neuritis
  2. Papilloedema (must be bilateral)
  3. Malignant hypertension
  4. Arteritic anterior ischaemic optic neuropathy (arteritic AION)
  5. Non-arteritic AION
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2
Q

What is optic neuritis?

A

Demyelinating inflammation of optic nerve

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3
Q

What are 6 clinical features associated with optic neuritis?

A
  1. Retrobulbar pain esp on eye movement, associated with globe tenderness
  2. Disc may not be swollen
  3. RAPD
  4. Red desaturation
  5. Central scotoma on field testing
  6. May have transient neurological symptoms
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4
Q

What is the long-term risk associated with optic neuritis?

A

Risk of developing MS

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5
Q

What is papilloedema?

A

Optic disc swelling that is caused by increased intracranial pressure

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6
Q

Can papilloedema be unilateral?

A

No

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7
Q

What are 5 clinical features of papilloedema?

A
  1. Transient visual obscurations
  2. May have splinter haemorrhages, exudates, cotton wool spots and retinal folds near the disc
  3. Enlarged blind spots
  4. Gradually progressive field loss - generalised constriction
  5. Eventual atrophic changes
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8
Q

What is arteritic AION?

A

Loss of vision caused by damage to the optic nerve as a result of insufficient blood supply due to inflammatory infarction of posterior ciliary artery

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9
Q

What are 5 clinical features of AAION?

A
  1. Temporal headache assoc with:
  2. Jaw claudication
  3. Weight loss
  4. Myalgia
  5. Raised ESR and CRP
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10
Q

What is the immediate treatment of AAION?

A

Urgent treatment with high dose steroids

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11
Q

How long does someone with AAION need to be treated?

A

2 years

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12
Q

What investigation needs to be done within a week of starting treatment for AAION?

A

Temporal artery biopsy

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13
Q

What is non-arteritic AION?

A

Non-inflammatory infarction of posterior ciliary artery, leading to damage to the optic nerve and loss of vision

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14
Q

What are the levels of ESR in NAION?

A

Not raised

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15
Q

Do you get associated systemic symptoms with NAION?

A

No

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16
Q

What condition are 50% of people with NAION associated with?

A

Hypertension

17
Q

What is optic atrophy?

A

Death of retinal ganglion cell axons which comprises the optic nerve - leads to optic nerve damage anywhere along the path from the retina to the lateral geniculate
=end stage eye disease

18
Q

What are 5 clinical features of optic atrophy?

A
  1. Vision loss
  2. Visual fields affected
  3. Subtle damage may lead to loss of contrast or colour vision
  4. RAPD
  5. Optic disc pallor (reflects absence of small vessels in disc head)
19
Q

Which extraocular eye muscles are affected by 3rd nerve palsy?

A
  1. Medial rectus
  2. Inferior rectus
  3. Superior rectus
  4. Inferior oblique
  5. Levator palpebrae superioris
20
Q

What are the 3 features of 3rd nerve palsy?

A
  1. Eye points down and out
  2. Ptosis
  3. +/- Dilated pupil (efferent defect)
21
Q

Why does the eye point down and out in 3rd nerve palsy?

A

Superior oblique and lateral rectus are spared so unopposed

22
Q

Which extraocular eye muscle is affected in IVth nerve palsy?

What does it lead to?

A

Superior oblique

Eye unable to look down and in on affected side

23
Q

Which extraocular eye muscle is affected in VIth nerve palsy?

What does it lead to?

A

Lateral rectus

Inability to abduct, eye may drift medially due to pull of medial rectus

24
Q

What is the innervation of orbicularis oculi and what is its function?

A

Temporal and zygomatic branches of the facial nerve (CN VII)

Function is to close eyelids

25
Q

What are ophthalmic consequences of facial nerve palsy?

A

May not be able to close eye properly

  • exposure
  • dry eyes
  • red eye
26
Q

What 2 ophthalmic examinations should you do for facial nerve palsy?

A
  1. Test corneal sensation

2. Test Bell’s phenomenon

27
Q

When the pupils are affected in 3rd nerve palsy, is the pupil inequality more apparent in bright light or dark?

A

Bright light

28
Q

What is painful 3rd nerve palsy with pupil involvement associated with and why?

A

Compression of the Oculomotor (III) nerve with aneurysm of posterior communicating artery
-the course of CNIII from EWN in the midbrain till it enters the orbit is closely associated with the posterior communicating artery

29
Q

What is Horner’s syndrome?

A

Lesion of sympathetic pathway

30
Q

What are 3 clinical features of Horner’s syndrome?

A
  1. Constricted pupil
  2. Partial ptosis
  3. Eye may be sunken in (apparent enophthalmos)
31
Q

Is the pupil inequality in Horner’s syndrome more pronounced in the dark or bright light?

A

Dark

32
Q

What are features of papilloedema on fundoscopy (4)?

A
  1. Blurred disc margin
  2. Disc swollen/raised
  3. Congested, pink disc
  4. Engorged, tortuous veins

Ophthalmology (12 decks)

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