Neuro-Ophthalmology

Question 1

The optic nerve is formed by the convergence of which cells?

Answer 1

Retinal ganglion cells

Question 2

The optic tract connects which two structures?

Answer 2

Optic chiasm and lateral geniculate nuclei

Question 3

The optic tract conveys signals from the contralateral nasal retina and ipsilateral temporal retina. True/false?

Answer 3

True

Question 4

The optic radiations connect which structures?

Answer 4

Lateral geniculate nuclei and visual cortex

Question 5

Superior optic radiations pass through the temporal lobe and inferior optic radiations pass through through the parietal lobe. True/false?

Answer 5

False - superior optic radiations pass through parietal lobe and inferior optic radiations pass through temporal lobe

Question 6

The oculomotor nerve is accompanied by parasympathetic fibres that innervate what?

Answer 6

Sphincter papillae

Ciliary muscles

Question 7

Where are the trochlear nuclei located?

Answer 7

Midbrain

Question 8

Where is the abducens nucleus located?

Answer 8

Pontine tegmentum

Question 9

What nerves supply the afferent and efferent limbs of the pupillary light reflex?

Answer 9

Afferent limb - CN II

Efferent limb - CN III

Question 10

Light projected along the eye is projected to which nuclei?

Answer 10

Edinger-Westphal

Question 11

Where do parasympathetic fibres from the Edinger-Westphal nuclei synapse?

Answer 11

Ciliary ganglion

Question 12

Parasympathetic fibres are carried from short ciliary nerves to innervate which structures?

Answer 12

Ciliary muscle

Sphincter pupillae

Question 13

What causes lens curvature to increase in the accommodation reflex?

Answer 13

Ciliary muscle contracts causing relaxation of suspensory lens ligaments

Question 14

What are the main signs of CN II dysfunction?

Answer 14

Decreased VA
Dyschromatopsia
Visual field defects
Diminished contact sensitivity
RAPD

Question 15

What is optic neuritis?

Answer 15

Inflammation of the optic nerve

Question 16

Give some ophthalmic clinical features of MS

Answer 16

Optic neuritis
Internuclear ophthalmoplegia
Nystagmus

Question 17

How is optic neuritis treated?

Answer 17

IV methylprednisolone

Question 18

What is neuromyelitis optica?

Answer 18

Demyelinating disorder with bilateral optic neuritis and transverse myelitis

Question 19

What occurs in anterior ischaemic optic neuropathy?

Answer 19

Damage to CN II due to ischaemia

Question 20

What is papilloedema?

Answer 20

Optic disc swelling secondary to elevated ICP

Question 21

Give some clinical features of papilloedema

Answer 21

Headache
N + V
Transient visual loss
Enlarged blind spot
Blurred optic disc margins
Splinter haemorrhages

Question 22

What are the clinical features of Horner’s syndrome?

Answer 22

Ptosis (drooping eyelid)
Miosis (constriction)
Ipsilateral anhidrosis

Question 23

What can be used to confirm Horner’s pupil?

Answer 23

Apraclonidine

Question 24

What occurs in lateral medullary syndrome?

Answer 24

Ischaemia to lateral part of medulla

Question 25

What can be affected in lateral medullary syndrome?

Answer 25

Vestibular nucleus Descending sympathetic system Spinal trigeminal tract Spinothalamic tract

Question 26

What is the cause of Adie's pupil?

Answer 26

Loss of postganglionic parasymapthetic innervation to iris sphincter and ciliary muscle

Question 27

Give some clinical features of Adie's pupil

Answer 27

Anisocoria absent light reflex Absent deep tendon reflex of lower limbs

Question 28

How can Adie's pupil be investigated?

Answer 28

``` Slit lamp Topical pilocarpine (Adie's pupil constricts) ```

Question 29

Describe an Argyll-Robertson pupil

Answer 29

Bilateral, irregular and small

Question 30

A chiasmatic optic nerve lesion causes which visual defect?

Answer 30

Bitemporal hemianopia

Question 31

An optic tract lesion causes which visual defect?

Answer 31

Contralateral homonymous hemianopia

Question 32

A temporal radiation lesion causes which visual defect?

Answer 32

Contralateral superior homonymous quadrantanopia

Question 33

A parietal radiation lesion causes which visual defect?

Answer 33

Contralateral inferior homonymous quadrantopia

Question 34

A lesion of the main optic radiations causes which visual defect?

Answer 34

Contralateral homonymous hemianopia

Question 35

An occipital cortex lesion causes which visual field defect?

Answer 35

Contralateral homonymous hemianopia with macular sparing

Question 36

Give some clinical features of a third nerve palsy

Answer 36

Ptosis Abduction and depression of eye Dilated pupil

Question 37

Give some clinical features of a fourth nerve palsy

Answer 37

Vertical diplopia Hypertropia Limited eye depression Compensatory head tilt

Question 38

Give some clinical features of a sixth nerve palsy

Answer 38

Horizontal double vision Esotropia Limited abduction

Question 39

Give some ocular features of myasthenia gravis

Answer 39

Ptosis (typically bilateral) Diplopia Ophthalmoplegia

Question 40

Give some ocular features of myotonic dystrophy

Answer 40

Early onset cataract Ptosis Hypermetropia Ophthalmoplegia

Question 41

Give some ophthalmic features of neurofibromatosis type I

Answer 41

Optic nerve glioma Bilateral Lisch nodules "Bag of worm" sensation

Question 42

What is benign essential belpharospasm?

Answer 42

An idiopathic condition with involuntary contraction of orbicularis oculi muscle

Question 43

What is the treatment for benign essential blepharospasm?

Answer 43

Artificial tears | Botulinum injection

Question 44

Give some clinical features of cavernous sinus syndrome

Answer 44

``` Ptosis and ophthalmoplegia Loss of corneal reflex Maxillary sensory loss Horner's syndrome Proptosis and periorbital swelling ```

Question 45

Give some causes of cavernous sinus syndrome

Answer 45

Infection Tumours Internal carotid aneurysms