Neuro-ophthalmology david.kinshuck@goodhope.nhs.uk

a semi-interactive tutorial to be used with the online files;

downloaded versions can be downloaded from here into the same folder. They are .exe files and should play on all laptops

Neuro-ophthalmology

Dilated pupil/ptosis/divergent eye= 3rd n palsy Vertical diplopia = 4th nerve palsyOne eye convergent = 6th nerve palsy7th nerve palsyDilated pupil/normal sight = adies pupil Dim vision one eye = optic neuritis (rarely tumour)Field defects

3rd nerve palsy

Common symptoms, 3rd button

3rd nerve palsy

3rd nerve palsy

Online, chronic eye disease, section 3 (3rd ‘?’ down on left) 2mb

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All recti except superior oblique and lateral rectus paralysed

4th nerve palsy

Online, chronic eye disease, section 3 (3rd ‘?’ down on left) 2mb

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Superior oblique palsy: vertical diplopia

6th nerve palsyOnline, chronic eye disease, section 3

(3rd ‘?’ down on left) 2mb

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Lateral rectus palsy

7th nerve palsy

Try and think, in pairs, 1 minute

Causes

Problems

What is the route of the 7th nerve?

7th nerve palsy

lesions

Bells palsy, possibly herpes simplex

Ramsay-Hunt with rash: herpes zoster

Upper motor neurone…forehead symmetrical

Detailed description

7th nerve palsy

Runs over petrous part of temporal bone…6,7,8th palsy

Herpes zoster: look in ear for vesicles

7th nerve palsy: eye problems

Dry cornea

can ulcerate

Use fluorescein for examination

Lubricate +++

Occasionally suture lids closed.

Serious problem for acoustic neuroma patients

Nystagmus

Involuntary eye movement…

Slow movement is the ‘problem’

Fast is the recovery

If worse looking straight, generally a central lesion

If worse looking to one side, generally vestibular online (section 12, double vision and pupil, 3 top

‘?’right)

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Optic atrophy

Think, again in pairs, about what may cause optic neuritis

Infection, genetic, toxic, vascular, nutritional, other diseases

Optic atrophy, photos

Optic atrophy, causes

Dim sight

Reduced visual field

CausesPernicious anaemia…B12 deficiencyCongenital..eg LebersToxic…methanol, smoking, poor diet

Optic atrophy, case

A 43y woman complains of a mild headache (left forehead). The headache has been present 2 months, and is not getting better.

As you listen she tells you the sight is dim in left eye.Examination confirms red colours in the left eye are

not as bright as when seen with the right eye. CT scan details:

(Further examination may show a pale optic disk and afferent pupillary defect, and visual field defect, but even without these findings a CT scan is needed.)

Field defects

Quiz…with each lesion, what would the field draw the field…in pairs.

AnswersOnline (tiny) folder

Here 1

Here 2

Here 3

Here 4(small, lower

occipital)