Transcript Neuro-ophthalmology - Diabetic Retinopathy

Neuro-ophthalmology
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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 palsy
One eye convergent = 6th nerve palsy
7th nerve palsy
Dilated 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
Folder similar
All recti except superior oblique and lateral
rectus paralysed
4th nerve palsy
Online, chronic eye disease, section 3
(3rd ‘?’ down on left) 2mb
Folder similar
Superior oblique palsy: vertical diplopia
6th nerve palsy
Online, chronic eye disease, section 3
(3rd ‘?’ down on left) 2mb
Folder similar
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)

Folder similar
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
Causes
Pernicious anaemia…B12 deficiency
 Congenital..eg Lebers
 Toxic…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.
Answers
Online (tiny)
 folder
Here 1
Here 2
Here 3

Here 4
(small, lower
occipital)