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

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.

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

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  1. 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

  2. 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

  3. 3rd nerve palsy Common symptoms, 3rd button

  4. 3rd nerve palsy

  5. 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

  6. 4th nerve palsy Online, chronic eye disease, section 3 (3rd ‘?’ down on left) 2mb Folder similar Superior oblique palsy: vertical diplopia

  7. 6th nerve palsy Online, chronic eye disease, section 3 (3rd ‘?’ down on left) 2mb Folder similar Lateral rectus palsy

  8. 7th nerve palsy Try and think, in pairs, 1 minute • Causes • Problems • What is the route of the 7th nerve?

  9. 7th nerve palsy lesions • Bells palsy, possibly herpes simplex • Ramsay-Hunt with rash: herpes zoster • Upper motor neurone…forehead symmetrical • Detailed description

  10. 7th nerve palsy Runs over petrous part of temporal bone… 6,7,8th palsy Herpes zoster: look in ear for vesicles

  11. 7th nerve palsy: eye problems • Dry cornea • can ulcerate • Use fluorescein for examination • Lubricate +++ • Occasionally suture lids closed. • Serious problem for acoustic neuroma patients

  12. 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

  13. Optic atrophy • Think, again in pairs, about what may cause optic neuritis • Infection, genetic, toxic, vascular, nutritional, other diseases

  14. Optic atrophy, photos

  15. Optic atrophy, causes • Dim sight • Reduced visual field • Causes • Pernicious anaemia…B12 deficiency • Congenital..eg Lebers • Toxic…methanol, smoking, poor diet

  16. 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.)

  17. Field defects Here 1 • Quiz…with each lesion, what would the field draw the field…in pairs. • Answers • Online (tiny) • folder Here 2 Here 3 Here 4 (small, lower occipital)

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