Neuroophthalmology david'kinshuckgoodhope'nhs'uk

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Neuro-ophthalmology david.kinshuck_at_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

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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

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3rd nerve palsy
Common symptoms, 3rd button
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3rd nerve palsy
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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
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4th nerve palsy

• Online, chronic eye disease, section 3 (3rd ?
  down on left) 2mb
• Folder similar
• Superior oblique palsy vertical diplopia

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6th nerve palsy

• Online, chronic eye disease, section 3 (3rd ?
  down on left) 2mb
• Folder similar
• Lateral rectus palsy

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7th nerve palsy

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

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7th nerve palsy

• lesions
• Bells palsy, possibly herpes simplex
• Ramsay-Hunt with rash herpes zoster
• Upper motor neuroneforehead symmetrical
• Detailed description

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7th nerve palsy
Runs over petrous part of temporal bone 6,7,8th
palsy
Herpes zoster look in ear for vesicles
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7th nerve palsy eye problems

• Dry cornea
• can ulcerate
• Use fluorescein for examination
• Lubricate
• Occasionally suture lids closed.
• Serious problem for acoustic neuroma patients

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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

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Optic atrophy

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

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Optic atrophy, photos
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Optic atrophy, causes

• Dim sight
• Reduced visual field
• Causes
• Pernicious anaemiaB12 deficiency
• Congenital..eg Lebers
• Toxicmethanol, smoking, poor diet

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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.)

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Field defects

• Quizwith each lesion, what would the field draw
  the fieldin pairs.
• Answers
• Online (tiny)
• folder

Here 1
Here 2
Here 3
Here 4 (small, lower occipital)