This document provides an overview of neuro-ophthalmology. It discusses the anatomy and physiology of the eye and related structures. Specific topics covered include optic neuropathies like optic neuritis and ischemic optic neuropathy, causes like multiple sclerosis and giant cell arteritis. Cranial nerve palsies of the third, fourth, and sixth nerves are examined. The approach to patients with neuro-ophthalmic complaints is outlined, including relevant history, examination findings, and differential diagnoses. Common pathologies are described along with their typical presentations and diagnostic approaches.
17. ION Non-arteritic Arteritic
Incidence Common
10/100,000
Rare
0.3/100,000
Cause Arteriosclerosis GCA
ESR& CRP N High
TAB -ve +ve
Risk to fellow eye Low High
Rx Aspirin Steroid
19. Papilledema Papillitis
• Bilateral
• Gradual
• Transient v. loss
• Blind spot
• Dye leakage-FFA
• Symp of ICP
• SOL on MRI
• Unilateral
• Rapid
• Profound
• Central scotoma
• Dye leakage-FFA
• Symp of MS
• Demyelinatin on MRI
21. OCULAR MOTOR NERVE PALSIES
1. Third nerve
2. Fourth nerve
3. Sixth nerve
22. Anatomy of third nerve
Oculomotor nucleus
Pituitary gland
Carotid artery
Cavernous sinus
III nerve
Clivus
Basilar artery
Post cerebral artery
Red nucleus
Pons
23. Applied anatomy of pupillomotor nerve fibres
Blood vessels on pia mater supply surface
of the nerve including pupillary
fibres ( damaged by
compressive lesions )
Vasa nervorum supply part
of nerve but not pupillary
fibres ( damaged by medical
lesions )
Pupillary fibres lie dorsal and peripheral
SurgicalSurgical
Medical
27. Anatomy of fourth nerve
• Only cranial nerve to emerge dorsally
• Crossed cranial nerve
• Very long and slender
Internal carotid artery
Postr. communicating
artery
III
VI
Postr.cerebral artery
Supr.cerebellar artery
Basilar artery
IV
28. Signs of right fourth nerve palsy
• Right overaction on left gaze
• Rt under action on depression
in adduction
• Vertical diplopia
• Rt hyperdeviation in primary
position when left eye fixating
• Excyclotorsion