Neuro-ophthalmology & Squint

Topics in this chapter

• Visual Pathway Localization
• Pupillary Reflexes and RAPD
• Papilledema and Intracranial Hypertension
• Third and Fourth Nerve Palsies
• Internuclear Ophthalmoplegia and MLF
• Strabismus Examination and Cover Testing
• Accommodative Esotropia and Bifocals
• Duane Syndrome and Ocular Motility

Practice questions

1. Question 1Q-33F048

   A patient has straight eyes when both eyes are open, but each eye makes a small refixation movement when the fellow eye is covered during the alternate cover test. What is the most likely diagnosis?

   1. A.Manifest strabismus (heterotropia)
   2. B.Latent strabismus (heterophoria)
   3. C.Internuclear ophthalmoplegia
   4. D.Congenital nystagmus
   See the answer and solution
2. Question 2Q-A1D4E3

   A 58-year-old patient develops sudden severe headache, diplopia, and left ptosis. Examination shows that the left eye is deviated down and out, and the left pupil is widely dilated and nonreactive. Which is the most likely cause?

   1. A.Diabetic microvascular third-nerve palsy
   2. B.Left optic neuritis
   3. C.Posterior communicating artery aneurysm
   4. D.Isolated sixth-nerve palsy
   See the answer and solution
3. Question 3Q-1A41DC

   A 24-year-old patient has horizontal diplopia. On looking to the left, the right eye fails to adduct, while the left eye abducts with nystagmus. Convergence is preserved. Where is the lesion?

   1. A.Left medial longitudinal fasciculus
   2. B.Right medial longitudinal fasciculus
   3. C.Right abducens nerve
   4. D.Left oculomotor nerve
   See the answer and solution
4. Question 4Q-8082F8

   A 3-year-old child has esotropia that is greater at near than at distance. After full cycloplegic correction of hypermetropia, a significant near esotropia persists, while the distance deviation is minimal. What is the most appropriate optical treatment?

   1. A.Occlusion of the dominant eye only
   2. B.Bifocal spectacles with an appropriate near addition
   3. C.Immediate bilateral medial rectus recession
   4. D.Plus lenses for distance only
   See the answer and solution
5. Question 5Q-80F667

   During the swinging-flashlight test, both pupils constrict when light is directed into the right eye, but the pupils paradoxically dilate when the light is moved from the right eye to the left eye. Which lesion best explains this finding?

   1. A.Right optic nerve lesion
   2. B.Left optic nerve lesion
   3. C.Right oculomotor nerve lesion
   4. D.Left facial nerve lesion
   See the answer and solution