7.1 Cranial Nerve III (Oculomotor) Palsy
7.2 Cranial Nerve IV (Trochlear) Palsy
7.3 Cranial Nerve VI (Abducens) Palsy
7.4 Cranial Nerve VII (Facial) Palsy
7.5 Optic Nerve Function
7.6 Visual Fields to Confrontation
7.8 Horner’s Syndrome
7.10 Neuro-Ophthalmic Differential Diagnoses and Aetiologies
A Horner’s syndrome arises from pathology in the sympathetic innervation of the eye. The two main clinical features are anisocoria and ptosis- the candidate may be directed to examine pupils or eyelids, although it is more common to request the pupillary examination. Once a Horner’s syndrome is diagnosed, associated signs should be sought that will assist with localising the lesion (to central, pre-ganglionic and post-ganglionic).
A Horner’s Syndrome may be central (red), pre-ganglionic (blue) or post-ganglionic (green).
Scars (neck scar with Horner’s, tracheostomy scar with previous trauma)
Check carefully for an ipsilateral minor abduction weakness or slowed abducting saccade CV VI (cavernous sinus)
Will NOT dilate Horner’s
Will ABNORMALLY dilate Horner’s
Will NOT dilate post ganglionic Horner’s
Will ABNORMALLY dilate post ganglionic Horner’s
Reversal of Signs in a Right Horner’s Syndrome Post Apraclonidine
Same patient as in Figure 7.8.3, 45 minutes post apraclonidine with reversal of anisocoria. Note the improvement of the ptosis and the reversal of the miosis.
Prevents noradrenaline reuptake dilating a normal pupil.
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