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Cranial nerve pathology.

This visual recognition feature presents a series of anomalies resulting from cranial nerve damage for the practitioner to interpret



01 Which of the following signs is not present in the image?

a) Lower eyelid retraction

b) Upper lid entropion

c) Left lagophthalmos during eyelid closure

d) Palpebral fissure widening

02 Which of the following non-ocular signs is unlikely to be present for this condition?

a) Bilateral loss of facial expression

b) Loss of forehead wrinkling

c) Eyebrow ptosis

d) Drooping of the mouth

03 Which other cranial nerve is it important to test the function of?

a) Fifth

b) Third

c) Fourth

d) Second

04 Which of the following signs is present in the image shown?

a) Left esotropia in primary position

b) Abduction deficit in both eyes

c) Bilateral underaction on depression in abduction

d) All of these options

05 Which nerve is likely to be affected?

a) Abducens

b) Trochlear

c) Oculomotor

d) Optic nerve

06 Which of the following statements about this condition is fa/se?

a) Bilateral palsy would show a V pattern esotropia

b) In a right unilateral palsy, the Hess chart would be contracted

c) Vascular disease is the most common cause in adults above 50 years age

d) The case above is the least common cranial nerve palsy

07 Which of the following signs is not present in the above image?

a) Right hypertropia in primary position

b) Head tilt to the right

c) Right underaction on depression in adduction

d) Right overaction in laevoversion

08 Which statement about the expected Hess chart for this patient is false?

a) An upward deviation of fixation spot on the right eye inner chart

b) Overaction of inferior rectus and underaction of superior rectus on left eye chart

c) Underaction of superior oblique and overaction of inferior oblique on right eye chart

d) Right eye chart much smaller than the left eye chart

09 Which of the following statements about the Parks-Bielchowsky test for this patient is false?

a) Increased right hypertropia on right head tilt is due to the unopposed elevating action of the inferior rectus

b) The purpose of the test is to differentiate a superior oblique palsy from a contralateral superior rectus palsy

c) Right hypertropia reduces on left head tilt

d) Right hypertropia increases on right head tilt

10 Which of the following signs is not present in the image shown?

a) Limited abduction right eye

b) Limited adduction right eye

c) Limited depression right eye

d) Limited elevation right eye

11 Which statement about the expected Hess chart for this patient is false?

a) There is contraction of the right chart

b) There is contraction of the left chart

c) There is overaction of all muscles in the left eye except medial rectus and inferior oblique

d) There is underaction of all muscles in the right eye except lateral rectus and superior oblique

12 Which of the following statements about this nerve palsy are false?

a) The most frequent aneurysm causing this palsy occurs at the junction between the internal carotid artery and posterior communicating artery

b) All nerve subnuclei in the midbrain project ipsilaterally to their individual extraocular muscles except the superior rectus nuclei

c) Within the orbit the superior division of the nerve carries fibres for the levator palpebrae and superior rectus muscles

d) Aberrent regeneration is more likely in ischaemic lesions rather than compressive or traumatic lesions


Figures A, B and C: University of Iowa and Figure D: Barton J, eTextbook of Eye Movements

Course code: C-59831 Deadline: 7 September 2018

Learning objectives

* Be able to assess patients presenting with ocular signs resulting from cranial nerve damage (Group 8.1.7)

Prashant Shah is an optometrist with postgraduate diplomas in ophthalmology and in clinical optometry and currently works in routine practice.

Yashita Shah is an optometrist working in independent practice. She holds a postgraduate diploma in ophthalmology.

Prashant Shah MCOptom, PGDipOphth, DipClinOptom and Yashita Shah MCOptom, PGDipOphth

Exam questions

Under the enhanced CET rules of the GOC, MCQs for this exam appear online at Please complete online by midnight on 7 September 2018. You will be unable to submit exams after this date.

Caption: A 65-year-old man presents with a gradual increase in left epiphora.

Caption: An 80-year-old man presents with sudden onset horizontal binocular diplopia.

Caption: A50-year-old man presents with vertical diplopia following a road traffic accident.

Caption: A 66-year-old man presents with a painful right eye.
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Title Annotation:Cranial nerve
Author:Shah, Prashant; Shah, Yashita
Publication:Optometry Today
Date:Aug 1, 2018
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