Board Certified Ophthalmologist Board Certified Ophthalmologist Neuro-Ophthalmology Questions and Answers 3

Question 1

A 62-year-old man with giant cell arteritis develops sudden bilateral vision loss. ESR is 95 mm/hr and CRP is elevated. What is the most critical immediate treatment?

Accepted Answer

High-dose intravenous methylprednisolone

Answer

High-dose IV methylprednisolone is the standard urgent treatment for GCA-related vision loss to prevent further ischemic damage to the fellow eye and other organs.

Question 2

A patient presents with a right homonymous hemianopia that is denser superiorly (pie-in-the-sky defect). Where is the most likely location of the lesion?

Accepted Answer

Left temporal lobe (Meyer's loop)

Answer

A right homonymous superior quadrantanopia (pie-in-the-sky) localizes to the left temporal lobe where Meyer's loop carries inferior retinal fibers representing the superior visual field.

Question 3

Which pupillary finding is characteristic of a dorsal midbrain (Parinaud) syndrome?

Accepted Answer

Light-near dissociation with large pupils

Answer

Dorsal midbrain syndrome classically presents with light-near dissociation where pupils react poorly to light but constrict with convergence, along with large, irregular pupils.

Question 4

A 28-year-old woman with known myasthenia gravis presents with fluctuating ptosis and diplopia that worsens throughout the day. Ice pack test improves the ptosis. What percentage of ocular myasthenia patients will develop generalized disease within two years?

Accepted Answer

50-60%

Answer

Approximately 50-60% of patients presenting with ocular myasthenia gravis will progress to generalized myasthenia within two years of symptom onset.

Question 5

A patient with thyroid eye disease presents with compressive optic neuropathy. Visual acuity is 20/60, color vision is reduced, and CT orbit shows enlarged extraocular muscles at the orbital apex. What is the initial treatment of choice?

Accepted Answer

High-dose systemic corticosteroids

Answer

High-dose systemic corticosteroids are the first-line treatment for compressive optic neuropathy in thyroid eye disease, with surgical decompression reserved for steroid-refractory cases.

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Board Certified Ophthalmologist Board Certified Ophthalmologist Neuro-Ophthalmology Questions and Answers 3