Moran Eye Center

Kathleen B. Digre, M.D.
Professor of Ophthalmology and Neurology
Director of Neuro-Ophthalmology
University of Utah School of Medicine

Bradley J. Katz, M.D., Ph.D.
Associate Professor of Ophthalmology &
Visual Sciences
University of Utah School of Medicine

Judith E.A. Warner, M.D.
Professor of
Ophthalmology and Visual Sciences,
University of Utah School of Medicine

Daniel L. Jacobson, M.D. (1956-2003)
Neuro-Ophthalmologist
Marshfield Clinic
University Iowa College of Medicine


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Table of Contents

  1. Anatomy and Physiology for the Neuro-Ophthalmologist
    1. Autonomic anatomy
      1. Sympathetic
      2. Parasympathetic
        1. Lacrimal

  2. Ocular and neurologic examination
    1. Evaluation of visual function
      1. Visual fields
      2. Visual acuity
    2. Pupillary examination
      1. Measuring the RAPD
      2. Pupillary drop testing
      3. Pupillogram
    3. Funduscopic examination
      1. Normal Optic Disc
      2. Tour of the Fundus
      3. Venous pulsations
    4. Use of:
      1. Transillumination
      2. Direct ophthalmoscope

    5. Ancillary tests obtained in neuro-ophthalmology
      1. Measure the Relative Afferent Pupillary Defect (RAPD)

  3. Neuro-Ophthalmic symptoms and signs
    1. Normal and abnormal optic nerve
      1. Papilledema
      2. Glaucoma
      3. Optociliary shunt vessels
      4. Optic disc anomolies
    2. Nystagmus
    3. Lid findings
      1. Lid retraction
      2. Lid twitch
      3. Lid Opening
    4. Orbital signs
      1. Pulsating exophthalmos
    5. Pupillary changes
      1. Anisocoria
      2. Dilation Lag
      3. RAPD
    6. Facial Weakness

  4. Disorders of the Afferent and Efferent Visual Pathways
    1. Diseases of the Retina
      1. Cone
      2. Macula
      3. Stargardt's
    2. Diseases of the Optic Nerve
      1. Glaucoma
    3. Orbital pathology
      1. Inflammation/Infection
        1. Thyroid Orbitopathy
    4. Pupillary pathology
      1. Congenital pupillary abnormalities
      2. Evaluation and management of anisocoria
      3. Evaluation andmanagement of a large or a small pupil
      4. Evaluation and management of specific pupillary disorders
        1. Adie's tonic pupil
        2. Tadpole pupil
        3. Argyll-Robertson pupil
        4. Physiologic anisocoria
        5. Dilation lag
        6. Horner's Syndrome
        7. Third nerve palsy
        8. RAPD (Afferent pupillary defect)
        9. Light near dissociation
        10. Flynn Phenomenon
    5. Eye movement systems pathology
      1. Supranuclear palsy
        1. Internuclear ophthalmoplegia
        2. Lateropulsion
      2. Gaze Palsy
      3. Congenital Ocular Motor Apraxia
      4. Cyclic Oculomotor Palsy
      5. Apraxia of Eyelid Opening
      6. Spasm of the Near
      7. Specific ocular motor syndromes
        1. Cranial nerve palsies
          1. Third nerve dysfunction
          2. Aberrant Regeneration of Third Nerve
          3. Aberrant Regeneration of the Third and Sixth Nerves
          4. Fourth Nerve Palsy
        2. Ocular Myotonia
    6. Ocular motility disturbance by location
      1. Dorsal Midbrain Syndrome
      2. Nystagmus and disorders of ocular stability
        1. Pendular nystagmus (binocular & monocular)
        2. Vestibular nystagmus
        3. Specific types of nystagmus and their localizing value(1 if common and 2 if rare)
          1. Spasmus nutans
          2. Congenital nystagmus
          3. Downbeat nystagmus
          4. Upbeat nystagmus
          5. Rebound nystagmus
          6. Brun's nystagmus
          7. Periodic alternating nystagmus
          8. Retraction nystagmus
          9. Convergence retraction nystagmus
          10. Rotary nystagmus
          11. See-Saw nystagmus
          12. Dissociated nystagmus
          13. Abducting nystagmus
          14. Latent nystagmus
          15. Rotary nystagmus
          16. Vestibular nystagmus
          17. End-gaze nystagmus
          18. Voluntary nystagmus
        4. Ocular oscillations
          1. Square wave jerks
          2. Flutter
          3. Opsoclonus
          4. Superior Oblique Myokymia
          5. Oculopalatal Myoclonus
      3. Eyelid position abnormalities
        1. Ptosis
          1. Bilateral Ptosis
          2. Levator dehiscence
          3. Ocular myasthenia
          4. Blepharospasm
        2. Marcus Jaw Winking
      4. Facial nerve dysfunction
        1. Facial myokymia
        2. Hemifacial Spasm
        3. Aberrant Regeneration of the Seventh Nerve
      5. Systemic disorders
        1. Neurofibromatosis (Transillumination -ciliary vessels and lisch nodules )
      6. Neurologic disorders
        1. Central retinal artery occlusion
        2. Intracranial Tumors
        3. Progressive supranuclear palsy
        4. Myasthenia gravis
        5. Thyroid Orbitopathy
        6. Duane's Syndrome
        7. Brainstem Trauma
        8. CPEO
      7. Ocular diseases
        1. Transillumination - (Ocular melanoma )
      8. Functional disorders
        1. Spasm of the Near Triad
        2. Voluntary Nystagmus

  5. Systemic, Neurologic, and Opthalmic Disorders Commonly Associated with Neuro-Ophthalmic Manifestations
    1. Developmental and congenital anomalies with neuro-ophthalmologic consequences
      1. Amblyopia
      2. Optic disc anomolies
    2. Neurologic disorders commonly associated with neuro-ophthalmologic manifestations
      1. Vascular disease of the brain and the eye
        1. Intracranial vascular malformations, diagnosis and neuro-ophthalmologic manifestations
          1. Dissection
      2. Neuro-muscular transmission deficits
        1. Myasthenia gravis
      3. Myopathies
        1. Mitochondrial diseases
          1. CPEO Plus - MELAS
    3. Ocular diseases commonly associated with- or mimicking neuro-ophthalmologic disorders
      1. Retinal Disorders
        1. Retinitis pigmentosa
    4. Headache
      1. Headaches - Migraine and tension
    5. Neuro-ophthalmic manifestations of iatrogenic diseases
      1. Various drugs with specific neuro-ophthalmologic complications
        1. Hydroxychloroquine (Plaquenil)

  6. Procedures Commonly Performed/Obtained in Neuro-Ophthalmology
    1. Tensilon Test
  7. History of Neuro-Ophthalmology

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