Neuro-ophthalmic

Dorsal Midbrain Syndrome SYMPTOMS Diplopia, Photophobia, Transient vision loss in the presence of papilledema SIGNS Typically bilateral Lid retraction (Collier’s sign), Impairment of voluntary upgaze and when attempting to look up will exhibit a convergence retraction nystagmus (Downgaze movement is typically preserved), Large pupils with a poor direct light response but a normal near response…

Progressive Supranuclear Palsy SYMPTOMS Diplopia, Poor downward vision, Difficulty reading SIGNS Slow vertical saccades (First ocular sign), Abnormal pursuits, Impairment of voluntary vertical gazes (Downward gaze affected before upward gaze but eventually all voluntary eye movements will be lost), Apraxia of eyelid opening, Retraction of upper lids, Blepharospasm, Convergence dysfunction, Square wave jerks, Loss of…

Charles-Bonnet Syndrome SYMPTOMS Visual hallucinations in the presence of vision/visual field loss SIGNS Any ocular disease such as age-related macular degeneration or glaucoma that can cause vision loss or visual field loss WORK-UP Pupils | EOMs | Full eye exam with dilation | Cranial nerve testing | Visual field | OCT TREATMENT Ways to stop…

Occipital Lobe Lesion SYMPTOMS Palinopsia, Visual hallucinations, Vision loss Right sided homonymous hemianopia: Difficulty seeing next letter or word Left sided homonymous hemianopia: Difficulty finding the next line SIGNS Fundus and optic nerves appear normal WORK-UP Pupils (typically normal) | EOMs (typically FROM) | Cover test | Color vision (Dyschromatopsia may be present) | Complete…

Parietal Lobe Lesion #1 https://www.researchgate.net/figure/MRI-brain-demonstrating-a-mass-lesion-in-the-right-parietal-lobe-that-measures-35-24_fig2_319050517 Parietal Lobe Lesion SYMPTOMS Lid tendernessVisual inattention, Visual neglect, Sensory integration deficits Right sided homonymous hemianopia: Difficulty seeing next letter or word Left sided homonymous hemianopia: Difficulty finding the next line SIGNS Fundus and optic nerves appear normal WORK-UP Pupils (typically normal) | EOMs (typically FROM) | Cover test |…

Temporal Lobe Lesion SYMPTOMS Headaches, Auditory hallucinations, Language difficulties, Memory difficulties Left sided homonymous hemianopia: Difficulty finding the next line Right sided homonymous hemianopia: Difficulty seeing next letter or word SIGNS Normal fundus with normal appearing optic nerves in both eyes WORK-UP Pupils (typically normal) | EOMs (typically FROM) | Cover test | Color vision…

Optic Chiasm Lesion SYMPTOMS Vision loss, Headache, Diplopia, Loss of stereopsis, Bitemporal hemianopia SIGNS Optic disc may show pallor, especially in a “bow tie” configurationOptic disc may show pallor, especially in a “bow tie” configuration Papilledema is an unusual sign but can be seen with craniopharyngiomas WORK-UP Pupils (An APD is typically present especially if…

Cranial VII Palsy https://eyerounds.org/cases-i/case256/f1L-Presentation.jpg Cranial Nerve VII Palsy SYMPTOMS Dry eyes, Epiphora, Decrease in vision due to exposure keratopathy SIGNS Loss of forehead wrinkling, Drooping of mouth, Brow ptosis, Inability to fully close eyelids, Upper lid retraction, Lower lid paralytic ectropion, Increase laxity of the eyelids, Lagophthalmos, Decreased tear production, Conjunctival injection, Exposure keratopathy (Signs…

Internuclear Ophthalmoplegia #1 https://casereports.bmj.com/content/2015/bcr-2014-207240 Internuclear Ophthalmoplegia (INO) SYMPTOMS Horizontal diplopia, Vertical diplopia in the presence of a skew deviation, Difficulty tracking moving objects, Dizziness on lateral gaze, Headaches, Vertigo SIGNS Adduction deficit (partial or complete) with a contralateral abduction nystagmus, Type ortho in primary position, Adduction lag in the eye with the adduction deficit, Skew…

Ocular Myasthenia Gravis #1 https://www.researchgate.net/figure/Figure1-Bilateral-ptosis-in-ocular-myasthenia_fig1_316439393 Ocular Myasthenia Gravis SYMPTOMS Diplopia, Droopy eyelids, and Blurry vision especially towards the end of the day SIGNS Signs are typically noted when there is muscle fatigue, especially toward the end of the day. Signs also tend to be asymmetric. Drooping eyelids (first sign in 50% of cases), Enhanced ptosis…