BOOK
The Neuro-Ophthalmology Survival Guide E-Book
Anthony Pane | Neil R. Miller | Mike Burdon
(2017)
Additional Information
Book Details
Abstract
This book is a practical, symptom-based, ‘how-to’ guide to neuro-ophthalmology and acquired strabismus for all trainee and practising ophthalmologists and optometrists. Each chapter focusses on a specific clinical symptom and includes an introduction to the clinical assessment of a symptom; an examination checklist; a management flowchart to be followed; clinical diagnostic criteria checklists; and further information on the diseases that can cause the symptom with a brief discussion of appropriate management.
- A practical and accessible handbook for the ophthalmologist or optometrist without a specialist interest in neuro-ophthalmology and acquired strabismus.
- The text simplifies a subject which is often a cause of litigation against practising ophthalmologists and exam failure for trainees and residents.
- The book aids diagnosis in a field in which mistakes may lead to medico-legal problems, e.g. brain tumours presenting with blurred or double vision.
- The book leads the reader from the symptom, through a series of simple but safe flowcharts and check-lists, to the diagnosis or the tests which need to be ordered.
- The first chapter presents 20 ‘golden rules’ to keep you and your patients out of trouble.
- A revised text with some new illustrations brings this highly-praised book up to date.
- New online videos demonstrate abnormal eye movements, eyelid problems and pupil abnormalities.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| The Neuro-ophthalmology Survival Guide | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Video contents | vi | ||
| Preface | ix | ||
| Index of key management flowcharts | xi | ||
| Index of key clinical diagnostic criteria | xii | ||
| Introduction | 1 | ||
| 1. You can’t avoid neuro-ophthalmology! | 1 | ||
| 2. Neuro-ophthalmology is special! | 1 | ||
| 3. You want your patients to see well! | 1 | ||
| 4. You want your patients to stay healthy! | 1 | ||
| 5. You want to stay out of trouble! | 2 | ||
| 6. You want to pass your exam (if you still have it ahead of you) | 2 | ||
| How can this book help? | 2 | ||
| 1 Staying out of trouble | 5 | ||
| Contents | 5 | ||
| Twenty neuro “rules” to keep you out of trouble | 5 | ||
| Patient presentation | 6 | ||
| Examination | 7 | ||
| Blurred vision or field loss | 8 | ||
| Bilateral disc swelling | 15 | ||
| Double vision | 17 | ||
| Giant cell arteritis (GCA) | 22 | ||
| Neuro-imaging | 23 | ||
| Ophthalmic emergencies | 24 | ||
| Three common mistakes | 25 | ||
| 2 Blurred vision or field loss | 27 | ||
| Contents | 27 | ||
| Introduction | 28 | ||
| Eye disease | 28 | ||
| Optic nerve disease | 28 | ||
| Optic chiasmal disease | 29 | ||
| Retrochiasmal disease | 29 | ||
| Non-organic visual loss | 29 | ||
| Examination checklist | 29 | ||
| Blurred vision or field loss | 29 | ||
| History | 29 | ||
| Examination | 30 | ||
| Plus: must perform some type of perimetry: | 30 | ||
| Management flowchart | 31 | ||
| Blurred vision or field loss NOT explained by visible ocular disease | 31 | ||
| Optic neuropathy | 39 | ||
| Acute optic neuropathies 40 | 39 | ||
| Chronic optic neuropathies 68 | 39 | ||
| Optic neuropathy that cannot be diagnosed clinically | 39 | ||
| Acute optic neuropathies | 40 | ||
| Typical optic neuritis | 40 | ||
| Demographic | 40 | ||
| Symptoms | 40 | ||
| Ophthalmic | 40 | ||
| Neurologic | 40 | ||
| Signs | 41 | ||
| Differential diagnosis | 42 | ||
| Investigations | 42 | ||
| Visual prognosis | 42 | ||
| Treatment for the visual loss of typical optic neuritis | 42 | ||
| Systemic prognosis: relationship of typical optic neuritis to multiple sclerosis | 43 | ||
| Treatment to delay development of MS | 43 | ||
| Corticosteroids: | 43 | ||
| Disease-modifying treatments for MS | 43 | ||
| Management recommendations | 44 | ||
| Anterior ischemic optic neuropathy (AION) | 44 | ||
| Causes | 44 | ||
| Risk factors | 45 | ||
| Arteritic AION | 45 | ||
| Non-arteritic AION | 45 | ||
| Symptoms | 45 | ||
| Signs | 45 | ||
| Differential diagnosis | 46 | ||
| Investigations | 46 | ||
| Distinguishing between arteritic and non-arteritic AION | 46 | ||
| Symptoms suggesting GCA | 46 | ||
| Signs suggesting GCA | 46 | ||
| Blood test results suggesting GCA | 48 | ||
| Investigation and treatment of suspected arteritic AION (AION due to GCA) | 48 | ||
| Referral | 48 | ||
| Initial treatment | 48 | ||
| Temporal artery biopsy | 49 | ||
| Further treatment and follow-up | 49 | ||
| Visual prognosis | 50 | ||
| Investigation, treatment and prognosis of non-arteritic AION | 50 | ||
| Investigations | 50 | ||
| Treatment | 51 | ||
| Follow-up | 52 | ||
| Prognosis | 52 | ||
| Note: “diabetic papillopathy” | 52 | ||
| Traumatic optic neuropathy | 53 | ||
| Mechanism | 53 | ||
| Symptoms | 53 | ||
| Signs | 53 | ||
| Investigations | 53 | ||
| Treatment | 54 | ||
| Neuromyelitis optica (NMO) | 54 | ||
| Demographic | 55 | ||
| Symptoms | 55 | ||
| Signs | 55 | ||
| Differential diagnosis | 55 | ||
| Investigations | 55 | ||
| Summary: suspect NMO if a patient with optic neuritis has: | 56 | ||
| Prognosis | 57 | ||
| Treatment | 57 | ||
| Anti-MOG antibody-related optic neuritis | 57 | ||
| Infectious optic neuritis | 57 | ||
| Causes | 57 | ||
| Symptoms | 58 | ||
| Signs | 58 | ||
| 3 Swollen disc/s, normal vision | 107 | ||
| Contents | 107 | ||
| Introduction | 108 | ||
| Examination checklist | 108 | ||
| Swollen disc/s, normal vision | 108 | ||
| History | 108 | ||
| Examination | 109 | ||
| Plus: perform perimetry: | 109 | ||
| Management flowchart | 110 | ||
| Swollen disc/s, normal vision | 110 | ||
| Disc pseudo-swelling | 114 | ||
| Definition | 114 | ||
| Causes | 114 | ||
| Characteristics | 116 | ||
| Spontaneous venous pulsations (SVPs) | 116 | ||
| Differentiation from true disc swelling | 116 | ||
| Investigations to help determine if pseudo- or true swelling is present | 117 | ||
| True disc swelling | 119 | ||
| Suggested investigations for swollen disc/s with normal vision | 119 | ||
| 1. Review history, examination and perimetry | 119 | ||
| 2. Urgent (same-day) MRI of optic nerves and brain with contrast, plus MRV brain, or CT brain and CTV | 120 | ||
| 3. Lumbar puncture if MRI and MRV or CT and CTV are normal | 120 | ||
| 4. Other investigations in ALL patients | 121 | ||
| Blood tests | 121 | ||
| Chest x-ray and/or chest CT scan | 122 | ||
| Eye disease | 122 | ||
| Optic nerve disease | 123 | ||
| Early or mild optic neuropathy | 123 | ||
| Optic perineuritis | 123 | ||
| Blood disease | 124 | ||
| Blood pressure: severe hypertension | 124 | ||
| Blood glucose: diabetic papillopathy | 124 | ||
| Blood electrolyte disturbance | 125 | ||
| Papilledema | 125 | ||
| Definition | 125 | ||
| Causes | 125 | ||
| Mechanism | 126 | ||
| Incidence and clinical interpretation | 127 | ||
| Not all patients with raised intracranial pressure develop papilledema | 127 | ||
| The severity of disc swelling in papilledema does not necessarily correlate with the level of intracranial pressure | 127 | ||
| “Dead discs can’t swell” | 127 | ||
| Timecourse | 127 | ||
| Symptoms | 127 | ||
| Neurologic symptoms | 128 | ||
| Ophthalmic symptoms | 128 | ||
| Signs | 128 | ||
| Disc appearance | 129 | ||
| Complications | 131 | ||
| Neurologic | 131 | ||
| Ophthalmic | 131 | ||
| Differential diagnosis | 132 | ||
| Investigations | 132 | ||
| Treatment | 132 | ||
| Diseases that can cause papilledema | 133 | ||
| Brain tumors | 133 | ||
| Demographic | 133 | ||
| Mechanism | 133 | ||
| Symptoms | 133 | ||
| Signs | 134 | ||
| Investigations | 134 | ||
| Treatment | 134 | ||
| Hydrocephalus | 135 | ||
| Definition | 135 | ||
| Demographic | 135 | ||
| Mechanism and types | 135 | ||
| Symptoms | 135 | ||
| Signs | 135 | ||
| Investigations | 135 | ||
| Treatment | 136 | ||
| Meningitis | 136 | ||
| Causes | 136 | ||
| Mechanism | 136 | ||
| Symptoms | 136 | ||
| Signs | 136 | ||
| Investigations | 136 | ||
| Treatment | 137 | ||
| Dural venous sinus thrombosis | 137 | ||
| Demographic | 137 | ||
| Mechanism | 137 | ||
| Causes | 137 | ||
| Symptoms | 138 | ||
| Signs | 138 | ||
| Investigations | 138 | ||
| Treatment | 138 | ||
| Extracranial venous outflow obstruction | 139 | ||
| Mechanism | 139 | ||
| Causes | 139 | ||
| Symptoms and signs | 139 | ||
| Investigations | 139 | ||
| Treatment | 139 | ||
| Secondary pseudotumor cerebri syndrome (pseudotumor cerebri of known cause other than obesity) | 139 | ||
| Definition | 139 | ||
| Demographic | 141 | ||
| Mechanism | 141 | ||
| Possible causes | 141 | ||
| Symptoms and signs | 141 | ||
| Investigations | 141 | ||
| Treatment | 142 | ||
| Idiopathic intracranial hypertension (IIH; also known as primary pseudotumor cerebri syndrome) associated with obesity | 142 | ||
| Definition | 142 | ||
| Terminology | 143 | ||
| Demographic | 143 | ||
| Mechanism | 144 | ||
| Symptoms | 144 | ||
| Signs | 144 | ||
| Complications | 144 | ||
| Differential diagnosis | 146 | ||
| Investigations | 146 | ||
| Treatment | 146 | ||
| Observation without treatment other than weight loss | 146 | ||
| Weight loss | 147 | ||
| Medical treatment | 147 | ||
| Oral acetazolamide (Diamox) | 147 | ||
| Oral diuretics | 148 | ||
| Oral topiramate (Topamax) | 148 | ||
| Surgical treatment | 149 | ||
| Follow-up | 150 | ||
| 4 Transient visual loss | 151 | ||
| Contents | 151 | ||
| Introduction | 152 | ||
| Monocular transient visual loss | 152 | ||
| Binocular transient visual loss | 153 | ||
| Examination checklist | 153 | ||
| Transient visual loss | 153 | ||
| History | 153 | ||
| Examination | 154 | ||
| Plus: perform perimetry: | 154 | ||
| Management flowchart | 155 | ||
| Transient visual loss | 155 | ||
| Monocular transient visual loss | 159 | ||
| Binocular visual loss mistakenly attributed to one eye | 159 | ||
| Eye disease | 159 | ||
| Optic nerve disease | 160 | ||
| Vascular disease | 160 | ||
| Giant cell arteritis (GCA) | 160 | ||
| Ocular ischemic syndrome | 161 | ||
| Symptoms | 161 | ||
| Signs | 161 | ||
| Investigations | 161 | ||
| Treatment | 161 | ||
| Embolic monocular transient visual loss (“amaurosis fugax”) | 162 | ||
| Causes | 162 | ||
| Symptoms | 162 | ||
| Signs | 162 | ||
| Investigations | 162 | ||
| Treatment | 163 | ||
| Vasospastic monocular transient visual loss (“retinal migraine”) | 163 | ||
| Symptoms | 164 | ||
| Signs | 164 | ||
| Investigations and treatment | 164 | ||
| Binocular transient visual loss | 164 | ||
| Monocular visual loss mistakenly attributed to both eyes | 164 | ||
| Bilateral simultaneous eye or optic nerve disease | 164 | ||
| Retrochiasmal disease | 164 | ||
| Seizure activity from a tumor or arteriovenous malformation (AVM) | 164 | ||
| Migraine | 165 | ||
| Mechanism | 165 | ||
| Symptoms | 165 | ||
| Signs | 166 | ||
| Investigations | 166 | ||
| Treatment | 166 | ||
| Vascular disease | 167 | ||
| Giant cell arteritis | 167 | ||
| Vertebrobasilar insufficiency | 167 | ||
| Mechanism | 167 | ||
| Causes | 167 | ||
| Symptoms | 167 | ||
| Signs | 168 | ||
| Investigations | 168 | ||
| Treatment | 168 | ||
| 5 Double vision | 169 | ||
| Contents | 169 | ||
| Introduction | 170 | ||
| Eye disease | 170 | ||
| Orbit or extraocular muscle disease | 171 | ||
| Neuromuscular junction disease | 171 | ||
| Ocular motor nerve disease | 171 | ||
| Brain disease | 171 | ||
| Examination checklist | 172 | ||
| Diplopia | 172 | ||
| History | 172 | ||
| Examination | 172 | ||
| Plus: perform perimetry if: | 173 | ||
| Management flowchart | 174 | ||
| Double vision | 174 | ||
| Monocular diplopia | 185 | ||
| Causes | 185 | ||
| Symptoms | 185 | ||
| Signs | 186 | ||
| Investigations and treatment | 186 | ||
| Binocular diplopia | 186 | ||
| Muscle or orbit disease | 186 | ||
| Restrictive myopathy | 186 | ||
| Causes | 186 | ||
| Symptoms | 187 | ||
| Signs | 187 | ||
| Investigations | 187 | ||
| Treatment | 188 | ||
| Paretic myopathy | 188 | ||
| Causes | 188 | ||
| Symptoms | 188 | ||
| Signs | 188 | ||
| Investigations | 188 | ||
| Treatment | 189 | ||
| Acute orbitopathy | 189 | ||
| Causes | 190 | ||
| Symptoms | 190 | ||
| Signs | 190 | ||
| Investigations | 192 | ||
| Treatment | 193 | ||
| Neuromuscular junction disease | 193 | ||
| Myasthenia gravis | 193 | ||
| Mechanism | 193 | ||
| Causes | 193 | ||
| Symptoms | 193 | ||
| Diplopia | 194 | ||
| Ptosis | 194 | ||
| Systemic symptoms | 194 | ||
| Signs | 194 | ||
| Abnormal ocular motility (Figs. 5.5 and 5.6, Videos 5.3 and 5.4) | 194 | ||
| Ptosis (see also Chapter 10, p. 300) | 196 | ||
| Other ophthalmic signs of myasthenia | 196 | ||
| Systemic signs | 197 | ||
| Clinical tests | 197 | ||
| Sleep/rest test | 197 | ||
| Ice test | 197 | ||
| Tensilon test | 197 | ||
| Prostigmin test | 199 | ||
| Investigations | 199 | ||
| Natural history | 200 | ||
| Treatment | 200 | ||
| Optical treatment | 200 | ||
| Medical treatment | 200 | ||
| Surgical treatment | 201 | ||
| Nerve disease | 201 | ||
| Third nerve palsy | 201 | ||
| Causes | 201 | ||
| Symptoms | 202 | ||
| Signs | 202 | ||
| Partial third nerve palsy (Figs. 5.8 and 5.9, Videos 5.5–5.8) | 204 | ||
| Complete third nerve palsy (Fig. 5.10, Video 5.9) | 206 | ||
| “Pupil-sparing” third nerve palsy (Fig. 5.11, Video 5.10) | 207 | ||
| Differential diagnosis | 208 | ||
| Investigations | 208 | ||
| Treatment | 208 | ||
| Fourth nerve palsy | 209 | ||
| Causes | 210 | ||
| Symptoms and signs | 210 | ||
| Acquired unilateral fourth nerve palsy (Fig. 5.14, Video 5.11) | 212 | ||
| Acquired bilateral fourth nerve palsy | 213 | ||
| Congenital unilateral fourth nerve palsy (Fig. 5.15, Video 5.12) | 213 | ||
| Differential diagnosis | 213 | ||
| Investigations | 215 | ||
| Treatment | 215 | ||
| Sixth nerve palsy | 215 | ||
| Causes | 216 | ||
| Symptoms | 216 | ||
| Signs | 217 | ||
| Differential diagnosis | 217 | ||
| Investigations | 220 | ||
| Treatment | 220 | ||
| Unilateral multiple nerve palsies | 221 | ||
| Cavernous sinus syndrome | 221 | ||
| Causes | 222 | ||
| Symptoms | 222 | ||
| Signs (Video 5.14) | 222 | ||
| Investigations | 222 | ||
| Treatment | 222 | ||
| Orbital apex syndrome | 223 | ||
| Bilateral multiple nerve palsies | 223 | ||
| Meningitis | 223 | ||
| Guillain–Barré syndrome and Miller Fisher variant | 224 | ||
| Symptoms and signs | 224 | ||
| Wernicke encephalopathy | 225 | ||
| Brain disease | 225 | ||
| Internuclear ophthalmoplegia (INO) | 225 | ||
| Causes | 225 | ||
| Mechanism (Fig. 5.21) | 225 | ||
| Symptoms | 225 | ||
| Signs | 226 | ||
| Unilateral INO (Fig. 5.22) | 226 | ||
| Bilateral INO (Video 5.16) | 227 | ||
| Differential diagnosis | 227 | ||
| Investigations | 227 | ||
| Treatment | 227 | ||
| Skew deviation | 227 | ||
| Causes | 227 | ||
| Symptoms | 227 | ||
| Signs (Fig. 5.23, Video 5.17) | 227 | ||
| Differential diagnosis | 228 | ||
| Investigations | 228 | ||
| Treatment | 228 | ||
| Supranuclear ophthalmoplegias | 228 | ||
| Dorsal midbrain syndrome | 229 | ||
| Causes | 229 | ||
| Mechanism | 229 | ||
| Symptoms | 229 | ||
| Signs (Fig. 5.24 and Video 5.18) | 230 | ||
| Investigations | 230 | ||
| Horizontal gaze palsy (Videos 5.19 and 5.20) | 230 | ||
| Horizontal saccadic palsy | 231 | ||
| 6 “Seeing things” | 241 | ||
| Contents | 241 | ||
| Introduction | 242 | ||
| Eye disease | 242 | ||
| Optic nerve disease | 242 | ||
| Brain disease | 242 | ||
| Examination checklist | 243 | ||
| “Seeing things” | 243 | ||
| History | 243 | ||
| Examination | 243 | ||
| Plus: perform perimetry: | 244 | ||
| Visual illusions (Table 6.1 and Fig. 6.1) | 245 | ||
| Metamorphopsia (Fig. 6.2) | 246 | ||
| 7 Abnormal movement or orientation of the visual world | 253 | ||
| Contents | 253 | ||
| Introduction | 254 | ||
| Inner ear disease | 254 | ||
| Brain disease | 254 | ||
| Types of eye movement disorders causing abnormal movement of the visual world | 255 | ||
| Examination checklist | 255 | ||
| Abnormal movement of the visual world | 255 | ||
| History | 255 | ||
| Examination | 256 | ||
| Plus: perform perimetry if: | 256 | ||
| Oscillopsia | 256 | ||
| Definition | 256 | ||
| Causes | 257 | ||
| Acquired nystagmus | 257 | ||
| Definition | 257 | ||
| Types | 257 | ||
| Common types of acquired nystagmus | 257 | ||
| Central vestibular nystagmus | 257 | ||
| Convergence retraction nystagmus (Video 7.16) | 258 | ||
| See-saw nystagmus (Video 7.6) | 259 | ||
| Periodic alternating nystagmus (Video 7.7) | 259 | ||
| Acquired pendular nystagmus (Video 7.15) | 259 | ||
| Rebound nystagmus (Videos 7.18 and 7.19) | 259 | ||
| Voluntary nystagmus (Video 7.20) | 259 | ||
| Saccadic intrusions | 259 | ||
| Types and significance | 259 | ||
| Square-wave jerks (Video 7.10) | 259 | ||
| Macrosquare-wave jerks (Video 7.11) | 260 | ||
| Macrosaccadic oscillations (Video 7.12) | 260 | ||
| Opsoclonus (Video 7.13) | 260 | ||
| Ocular flutter (Video 7.14) | 260 | ||
| Superior oblique myokymia (Video 7.9) | 260 | ||
| Abnormal vestibulo-ocular reflex | 260 | ||
| Treatment of oscillopsia | 260 | ||
| Akinetopsia | 261 | ||
| Definition | 261 | ||
| Types | 261 | ||
| Etiology | 261 | ||
| Testing | 261 | ||
| Manifestations | 261 | ||
| Associated deficits | 262 | ||
| 8 Abnormal eye movements without visual symptoms | 265 | ||
| Contents | 265 | ||
| Introduction | 266 | ||
| Examination checklist | 266 | ||
| Abnormal eye movements without visual symptoms | 266 | ||
| History | 266 | ||
| Examination | 267 | ||
| Plus: perform perimetry if: | 267 | ||
| Misaligned eyes without diplopia | 267 | ||
| Poor vision or childhood-onset strabismus | 267 | ||
| Abnormal voluntary eye movements without diplopia | 268 | ||
| Normal age-related loss of upgaze | 268 | ||
| Gaze palsy | 268 | ||
| Horizontal gaze palsy | 268 | ||
| Signs | 268 | ||
| 9 Unequal pupils | 275 | ||
| Contents | 275 | ||
| Introduction | 276 | ||
| Iris disease | 276 | ||
| Parasympathetic chain disease (brain, third nerve, ciliary ganglion) | 276 | ||
| Sympathetic chain disease (brain, neck, upper chest) | 276 | ||
| Examination checklist | 277 | ||
| Unequal pupils | 277 | ||
| History | 277 | ||
| Examination | 277 | ||
| Plus: perform perimetry if: | 278 | ||
| Management flowchart | 279 | ||
| Unequal pupils | 279 | ||
| Approach to anisocoria | 280 | ||
| Definition | 280 | ||
| Etiology | 280 | ||
| Rule | 280 | ||
| Question | 280 | ||
| Answer | 280 | ||
| Explanation | 280 | ||
| Anisocoria with normally reactive pupils | 280 | ||
| Differential diagnosis | 280 | ||
| Physiologic anisocoria (Fig. 9.1) | 280 | ||
| Horner syndrome (Fig. 9.2 and Video 9.1) | 281 | ||
| Signs | 281 | ||
| Pharmacologic testing to confirm the diagnosis of Horner syndrome (Table 9.1) | 281 | ||
| Causes | 284 | ||
| Clinical clues to the location of the lesion | 285 | ||
| Pharmacologic testing to determine the location of the lesion | 285 | ||
| Investigations | 286 | ||
| Intermittent unilateral pupillary mydriasis (sympathetic form) (Fig. 9.7) | 286 | ||
| Anisocoria with one pupil that is poorly reactive or non-reactive to light | 287 | ||
| Differential diagnosis | 287 | ||
| Evaluation | 287 | ||
| Iris sphincter damage (traumatic mydriasis) (Fig. 9.8) | 287 | ||
| Pharmacologic blockade (Fig. 9.9) | 288 | ||
| Topical parasympatholytic agents (causing dilated pupil/s) | 288 | ||
| Topical parasympathomimetic agents (causing constricted pupil/s) | 289 | ||
| Tonic pupil (Fig. 9.10 and Video 9.2) | 289 | ||
| Signs | 289 | ||
| Etiology | 289 | ||
| Causes | 290 | ||
| Pharmacologic testing for tonic pupil (Fig. 9.10) | 291 | ||
| Third nerve palsy (Fig. 9.11) | 291 | ||
| Intermittent unilateral pupillary mydriasis (parasympathetic form) (Fig. 9.12) | 292 | ||
| 10 Ptosis | 293 | ||
| Contents | 293 | ||
| Introduction | 294 | ||
| Examination checklist | 294 | ||
| Ptosis | 294 | ||
| History | 294 | ||
| Examination | 295 | ||
| Management flowchart | 297 | ||
| Aponeurotic ptosis | 298 | ||
| Cause | 298 | ||
| Demographic | 298 | ||
| Symptoms | 298 | ||
| Signs | 298 | ||
| Investigations | 298 | ||
| Treatment | 298 | ||
| Caution | 298 | ||
| Ptosis due to levator myopathy | 299 | ||
| Causes | 299 | ||
| Demographic | 299 | ||
| Symptoms | 299 | ||
| Signs | 299 | ||
| Investigations | 299 | ||
| Treatment | 299 | ||
| Ptosis due to myasthenia gravis | 300 | ||
| Demographic | 300 | ||
| Symptoms and signs | 300 | ||
| Investigations and treatment | 301 | ||
| Ptosis due to partial third nerve palsy | 301 | ||
| Caution | 301 | ||
| Causes | 301 | ||
| Demographic | 301 | ||
| Symptoms and signs | 301 | ||
| Investigations | 302 | ||
| Treatment | 302 | ||
| Ptosis due to Horner syndrome | 303 | ||
| Causes | 303 | ||
| Demographic | 303 | ||
| Symptoms and signs | 303 | ||
| Pharmacologic testing | 303 | ||
| Investigations | 304 | ||
| Treatment | 304 | ||
| 11 Facial weakness or spasm | 305 | ||
| Contents | 305 | ||
| Introduction | 306 | ||
| Facial weakness | 306 | ||
| Involuntary facial movements | 306 | ||
| Examination checklist | 307 | ||
| Facial weakness or spasm | 307 | ||
| History | 307 | ||
| Examination | 307 | ||
| Facial weakness | 308 | ||
| Facial nerve palsy | 308 | ||
| Causes | 308 | ||
| Symptoms and signs (Figs. 11.1 and 11.2, Video 11.1) | 308 | ||
| Ophthalmic | 308 | ||
| Other symptoms of facial nerve dysfunction | 308 | ||
| Possible localizing symptoms and signs | 309 | ||
| Differential diagnosis | 311 | ||
| Investigations | 311 | ||
| Ophthalmic complications | 311 | ||
| Ophthalmic treatment | 311 | ||
| Involuntary facial movements | 312 | ||
| Orbicularis oculi myokymia | 312 | ||
| 12 Unexplained eye pain, orbital pain or headache | 317 | ||
| Contents | 317 | ||
| Introduction | 318 | ||
| Examination checklist | 318 | ||
| Unexplained eye pain or headache | 318 | ||
| History | 318 | ||
| Examination | 319 | ||
| Ophthalmic causes of headache or facial pain | 319 | ||
| Headache due to angle-closure glaucoma | 320 | ||
| Headache due to herpes zoster ophthalmicus | 320 | ||
| Headache due to refractive error | 320 | ||
| Headache due to heterophoria or heterotropia | 320 | ||
| Ophthalmic symptoms and signs of an intracranial or systemic cause of headache or facial pain | 320 | ||
| Giant cell arteritis (GCA) | 321 | ||
| Raised intracranial pressure | 321 | ||
| Pituitary apoplexy | 322 | ||
| Internal carotid artery (ICA) dissection | 322 | ||
| Causes | 322 | ||
| Symptoms and signs | 322 | ||
| Investigations | 322 | ||
| Treatment | 322 | ||
| Trigeminal neuralgia | 322 | ||
| Causes (Fig. 12.1) | 322 | ||
| Symptoms | 323 | ||
| Signs | 323 | ||
| Investigations | 323 | ||
| Treatment | 323 | ||
| Common “benign” headache patterns with ophthalmic features | 324 | ||
| Migraine | 324 | ||
| Trigeminal autonomic cephalalgias (TACs) | 325 | ||
| When to refer other patients for further investigation | 325 | ||
| 13 Neuro-ophthalmic history and examination | 327 | ||
| Contents | 327 | ||
| Introduction | 328 | ||
| History | 328 | ||
| Patient Details | 328 | ||
| Presenting complaint | 328 | ||
| Other ophthalmic symptoms | 329 | ||
| Ophthalmic history | 329 | ||
| Medical history | 329 | ||
| Medications | 329 | ||
| Family history | 329 | ||
| Social and occupational history | 329 | ||
| Symptoms of giant cell arteritis (GCA) | 330 | ||
| Systems review questions | 330 | ||
| General | 330 | ||
| Neurologic | 330 | ||
| Ear, nose, throat | 330 | ||
| Respiratory | 330 | ||
| Cardiovascular | 331 | ||
| Gastrointestinal | 331 | ||
| Genitourinary | 331 | ||
| Musculoskeletal | 331 | ||
| Skin | 331 | ||
| Infectious risk factors | 331 | ||
| Examination | 331 | ||
| Visual acuity (VA) | 333 | ||
| Color vision (Video 13.1) | 333 | ||
| Subjective color desaturation (Fig. 13.1) | 333 | ||
| Color plate tests (e.g. Ishihara or Hardy-Rand-Rittler pseudoisochromatic color plates) | 333 | ||
| Visual fields to confrontation (Fig. 13.2 and Video 13.2) | 334 | ||
| Descriptive | 335 | ||
| Finger counting in quadrants | 335 | ||
| Red target for central field | 335 | ||
| Red target for hemianopic defect | 335 | ||
| Perimetry | 336 | ||
| Fixation, alignment and eye movements (Video 13.3) | 336 | ||
| Suggested reading | 365 | ||
| Appendix: Checklists | 367 | ||
| Neuro-ophthalmic history checklist | 367 | ||
| Neuro-ophthalmic examination checklist | 367 | ||
| Index | 369 | ||
| A | 369 | ||
| B | 371 | ||
| C | 371 | ||
| D | 373 | ||
| E | 374 | ||
| F | 375 | ||
| G | 376 | ||
| H | 377 | ||
| I | 378 | ||
| J | 379 | ||
| K | 379 | ||
| L | 379 | ||
| M | 380 | ||
| N | 382 | ||
| O | 383 | ||
| P | 385 | ||
| Q | 387 | ||
| R | 387 | ||
| S | 388 | ||
| T | 389 | ||
| U | 391 | ||
| V | 391 | ||
| W | 392 | ||
| Z | 392 |