Ophthalmology clinics of North America
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Diplopia is one of the most vexing problems to confront a physician. When diplopia is binocular, it commonly results from dysfunction of one or more of the ocular motor nerves. ⋯ In this article, an anatomic approach is presented for the diagnosis and treatment of ocular motor nerve lesions. Emphasis is placed on the identification of associated neurologic and ophthalmologic findings that are critical for management of patients with acquired and congenital ocular motor palsies.
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Ophthalmologic practice requires a solid foundation in the principles and interpretation of the neuro-ophthalmologic examination. This article reviews the techniques used in the neuro-ophthalmologic examination to assess visual acuity, ocular motility, visual fields, the pupils, the eyelids, and the fundus. The neuro-ophthalmological examination in comatose patients is also reviewed. Neuro-ophthalmic techniques are paramount in the assessment of comatose patients, especially with regard to brainstem localization and diagnosis.
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The orbit contains the globe, extraocular muscles, and their cranial nerve supply. Orbital diseases may damage these structures, resulting in decreased vision and ocular motility deficits. Any process that increases the volume of the orbit may displace the globe and cause proptosis or ocular dystopia. This article focuses on several orbital diseases that present with neuro-ophthalmic signs.
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The pupil is one objective marker of vision and autonomic pathways. A good understanding of its anatomy and careful examination techniques are the essential tools for proper clinical diagnosis of pupillary disorders.