Ophthalmology clinics of North America
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Ophthalmologists are often the first physicians to evaluate patients with headaches, eye pain, and headache-associated visual disturbances. Although ophthalmic causes are sometimes diagnosed, most eye pain and many types of visual disturbances are neurologic in origin. ⋯ This article reviews the primary headache disorders and focuses on their ophthalmic manifestations. The major divisions are migraine and the trigeminal autonomic cephalgias.
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Ophthalmol Clin North Am · Jun 2003
ReviewEvaluation of the pupillary light response as an objective measure of visual function.
Examination of the pupil provides critical objective information that complements subjective visual measurements and can provide important clues for distinguishing among different etiologies of loss of visual function. Although automated technologies and pupillary perimetry provide valuable insight into the correspondence between visual and pupillary dysfunction, a firm understanding of the principles of the afferent examination of the pupil is all that is required for the clinician to quickly obtain this objective measure of function during any routine examination.
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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.