Neurophthalmology

1–8 of 8 articles

All Cornea 36 Cataract 17 Glaucoma 14 Retina & Vitreous 72 Neurophthalmology 8 Oculoplasty 15 Uvea & Inflammatory Diseases 24 Miscellaneous 20 Oncology 9 Pediatric Ophthalmology 16

11 min read

Differentiating true disc edema from pseudo disc edema: Utility of Multimodal imaging

Papilledema is a term used to define optic disc edema. However, it is specifically used for non-inflammatory, often bilateral, passive edema of the optic nerve head secondary to raised intracranial tension. The cause for raised intracranial pressure can be space-occupying lesions, meningitis, or idiopathic intracranial hypertension. The disc swelling results due to axoplasmic stasis and intracellular fluid accumulation. Ophthalmoscopically, the disc appears elevated, and hyperemic, with blurred margins. The ophthalmoscopic signs of papilledema include mechanical and vascular signs [Table 1]. Mechanical signs Vascular signs a.Elevation of the disc surface b.Blurring of the disc margins c.Filling of the cup d. Edema and opacification of the nerve fiber layer e.Paton’s lines or retinochoroidal folds (in circumpapillary fashion) a. Disc hyperemia b. Congested veins c. Splinter hemorrhages in peripapillary area d. Absence of spontaneous venous pulsations e. Macular star formation at later s

Madhurima A Nayak · Dr. NV Raghunath Rao · +1 other
6 min read

Ten mistakes to avoid while testing for RAPD

Introduction: A relative afferent pupillary defect (RAPD) is an important sign that detects a lesion in the afferent pathway of light reflex. It is seen in unilateral or asymmetric bilateral lesions of the retina and optic nerve upto but not involving the chiasm. It has been noted though, even in lesions of optic tract and pretectal afferent fibres of dorsal mid brain. Although the test requires both eyes, it is essential to note that it requires only one working pupil. Swinging flashlight test of Levitan: Before performing the test, one must examine the pupil for shape, size of the pupils, anisocoria if any and reaction to light. It is important to note all these since anisocoria and small sized pupils may make it difficult to detect relative afferent pupillary defect. After completing this basic examination, one must proceed to perform the swinging flash light test, keeping in mind the following ten avoidable mistakes: 1. The ideal light: The test must be performed with a halogen tra

Dr. Nikita Pathare
6 min read

Visual Fields in Neuro-Ophthalmology : 10 Pearls for the Postgraduates

1. Is there something we can do before ordering a visual field in neuro-ophthalmology? Confrontation visual field testing is an important clinical examination, especially when it comes to neuro-ophthalmology cases. A simple test can give us clues as to what may be the underlying cause of patients’ symptoms. The test is done presuming the visual field of the examiner is normal. Both the patient and the examiner should be seated at an equal height at a distance of 1 meter. The right eye field is tested by asking the patient to close their left eye and the examiner closes his/her right eye. The first question the examiner must ask the patient, if they are able to see the examiner’s face clearly, without any parts missing. The examiner then moves a pin-point target from out to in all 4 quadrants, while instructing the patient to continuously look into the examiner’s eye. When the patient sees the object, they inform the examiner, who is then able to compare when they themselves saw the obj

Dr. Simranjeet Aulakh
16 min read

Papilledema- A Ready Reckoner for Postgraduates

Introduction Papilledema is used to describe optic disc edema resulting from increased intracranial pressure while disc edema could be due to any cause. While disc edema can be unilateral or bilateral, papilledema is usually bilateral, however, it can be asymmetric, to begin with. Another important differential of true papilledema is pseudo papilledema which is seen in conditions like a small hyperopic optic disc or optic disc drusen, etc. This chapter shall entail a discussion on the etiopathogenesis of papilledema and the approach to diagnosis and management of papilledema. Papilledema and its mechanism It’s a form of bilateral optic disc swelling associated with increased intracranial pressure. An increase in intracranial pressure can occur secondary to an intracranial space-occupying lesion, cerebral venous thrombosis, or can be idiopathic as in the case of Idiopathic Intracranial hypertension (IIH). Figure 1 depicts the mechanism of the development of papilledema. Pseudo vs true p

Prof. Rohit Saxena · Dr. Monika Yadav · +1 other
25 min read

Learn from the Masters: Clinical Highlights in Neuro-ophthalmology

Neuro-ophthalmology is a unique subspecialty of ophthalmology and neurology where there is a complex interaction of neurologic and systemic disorders in the visual system. Neuro-ophthalmic conditions are not only about vision-threatening but sometimes life-threatening too! It needs the most comprehensive examination from ophthalmic, neurologic, and medical viewpoint. The trick lies with a systematic approach starting from history taking to specific examination techniques and localization of the condition. We have put together a few fundamental questions on clinical highlights in neuro-ophthalmology, and they were addressed to the experts who have been phenomenal in the field. Let’s learn from their vivid explanation and expand our neuro-ophthalmology skills. Dr. Ambika Selvakumar is a senior consultant and the head of the Neuro-ophthalmology services, Sankara Nethralaya, Chennai, India. She has done MBBS from prestigious Stanley medical college, Chennai. Postgraduation in ophthalmology

Dr. DurgaPriyadarshini S
9 min read

Ten Tips for Management of Nystagmus

Nystagmus is defined as an involuntary rhythmic oscillation of one or both the eyes. Clinical assessment and eye movement recordings are important to diagnose and classify nystagmus. It is essential to have patience while examining a child, as anxiety often increases nystagmus. 1.Classification Physiological eye movements have to be differentiated from pathological eye movements. The older etiology-based classification of nystagmus is redesigned into characteristics-based new classification by CEMAS (Classification of Eye Movement and Strabismus). Infantile nystagmus syndrome (INS) is characterized by horizontal conjugate nystagmus, infantile-onset, accelerating slow phase, increase with fixation attempt, convergence dampening, and presence of null zone with decreased amplitude. Fusion maldevelopment nystagmus syndrome (FMNS) is characterized by decelerating slow phase, associated strabismus, a latent component with fast phase towards fixing eye and decrease in intensity with adduction

Dr. Ramesh Kekunnaya · Dr. Mayank Jain
17 min read

Understanding Optic Disc Pallor- Shades of White

Introduction The optic nerve consists of approximately 1.2 million axons that arise from the retinal ganglion cells and acquire myelin sheath proximal to lamina cribrosa. These axons do not have the capacity to regenerate. The normal optic disc is pink in color due to the fact that light entering the optic disc is conducted along the transparent nerve fibers and they diffuse among columns of glial tissue and capillaries. When axons are damaged in optic atrophy, light is reflected from opaque glial cells and does not pass through the capillaries. In addition, the reduced capillary vascularity and loss of tissue causes visibility of opaque scleral lamina cause the disc to appear pale. Optic atrophy is the sequelae of progressive optic nerve disease that causes irreversible damage of ganglion cells and the retinogeniculate pathway. This degeneration along with gross reduction in capillaries results in loss of optic pathway conduction and pallor. Exploring the etiology of optic atrophy may

Dr. Ambika Selvakumar
13 min read

Evaluation of a case of Diplopia

What is diplopia or double vision? Diplopia or double vision by definition is the simultaneous perception of two images of a single object that may be displaced in any direction. Other terms could be blurred vision, shadowing, or confusion. Is it uniocular or binocular diplopia? The first step to evaluate diplopia is to differentiate between uniocular and binocular diplopias as the management varies completely. If the diplopia disappears on covering either eye the diplopia is binocular. If diplopia is persistent or worsens if one of the eyes is occluded then it’s uniocular diplopia of the other eye. Uniocular diplopia Any corneal surface problems like tear film abnormalities, uncorrected astigmatism, early stages of cataract, subluxated lens, or early macular issues can cause uniocular diplopia. A simple pinhole test can confirm the same. The management of this is to address the cause. Binocular diplopia Binocular diplopia is double vision typically arising as a result of strabismus or

Dr. Kavitha Kalaivani · Dr. Hennaav Kaur Dhillon