CHAPTER 1 An Approach to Visual Field Interpretation   KEY CONCEPTS When interpreting visual field defects, an all important decision that you have to make is whether or not the visual field defect stops sharply along the vertical meridian (called a vertical cut). If a vertical cut is not present, a retinal or optic nerve lesion is causing the defect With retinal causes a defect corresponding to the pattern of the retinal lesion can usually be seen. With optic nerve causes there can be a number -- CHAPTER 2 An Approach to Optic Nerve Disease   KEY CONCEPTS The diagnosis of optic nerve disease is based on three parameters -- visual field, pupil, and disc appearance. Unilateral optic nerve disease is easier to diagnose than bilateral disease. Bilateral mild disease can be particularly difficult to diagnose with certainty. Optic nerve disease presents in three different patterns: two acute and one chronic. We have identified 12 causes of optic nerve disease to be considered when determining et -- CHAPTER 3 Unexplained Visual Loss   KEY CONCEPTS Unexplained visual loss refers to cases in which the usual three ocular causes of visual loss are not in play (eg, uncorrected refractive error, media opacification, and visible retinal disease). There are seven causes that need to be considered Most of the causes can be diagnosed on the basis of the clinical examination of pupils, discs, and visual fields. Two of the causes, in addition, will require laboratory tests. DEVELOPING AN APPROACH The P.

CHAPTER 4 An Approach to Disc Edema   KEY CONCEPTS In separating true from pseudo disc edema, findings lending strong support for true disc edema are peridisc hemorrhages and exudates and documented increased blurring of the disc borders. True disc edema can be assigned to one of three groupings A medical problem Papilledema, (ie, disc edema secondary to increased intracranial pressure) An anterior optic neuropathy Disc edema with peripheral hemorrhages defines the medical problem group Papilled -- CHAPTER 5 Ocular Motility: Some Basic Concepts   KEY CONCEPTS A phoria is an ocular misalignment that is manifest only when the eyes are prevented from focusing on the same visual object A tropia is an ocular misalignment while fusion was being attempted, but was not possible because of a palsy or a restriction. Thus, a tropia is an ocular misalignment that is manifest despite the attempt to focus both eyes on the same visual object A comitant deviation does not change as the eyes move in a hori -- CHAPTER 6 Neurologic Motility Patterns: An Overall Survey KEY CONCEPTS Diplopia and eye movement deviations can occur from lesions at a number of points along the ocular motor pathways For this discussion, six major levels along the oculomotor pathways are considered. Particular patterns of abnormal motility will occur with lesions at each of these various levels. The patterns can be pathognomonic or nonspecific. DEVELOPING AN APPROACH Overview The ocular motility system has elements that extend.

CHAPTER 7 Neurological Motility Patterns: A Cranial Nerve Focus   KEY CONCEPTS Bilateral lateral rectus and medial rectus palsies can present as comitant deviations Bilateral symmetrical fourth nerve palsies will not have any significant vertical tropia in the primary position and in straight up and downgaze Nuclear third, fourth, and sixth nerve palsies can present distinctive patterns In the presence of a third nerve palsy, to test for a concomitant fourth nerve palsy, a test for torsion will -- CHAPTER 8 Performing the Motility Exam   KEY CONCEPTS Before you embark on a ocular motility investigation, be sure you are not dealing with monocular diplopia The motility exam can be looked upon as having two main tasks To detect comitant and noncomitant deviations To perform certain ancillary tests or focused observations when specific patterns are revealed There are four main steps in a motility exam: observing versions, alternate cover testing, Maddox rod testing and performing confirmatory -- CHAPTER 9 A Brief Summary: Case Studies in Neuromotility Disorders   KEY CONCEPTS The oculomotor system can be clinically divided into six levels based on anatomic and some clinical criteria. It will serve as a motility pattern recall list Characteristic ocular motility patterns are produced by lesions at each of these levels These motility patterns can be Noncomitant esotropias, exotropias, or hypertropias Comitant esotropias, exotropias, or hypertropias Combinations of the above Comitant devia.

CHAPTER 10 Nystagmus   KEY CONCEPTS Nystagmus can be divided into five categories that indicate the disease process and an appropriate clinical response. Congenital Due to medications Due to visual loss Due to peripheral vestibular disease Due to acquired posterior fossa disease Some nystagmus forms can suggest a likely location of the lesion that caused it Some nystagmus forms can suggest a likely etiology. DEVELOPING AN APPROACH General Comments In this chapter, of three types of spontaneous m -- CHAPTER 11 Pupil Problems   KEY CONCEPTS Pupil problems in large part will be one of two types: There is a difference in pupil sizes, (anisocoria), but the response to light is normal There is a defective light response With anisocoria, and normal light responses, there are three diagnostic categories: Horner's pupil Mild motor pupil Physiological anisocoria With the defective light response problem, there are five diagnostic categories: An afferent pupil Dorsal midbrain pupils Motor preganglion -- Bibliography   BOOKS Anderson DR. Perimetry: With and Without Automation. 2nd ed. St. Louis, Mo: CV Mosby -- 1987. Bundez PL. Atlas of Visual Fields. Philadelphia, Pa: Lippincott-Raven -- 1997. Burde RM, Savino PJ, Trobe JD. Clinical Decisions in Neuro-Ophthalmology. 3rd ed. St. Louis, Mo: Mosby -- 2002. Kline LB, Bajandas FJ. Neuro-Ophthalmology Review Manual. 5th ed. Thorofare, NJ: Slack -- 2004. Kline LB, ed. Optic nerve disorders. In: Ophthalmology Monographs. vol 10. San Francisco, Calif: American.