Neuro-Ophthalmology Dr. Alberto January 4, 2010

Picture: Left tonic pupil = greater anisocoria in light illumination Picture: Left tonic pupil = greater anisocoria in light illumination than dark illumination; left eye abnormal

Picture: Right tonic pupil – near response is seen in lower photo

Picture: 12 yr old with recent onset od filated right pupil Picture: 30 minutes after instillation of 0.125% pilocarpine qtt OU. Note lack of effect on normal left eye

Picture: Right congenital Horner’s syndrome: miosis, mild ptosis Picture: Right congenital Horner’s syndrome: miosis, mild ptosis and hypochromic iris. Dim the lights and the normal response of dilation will not be seen.

IDENTIFY A B A: Right eye: ptosis, miosis Horner’s Sydnrome B: Right eye: severe ptosis, mydriasis CN 3 lesion

Picture: Visual fields

Picture: Recti Muscles

Picture: Oblique Muscles

Picture: Yoke Muscles

Picture: Concomitant Strabismus Abnormal eye is left Looking at right  esotropia Looks to the left  not as much but more or less equal in strength

Picture: Inconcomitant Strabismus Looking straight  almost normo( Picture: Inconcomitant Strabismus Looking straight  almost normo(?)phoric Looks to the right  normo(?)phoric Looks to the left  one eye does not move. Inwardly turned left eye.

Exotropia – abnormal is both eyes

Esotropia – abnormal is right eye, temporal side

Pic: Cardinal Positions

Cover Test: Tropias [pic] x 2 Pen light test, one eye already deviated Cover fixating eye, deviated eye will look at the light

Cover –Uncover Test: Esotropias Right eye shows esotropia; covering the left eye, it (right) fixates and reflex is centered; however, on uncovering the left eye it reverts back to esotropia

Cover Test – Phoria [pic] Alignment maintained if both eyes opened Cover Test – Phoria [pic] Alignment maintained if both eyes opened. Cover one eye = break the fusion. Deviating eye moves inwards/outwards. Cover other eye = recovery Sometimes, if you cover both eyes = deviation manifested. Persistence of misalignment when uncovered. Sometimes very subtle As your break fusion, deviation will manifest itself

Latent Exophoria [pic] Delayed May be able to catch deviation for a while

Hirschberg Test [pic[ Number of prism diopters At pupil margin = 5 Margin of cornea = 10-15 Beyond that = about 25 Varying degrees of esotropia show the corneal reflex becoming progressively more temporal

Krimksy Test Measure objectively how many prism diopters we have

Pic of child (Oriental looking)  pseudostrabismus – reflexes are centered; epicanthal fold in Oriental children creates illusion of strabismus

Pic of next child  right hypertropia

Squint Surgery

God Bless!!!