1. Neuro-Ophthalmology
Dr. Alberto
January 4, 2010

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

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

4. 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

5. 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.

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

7. Picture: Visual fields

8. Picture: Recti Muscles

9. Picture: Oblique Muscles

11. Picture: Yoke Muscles

12. 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

13. 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.

14. Exotropia – abnormal is both eyes

15. Esotropia – abnormal is right eye, temporal side

16. Pic: Cardinal Positions

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

18. 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

19. 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

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

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

22. Krimksy Test Measure objectively how many prism diopters we have

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

24. Pic of next child  right hypertropia

25. Squint Surgery

26. God Bless!!!