Neuro-Ophthalmology: Key
Insights
Summarizing the October 2019
Publication
Prepared for Educational Purposes
Introduction
• Neuro-ophthalmology bridges neurology and
ophthalmology, focusing on vision disorders
caused by neurological conditions.
• This presentation summarizes key topics from
the October 2019 Neuro-Ophthalmology
publication:
• - Pupillary Function
• - Optic Neuropathies
• - Visual Pathway Disorders
The Pupil
• Key Points:
• - Anatomy: Parasympathetic (miosis) and
sympathetic (mydriasis) control
• - Disorders: Anisocoria, Horner Syndrome,
tonic pupil
• - Examination: Light reflex, near reflex,
pharmacologic testing
• Clinical Tip: Measure pupil size in varying light
conditions for accurate diagnosis.
Ischemic Optic Neuropathy
• Types:
• - Arteritic (associated with giant cell arteritis)
• - Non-Arteritic (linked to vascular risk factors)
• Key Features:
• - Sudden, painless vision loss
• - Optic disc swelling (in acute phase)
• Management:
Optic Neuritis
• Causes:
• - Multiple sclerosis
• - Neuromyelitis optica spectrum disorders
(NMOSD)
• - Myelin oligodendrocyte glycoprotein (MOG)
antibody disease
• Clinical Features:
• - Pain with eye movement
Toxic-Metabolic and Hereditary
Optic Neuropathies
• Toxic-Metabolic Causes:
• - Alcohol, tobacco, methanol, nutritional
deficiencies
• - Medications (e.g., ethambutol)
• Hereditary Causes:
• - Leber Hereditary Optic Neuropathy (LHON)
• - Dominant optic atrophy
Idiopathic Intracranial
Hypertension (IIH)
• Overview:
• - Common in young women with obesity
• - Presents with headache, papilledema, and
visual changes
• Diagnostic Criteria:
• - Elevated intracranial pressure on lumbar
puncture
• - Normal brain imaging (except for signs of
Higher Cortical Visual Disorders
• Causes:
• - Stroke, trauma, tumors affecting visual
pathways
• Examples:
• - Visual agnosia
• - Balint syndrome (optic ataxia,
simultanagnosia)
• - Hemispatial neglect
Approach to Diplopia
• Definition:
• - Binocular (neurological cause) vs Monocular
(ocular cause)
• Causes:
• - Cranial nerve palsies (III, IV, VI)
• - Myasthenia gravis
• - Thyroid eye disease
Nystagmus and Saccadic Intrusions
• Nystagmus:
• - Types: Jerk, pendular
• - Causes: Vestibular dysfunction, cerebellar
lesions
• Saccadic Intrusions:
• - Examples: Opsoclonus, square wave jerks
• - Associated with neurodegenerative disorders
Imaging in Neuro-Ophthalmology
• Importance:
• - Critical for diagnosis and management
• - Differentiates structural vs functional causes
• Techniques:
• - MRI: Visual pathway lesions, demyelination
• - CT: Bone fractures, acute hemorrhage
• - OCT: Retinal and optic nerve analysis.
Conclusion
• Neuro-ophthalmology provides vital insights
into vision-related neurological disorders.
• Key Takeaways:
• - Accurate diagnosis requires understanding
anatomy, physiology, and imaging.
• - Multidisciplinary approach enhances patient
outcomes.
