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Browsing items in: EHSL - Moran Eye Center Neuro-Ophthalmology Collection

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    • See-Saw Nystagmus

    • Katz_seesaw
    • 7-year-old female whose mother noticed her eyes "bouncing" for 2 months. Visual acuity 20/70 OD and 20/40 OS, reduced color vision OU, and no afferent pupillary defect. See-saw nystagmus documented with videography. Manual perimetry revealed a...
    • See-Saw Nystagmus
    • 4-52b - Dominant Optic Neuropathy

    • 4-52b
    • A son presented with bilateral optic atrophy of unknown etiology after he failed a school visual exam. When looking for dominant optic atrophy, look at the parents. Mother was examined to find similar kind of atrophy. 4-52a mother, 4-52b son.
    • Dominant Optic Neuropathy
    • 4-60a - Dominant Optic Neuropathy

    • 4-60a
    • A son presented with bilateral optic atrophy of unknown etiology after he failed a school visual exam. When looking for dominant optic atrophy, look at the parents. Mother was examined to find similar kind of atrophy. 4-60a mother, 4-60b son.
    • Dominant Optic Neuropathy
    • Aberrant regeneration of the right pupil

    • Figure-15
    • Aberrant regeneration of the right pupil in a man with a large intracavernous sinus meningioma causing a pupil-involving, incomplete third cranial nerve palsy. His pupil is round when he gazes straight ahead (top). When he tries to rotate the eye...
    • Pupil Disorders; Aberrant Regeneration; Third Nerve Palsy
    • Anatomy of the oculosympathetic pathway

    • Figure-04
    • Anatomy of the oculosympathetic pathway. (Maloney WF, Younge BR, Moyer NJ: Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. Am J Ophthalmol 1980;90:394–402, Ophthalmic Publishing Company with permission.)
    • Anatomy of the oculosympathetic pathway; Horner's syndrome
    • Anatomy of the pupillary light reflex pathway

    • Figure-02
    • Anatomy of the pupillary light reflex pathway. (Miller NR: Walsh And Hoyt's Clinical Neuro-Ophthalmology, p 421. Vol 2, 4th ed. Baltimore: Williams & Wilkins, 1985, with permission.)
    • Reflex, Pupillary; Parasympathetic Pupil
    • Argyll Robertson pupils

    • Figure-14
    • Argyll Robertson pupils in an elderly man treated for tabes dorsalis in 1952. His pupils are small and slightly irregular, constrict poorly in response to light stimulation (top), dilate poorly in darkness (middle), but constrict promptly in...
    • Argyll-Robertson pupil; Pupil Disorders/diagnosis; Pupil Disorders/etiology; Pupil Disorders/history; Pupil Disorders/pathology
    • Assessment of an afferent pupillary defect when only one iris is functional

    • Figure-10
    • Assessment of an afferent pupillary defect when only one iris is functional. In this example, a right-sided parasellar tumor is compressing both the optic and oculomotor nerves, causing an optic neuropathy and a pupil-involving third crainial nerve...
    • Pupil Disorders; RAPD; Afferent Pupillary Defect;
    • 4-35 - Cupped Optic Nerve

    • 4-35
    • Atrophic Glaucoma Atrophic glaucomatous discs show thinning of the neuro-retinal rim, "saucerization" (which is shallow cupping), evidence of peripapillary atrophy, and pallor of the very narrow neuroretinal rim. Notice that there is severe atrophy...
    • Cupped Optic Nerve
    • Bilateral iris colobomas (B)

    • Figure-19B
    • Bilateral iris colobomas. B. Bilateral colobomatous defects of the inferonasal retina (black arrows) are also present, as shown in the right eye.
    • Congenital pupillary abnormalities; Pupil; Pupil Disorders/etiology; Pupil Disorders/pathology
    • 3-65 - Shunt Vessels (Glaucoma)

    • 3-65
    • Chronic end-stage glaucoma produces high pressure that interferes with venous drainage from the disc and broad smooth venous collaterals drain the disc centrifugally to the disc margin where they drain.
    • Shunt Vessels (Glaucoma)
    • Duane's Syndrome Type I

    • Bell_J_Duanes_type_1
    • Clip of patient with Duane's Syndrome Type I. Presented at the Neurology Grand Rounds in Fall 2011 at the University of Utah. Presentation can be found in this collection at: Why Don't You See Double?...
    • Duane's Syndrome; Duane's Type I
    • Duane's Syndrome Type III

    • Bell_J_Duanes_type_III
    • Clip of patient with Duane's Syndrome Type III. Presented at the Neurology Grand Rounds in Fall 2011 at the University of Utah. Presentation can be found in this collection at: Why Don't You See Double?...
    • Duane's Syndrome; Duane's Type III;
    • Bilateral iris colobomas

    • coloboma.jpg
    • Coloboma literally means a "gap"-and can be used to describe any fissure, hole, or gap in the eye. The term most often is used to refer to a congenital gap in the disc, retina, the choroid, and the iris. Colobomas occur because the embryonic...
    • Congenital pupillary abnormalities; Pupil; Pupil Disorders/etiology; Pupil Disorders/pathology; Correctopia
    • Amsler Grid Testing

    • Amsler_Grid
    • Demonstration of Amsler Grid examination.
    • Examination, Ocular; Amsler Grid
    • Basic Eye Alignment Exam

    • Basic_Eye_Alignment
    • Demonstration of basic eye alignment examination. Includes: a. Tools b. Cover-Uncover and SPCT c. Alternate Cover and APCT d. Maddox Rod Testing
    • Examination, Ocular; Basic Eye Alignment
    • Color Vision Testing

    • Color_Vision
    • Demonstration of color vision examination.
    • Examination, Ocular; Color Vision
    • Stereoacuity Testing

    • Stereoacuity
    • Demonstration of examination for stereoacuity.
    • Examination, Ocular; Stereoacuity
    • Fourth Nerve Palsy

    • NOVEL_Moran_2-22
    • Demonstration of examination of patient who experienced blurry vision and pain in the left eye. Demonstrates checking of eye movements, focusing on object while each eye is covered and uncovered, turning head both ways and repeating. Shows...
    • Fourth Nerve Palsy, 3 Step Test
    • Exophthalmometry

    • Exophthalmometry
    • Demonstration of exophthalmometry examination.
    • Examination, Ocular; Exophthalmometry
    • Eyelid Measurements

    • Eyelid_Measurements
    • Demonstration of eyelid measurements examination.
    • Examination, Ocular; Eyelid Measurements
    • Fusional Vergence Amplitudes

    • Fusional_Vergence
    • Demonstration of fusional vergence amplitudes examination. Incluudes: a. Convergence Amplitudes b. Divergence Amplitudes c. Vertical Ampitudes
    • Examination, Ocular; Fusional Vergence Amplitudes
    • 3 Step Test

    • NOVEL_Moran_3a-20
    • Demonstration of patient examination.
    • 3 Step Test, Fourth Nerve Palsy; Ocular Motility; Fourth (Trochlear)
    • Physiologic (End-Gaze) Nystagmus

    • 2-16
    • Demonstration of physiological nystagmus, where oscillations do not represent pathology, but occur when the patient’s gaze is drawn too far laterally.
    • End-Gaze nystagmus; Physiologic nystagmus
    • Pupil Exam

    • Pupil_Exam
    • Demonstration of pupil examination.
    • Examination, Ocular; Pupil Exam
    • Transillumination - Lisch nodules

    • 1-29
    • Demonstration of transillumination of the Lisch nodules on a patient with neurofibromatosis. Shows how Lisch nodules that were not very visible in slit-lamp examination are better seen with transillumination, which may therefore be useful in...
    • Transillumination; Examination, Ocular; Lisch nodules; Neurofibromatosis1
    • How to Use the Direct Ophthalmoscope in an Exam

    • ophthalmoscope
    • Demonstration of using the direct ophthalmoscope to examine the optic disc. Covers hand placement , which eye to use, and distance from patient.
    • Direct Ophthalmoscope; Examination, Ocular;
    • Testing the Visual Fields

    • Visual_Fields
    • Demonstration of various methods of testing visual fields, including counting fingers, motion, and color of several objects.
    • Visual Fields; Examination, Ocular; Visual Field Loss
    • Measuring Visual Acuity

    • visual_acuity
    • Demonstration on self of visual acuity exam, using a standard card.
    • Visual Acuity; Examination, Ocular
    • Papilledema 2013

    • Papilledema 2013.pdf
    • Discussion of papilledema, the swelling due to increased pressure.
    • Papilledema
    • Retinitis pigmentosa disease of rods

    • Retinitis pigmentosa disease of rods.pdf
    • Discussion of retinitis pigmentosa which is a retinal/choroidal degeneration caused by various genetic defects.
    • Retinitis pigmentosa; Rods:
    • Stargardt’s Disease

    • Stargardt’s Disease.pdf
    • Discussion of Stargardt's disease, an inherited maculopathy which frequently presents with a loss of central vision.
    • Stargardt’s Disease; Maculopathy;
    • Optic Disc pallor pseudo and real

    • Optic Disc pallor pseudo and real.pdf
    • Discussion of the causes of optic disc pallor.
    • Optic Disc; Optic Atrophy; Pallor;
    • Vestibular Nystagmus

    • 2-15
    • Discussion of vestibular nystagmus. Seen with peripheral disorders and central disorders, and in two varieties: spontaneous and positional. Horizontal jerk with small amplitude.
    • Vestibular Nystagmus; Jerk Nystagmus; Peripheral Vestibular Nystagmus; Positional Nystagmus
    • Optic Disc:  Anatomy, Variants, Unusual discs

    • Optic disc anat variants ophthres 2012.pdf
    • discussion of viewing the optic disc. Includes development of direct ophthalmoscope. Covers normal optic disc and nerve fiber; nerve fiber loss and defects; cilioretinal arteries; venous anomolies; papilledema; pseudopapilledema; myopic disc;...
    • Optic Disc; Anomolies; Anatomy
    • Dysthyroid optic neuropathy: A preventable cause of blindness

    • weinberg_1.pdf
    • Dysthyroid Optic Neuropathy (DON) is a treatable cause of visual loss in ~5% of pts w/ ted. Monitor closely those pts with risk factors (proptosis, tight orbit, restricted motility, strabismus, smoker, diabetic). Oral prednisone is often...
    • Dysthyroid ophthalmopathy; Thyroid orbitopathy; Thyroid eye disease; Thyroid associated ophthalmopathy (TAO); Graves' disease; Restrictive orbitopathy;
    • Enhanced mydriasis in response to hydroxyamphetamine

    • Figure-23
    • Enhanced mydriasis in response to hydroxyamphetamine in a 77-year-old woman with a long-standing, preganglionic, right-sided Horner's syndrome that occurred following cervical neck dissection for thoracic outlet syndrome 30 years earlier. Miosis of...
    • p-Hydroxyamphetamine/diagnostic use; p-Hydroxyamphetamine/pharmacology; Pupil/drug effects; Amphetamines/pharmacology; Horner Syndrome/diagnosis; testing, pupillary drop; Effects of Drugs on the Pupils
    • Flutter in Downgaze

    • NOVEL_Moran_3a-8
    • Examination of patient with flutter in downgaze (no audio)
    • Downgaze, Eye Flutter
    • Bilateral Facial Myokymia

    • 1-21
    • Example of a patient with a brain stem glioma. Shows bilateral facial myokymia.
    • Bilateral Facial Myokymia; Facial Myokymia
    • Abducting (Dissociated) Nystagmus

    • 2-7
    • Example of a patient with abducting (dissociated) nystagmus. Patient has a subtle internuclear ophthalmoplegia. Right eye has right-beating jerk nystagmus, with smaller oscillations in the left eye.
    • Abducting Nystagmus; Dissociated nystagmus
    • Binocular Pendular Nystagmus

    • 2-10
    • Example of a patient with binocular pendular nystagmus. Patient has somewhat dissociated nystagmus, with nystagmus seen more prominently in the left eye. Patient shows an occasional jerk nystagmus to the right in the right eye. Left eye...
    • Binocular Pendular Nystagmus; Pendular Nystagmus; Acquired Pendular Nystagmus
    • Cogan's Lid Twitch

    • 1-25
    • Example of a patient with Cogan’s lid twitch, with discussion of how to detect it in an exam.
    • Cogan's Lid Twitch; Lid Twitch
    • Dissociated Nystagmus

    • 2-14
    • Example of a patient with dissociated nystagmus. Demonstrates difference in movements between each eye.
    • Dissociated Nystagmus
    • Latent Nystagmus

    • 2-2
    • Example of a patient with latent nystagmus. Demonstrates a lack of oscillations in forward gaze, followed by the occlusion of each eye, showing how this generates a jerking oscillation in the non-occluded eye away from the occluded eye.
    • Latent Nystagmus; Fusional Maldevelopment Nystagmus Syndrome
    • Monocular Pendular Nystagmus

    • 2-9
    • Example of a patient with monocular pendular nystagmus, with discussion of situations in which this condition is seen: acquired disorder of the visual-sensory pathway, and acquired disorder of the brain stem (e.g. multiple sclerosis).
    • Monocular Pendular Nystagmus; Sensory Nystagmus; Pendular Nystagmus; Acquired Pendular Nystagmus
    • Pulsating Exophthalmos

    • 1-22
    • Example of a patient with neurofibromatosis with an absent sphenoid wing. Shows left eye pulsating back and forth with the pulse from front and side views.
    • Pulsating Exophthalmus
    • Periodic Alternating Nystagmus

    • 2-12
    • Example of a patient with periodic alternating nystagmus, showing an alternation between left-beats and right-beats as the patient maintains forward gaze. Nystagmus maintain horizontal direction regardless of position of gaze.
    • Periodic Alternating Nystagmus
    • Rebound Nystagmus

    • 2-8
    • Example of a patient with rebound nystagmus, where the oscillations alternate direction as the patient shifts gaze in different directions. Discussion of relationship to disease and disorders of the cerebellum, including degenerations of the...
    • Rebound Nystagmus; Gaze-Evoked Nystagmus
    • Rotary Nystagmus

    • 2-13
    • Example of a patient with rotary nystagmus, showing occasional counterclockwise rotary movements of both eyes. Seen more in intrinsic disorders of the brainstem.
    • Rotary (Torsional) Nystagmus
    • See-Saw Nystagmus

    • 2-4
    • Example of a patient with see-saw nystagmus, showing how one eye elevates as the other depresses, with the elevating eye intorting as the depressing eye extorts. Shows vertical oscillations with pendular waveforms. Suggests a large structural...
    • See-Saw Nystagmus
    • Gaze Palsy with Facial Weakness from Pontine AVM

    • NOVEL_Moran_2-6
    • Example of a patient with torsional nystagmus in both eyes and pendular nystagmus in the left eye. Patient is led through instructions for direction of gaze.
    • Gaze Palsy, Facial Weakness, Pontine AVM
    • Duane's Retraction Syndrome Type 3

    • 1-12
    • Example of a patient with Type 3 Duane’s Retraction Syndrome, as well as bilateral Duane’s Syndrome. Shows limitation of abduction in both eyes and adduction in the left eye. Also shows side-view of globe retraction in abduction.
    • Duane's Retraction Syndrome Type 3; Lid retraction
    • Upbeat Nystagmus

    • 2-5
    • Example of a patient with upbeat nystagmus. Shows vertical jerk nystagmus with fast phases in the up direction. Localizes to brain stem, and occurs with strokes, demyelination, and tumors.
    • Upbeat Nystagmus; Blepharospasm
    • Nutritional amblyopia

    • Nutritional amblyopia.pdf
    • Example of patient with amblyopia with nutritional causes.
    • nutritional optic atrophy, Wernicke's encephalopathy
    • Light-Near Dissociation

    • 1-3_5
    • Example of patient with Argyll Robertson pupil with neurosyphilis. Shows a lack of pupillary response to light and some pupillary response to nearness of finger.
    • Light-Near Dissociation; Argyll-Robertson Pupil;
    • Sector Palsies and Light-Near Dissociation

    • 1-3
    • Example of patient with bilateral Adie’s pupils. Exam is performed with a slit-lamp. Shows iris stroma and focal segments of iris sphincter that retain their contractilty. Suggests post-ganglionic parasympathetic denervation.
    • Sector Palsies; Light-Near Dissociation; Bilateral Adie's Pupil; Adie's Tonic Pupil;
    • Bilateral Internuclear Ophthalmoplegia

    • NOVEL_Moran_2-30
    • Example of patient with bilateral internuclear ophthalmoplegia. Patient is led through instructions for direction and distance of gaze.
    • Internuclear Ophthalmoplegia
    • Blepharospasm

    • NOVEL_Moran_2-5
    • Example of patient with blepharospasm. Patient is led through instructions for direction of gaze and opening and closing of eyes. Patient is led through same exercises again after receiving indomethacin treatment.
    • Blepharospasm
    • Cyclic Oculomotor Palsy

    • NOVEL_Moran_2-11
    • Example of patient with cyclic oculomotor palsy.
    • Cyclic Oculomotor Palsy; Cyclical; Cyclic Oculomotor Paresis
    • Downbeat Nystagmus

    • NOVEL_Moran_3a-9
    • Example of patient with downbeat nystagmus. Patient is led through instructions of where to gaze.
    • Downbeat Nystagmus
    • Downbeat Nystagmus

    • NOVEL_Moran_3a-1
    • Example of patient with downbeat nystagmus. Patient is led through instructions of where to gaze. (no audio)
    • Downbeat Nystagmus
    • Duane's Syndrome

    • NOVEL_Moran_2-23
    • Example of patient with Duane’s Syndrome. Patient is led through instructions for pursuit.
    • Duane's Syndrome
    • Facial Myokymia Unilateral

    • 1-20
    • Example of patient with facial myokymia, a disorder of the seventh nerve, probably due to brain stem involvement. Patient has multiple sclerosis. Discussion of characteristics, such as continuous, undulating, contractions in the distribution of the...
    • Superior Oblique Myokymia; Facial Myokymia Unilateral; Facial Myokymia
    • Wall-Eyed Bilateral Internuclear Ophthalmoplegia (WEBINO)

    • NOVEL_Moran_2-17
    • Example of patient with horizontal binocular diplopia. Demonstration of exam, which shows alternating exotropia in cover test. As patient follows object, right eye does not pass the midline as the object moves to the left, while left eye go...
    • Internuclear Ophthalmoplegia, WEBINO
    • Levator Disinsertion

    • 1-26
    • Example of patient with levator disinsertion, a lid disorder. Patient is pregnant and wears poorly fitting contacts. Discussion of characteristics, such as lid ptosis (shown in the left eye of patient), but with full levator function.
    • Levator Disinsertion; Levator dehiscence
    • Marcus Jaw Winking

    • NOVEL_Moran_2-31
    • Example of patient with Marcus Jaw Winking. Patient is led through instructions for movement of jaw (open, close, back and forth), with eyelid seen to be affected. Patient is then led through instructions for direction of gaze and pursuit.
    • Marcus Jaw Winking
    • Before Tensilon

    • 1-24
    • Example of patient with myasthenia gravis. Demonstration of baseline examination, followed by administration of 2mg of tensilon, which is a test dose. Procedure for administration of tensilon test is described, including variations. Patient is then...
    • Myasthenia gravis; Tensilon Test;
    • Ocular Myasthenia

    • 1-23
    • Example of patient with myasthenia gravis. Demonstration of tensilon test. Patient shown to have bilateral ptosis, bilateral duction deficits, and left hypertropia. Discussion of techniques to observe subtle changes, such as bringing in a neutral...
    • Ocular Myasthenia; Myasthenia gravis; Ptosis -- Myasthenic; Tensilon Test
    • Ocular Lateropulsion (Wallenberg's Syndrome)

    • 1-9
    • Example of patient with ocular lateropulsion. Patient also has central Horner syndrome and nystagmus in right gaze. When shifting gaze back to forward, eyes overshoot their mark. Eyes laterally deviate to the right upon opening.
    • Ocular Lateropulsion; Wallenberg's Syndrome; Lateropulsion; Lateral Medullary Syndrome; Posterior Inferior Cerebellar Artery; Wallenberg Syndrome
    • Ocular Myotonia

    • NOVEL_Moran_2-29
    • Example of patient with ocular myotonia. Patient is led through instructions for direction of gaze and opening and closing of eyes. Right eye is shown to be stuck in position after held gaze to the left and right, with very slow relaxation back...
    • Ocular Myotonia; Ocular Neuromyotonia; Dystrophies
    • Progressive Supranuclear Palsy

    • 1-14
    • Example of patient with progressive supranuclear palsy. Discussion of difference between saccadic movement in supranuclear palsy and nystagmus. Shows saccadic intrusions in forward gaze, pursuit, saccades, and doll’s head maneuver.
    • Progressive Supranuclear Palsy
    • Spasm of the Near Reflex

    • 1-13
    • Example of patient with spasm of the near reflex and voluntary nystagmus. Discussion of similar-looking conditions (e.g. six nerve palsy, limitation of abduction, lateral rectus muscle problems) and how to tell them apart from spasm of the near...
    • Spasm of the Near Reflex; Spasm of the near triad; Voluntary Nystagmus
    • Spasmus Nutans

    • 2-3
    • Example of patient with spasmus nutans. Discussion of characteristics of this disorder, such as dissociated or monocular nystagmus, abnormal head position, and to-and-fro head oscillation. Sometimes an eccentric gaze is seen as well (as in...
    • Spasmus Nutans
    • Square Wave Jerks

    • 2-20
    • Example of patient with square wave jerks. Discussion of difference between square wave jerks (saccadic oscillations) and horizontal nystagmus.
    • Square Wave Jerks
    • Third Nerve Palsy, Pupil Involving

    • 1-5
    • Example of patient with third nerve palsy. Left eye shows pupilary involvement. Left eye doesn’t immediately duct, but abducts well, with impaired superduction. Secondary and primary deviations are demonstrated. Anisocoria is more prominent when...
    • Pupil; Third Nerve Palsy; Third nerve dysfunction
    • Unilateral Blepharospasm

    • NOVEL_Moran_2-16
    • Example of patient with unilateral blepharospasm.
    • Blepharospasm
    • Vestibular Nystagmus

    • NOVEL_Moran_3a-22
    • Example of patient with vestibular nystagmus. Patient is led through instructions for direction of gaze. Shown also with Frenzel goggles.
    • Vestibular Nystagmus
    • Voluntary Nystagmus

    • 2-22
    • Example of patient with voluntary nystagmus. Discussion of how a lack of uniform, patterned movement of the eyes along with associated lid movements suggests that activity is voluntary.
    • Voluntary Nystagmus; Voluntary Flutter
    • Paradoxical Constriction of Pupils to Darkness (Flynn Phenomenon)

    • 1-4
    • Example of patients both with and without paradoxical constriction of pupils. Observed in many congenital retinal disorders, such as achromatopsia, congenital stationary night-blindness, and Leber’s congenital amaurosis. Sometimes seen in optic...
    • Pupil; Flynn Phenomenon
    • Congenital Nystagmus

    • 2-1
    • Example of patients with congenital nystagmus. First patient’s nystagmus are mostly jerk and not pendular. Second patient’s nystagmus are mostly pendular. Both patients show a uniform horizontal oscillation. Second patient also shows...
    • Congenital Nystagmus
    • 3-33b - Papilledema Stages

    • 3-33b
    • Grading Papilledema: Stage 2 = Elevation of the disc margin 360 degrees. Since the blood vessels at the disc margin are not swollen or obscured, this disc could be mistaken for pseudo-papilledema.
    • Papilledema Stages; Raised Intracranial Pressure
    • Stages of Papilledema

    • Stages of Papilledema
    •  
    • Papilledema Stages; Raised Intracranial Pressure

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