Neuro-Ophthalmic Disease

TOXIC/NUTRITIONAL OPTIC NEUROPATHY

Signs and Symptoms Due to myriad potential causes, toxic/nutritional optic neuropathy has no clearly identifiable racial, gender or age-dependent predilection.1,2 The condition presents as a painless, often progressive, bilateral, symmetric visual disturbance with variable optic nerve pallor. Temporal pallor tends to be the classic rule. This may manifest as a reduction of visual acuity, which…

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MORNING GLORY SYNDROME

Signs and Symptoms Morning glory syndrome (MGS) is a congenital optic disc anomaly that can be discovered at any age, though most patients are usually made aware of the condition at their first eye examination. The incidence is unknown and the condition is found equally in males and females.1,2 MGS can be either bilateral or…

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LEBER’S HEREDITARY OPTIC NEUROPATHY

Signs and Symptoms Most patients affected with Leber’s hereditary optic neuropathy (LHON) are males in early adulthood with vision loss occurring typically between the ages of 15 and 35.1-7 Ninety-five percent of patients will be affected by vision loss before age 50.3 Rarely, LHON may manifest after age 50.8 LHON affects approximately one in 14,000…

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TILTED DISC SYNDROME

Signs and Symptoms Tilted disc syndrome (TDS) is a unilateral or bilateral congenital optic disc anomaly that may be discovered in patients of any age, with an incidence of 2% in the general population.1 There is neither a sexual predilection nor an identifiable hereditary pattern.1 The ophthalmoscopic appearance is variable.2 In TDS, the disc appears…

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NEURORETINITIS

Signs and Symptoms While neuroretinitis can present in any age group due to several potential causative etiologies, patients are typically younger, and the condition commonly occurs in children. In fact, the majority of patients are under the age of 20.1-13 There is no sexual predilection. Neuroretinitis typically presents as a unilateral, acute, painless loss of…

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HEMIFACIAL SPASM

Signs and Symptoms Hemifacial spasm (HFS) is a facial nerve disorder characterized by episodic involuntary ipsilateral facial muscle contraction. Patients with HFS are typically acutely aware of a painless facial contracture. Half of the patient’s face is usually seen in constant, spastic motion.1,2 The spasms often start in the upper portion of the face and…

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BRAIN AND ORBITAL TUMOR

Signs and Symptoms Brain and orbital tumors may either be primary lesions or the result of metastasis from primary tumors originating elsewhere. Brain tumors can directly and indirectly affect the systemic and visual systems.1-4 They can occur spontaneously and idiopathically or as part of a genetic hereditary syndrome.1-3 When they grow large enough, intracranial masses…

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NEUROMYELITIS OPTICA

Signs and Symptoms Neuromyelitis optica (NMO) was first described by Albutt in 1870, but the term was not applied until 1894 by Devic; hence the alternate name Devic’s disease.1,2 It wasn’t until 2004 that a serologic marker was identified, allowing NMO to be differentiated from multiple sclerosis (MS) rather than being considered a subset of…

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INTERNUCLEAR OPHTHALMOPLEGIA

Signs and Symptoms Internuclear ophthalmoplegia (INO) can present in either the young or old and can be due to various etiologies. Patients with INO generally report a painless visual disturbance involving horizontal diplopia in lateral gaze, but typically no diplopia in primary gaze.1-4 Those who complain of diplopia in primary gaze typically have a concurrent…

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FACIAL NERVE PALSY

Signs and Symptoms The seventh cranial nerve (CN VII, facial nerve) is responsible for the voluntary motor innervation to the muscles of facial expression, the stapedius muscle of the inner ear and for sensory innervation to the anterior two-thirds of the tongue.1–7 The orbicularis oculi, responsible for eyelid closure, is under the control of CN…

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