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Neurology

  • Anything can cause ophthalmic disease as ophthalmology comprises the eye and visual system (one third of brain devoted to visual system)

  • Any lesion that interferes with the visual pathways may present to ophthalmologist

  • III, IV, VI cranial nerve palsies

  • Horner’s syndrome

    • Ptosis and meiosis (and anhidrosis)

  • Demyelinating disease

    • Multiple sclerosis -> optic neuritis

  • Myasthenia gravis

    • Ptosis, ocular motility problems

  • Myotonic dystrophy

    • Ocular motility problems and ptosis

  • Horner’s syndrome

    • Right sided ptosis and pupil meiosis

    • Left pupil changes in size between two images – top is looking at bright light, in lower this source is removed; right pupil smaller in both

    • Anisocoria – difference in size of pupils

    • Due to compression of sympathetic chain anywhere along its root

    • Carotid artery dissection is the main concern

  • Pituitary adenoma

    • Pituitary is close to optic chiasm - bitemporal visual field loss

    • (rare in practice, tends to be incongruous temporal hemianopia – slightly different in each eye)

  • Myoclonic dystrophy 

    • Bilateral ptosis

    • Double vision due to problems with eye movements and use of extraocular muscles

    • Systemic features

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