• complete vs. partial
• pupil vs. non pupil involving

• congenital due to birth trauma or neurologic syndrome
• kids- post viral infection, trauma, tumors
• adults- ischemia/microvascular problem (MAJOR), aneurysm, trauma, tumors

• ptosis
• ophthalmoplegia EXCEPT lateral down gaze
• enlarged pupil

MUST LOOK FOR OTHER NEUROLOGIC DEFICITS OR OTHER CN PALSIES!!!

• myasthenia gravis
• graves disease

BOTH are type 2 hypersensitivities

• evaluation- good ophthalmic examination with emphasis and pupil rxn
• work up- imaging (esp. if pupil involved)
• labs- blood sugar
• check bp
• good prognosis for microvascular abnormalities

• anything that could weaken superior oblique
  • usually trauma or microvascular diagnosis

• evaluation- ophthalmic exams, labs (fasting blood sugar), check bp, MRI if doesnt resolve
• prognosis- good for microvascular diagnosis (usually resolves within 3-4 mnths)

• etiology
  • 0-15 yrs- intracranial tumors
  • 15-40 yrs: MS, misc.
  • over 40: microvascular diagnosis
• complain of horizontal binocular diplopia

• differential- Graves, MG
• evaluation
  • history, neuro-opth. exam
  • imaging
  • bp and blood sugar
  • lumbar puncture if suspect increased intraocular pressure

• treat underlying cause
  • ex: if HTN, decrease bp
  • ex: decrease ICP
  • decrease blood sugar
• observe and can patch one eye

• def.- systemic disease of neuromuscular junction
• symptoms
  • muscle weakness
  • hallmark variability and fatigability
• cause- Ab's to ACh R's in striated muscle

• asymptomatic
• ptosis
• diplopia
• strabismus

• mainly in females
• increase incidence of thyroid disease or other autoimmune diesae
• 90% have ocular involvement and 75% have initial manifestation

• evaluation
  • anti-ACh receptor Ab;s
  • thyroid function test
  • CT of chest
• tensilon test

• oral AChE
• steroids
• surgery for thymoma

• cause- optic disc swelling caused by increased ICP
• symptoms
  • asymptomatic
  • HA
  • nausea
  • diplopia
  • altered mental status
  • any neurologic defects

• NI or decreased vision
• decreased color vision
• disc edema
• hemorrhages
• cotton wool spots

• mass
• pseudotumor
• venus sinus thrombosis
• meningitis

head MRI

lumbar puncture

• def.- unilateral or bilateral loss of vision in an otherwise anatomically normal eye
• cause
  • strabismus (most common)
    • in kid with constant misaligned eyes leading to inhibition of visual input to deviate eye
    • mechanism to suppress double vision
  • uncorrected refractive error
  • deprivation

• def.- white pupil
• causes
  • decrease vision
  • eye turn
  • abnormal eye size
• causative agent
  • cataract
  • retinoblastmoa
  • retinopathy
  • toxoplasmosis
• need to evaluate and treat to prevent amblyopia

• def.- glaucoma from birth to 3 months age
• caused by increase intraocular pressuree
• associated with tearing, photophobia, blepharospasm
• symptoms
  • decrease vision
  • cornea edema
  • enlarged eye
• treatment- medical or surgical to prevent vision loss