neuro-ophthalmology

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Congenital Optic Disc Anomalies

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Funny-looking optic discs are a "fun" diversion in an ophthalmology clinic (sarcasm implied here).  What was initially a routine exam immediately turns into an agonizing "is this normal or not" exercise.  Part of the angst that comes from seeing anomalous optic discs is that some of the congenital disc anomalies are associated with systemic diseases.  If there is concurrent visual field loss or decreased visual acuity, the challenge becomes deciding if those defects in the visual system are due to the anomalous nerve, or if there is some other ophthalmic cause that we don't want to miss.

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Optociliary Shunt Vessels

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Optociliary shunt vessels (retinochoroidal shunts), are normal congenital collaterals between the retinal and choroidal venous circulation.  In conditions that cause chronic central retinal vein obstruction, venous outflow becomes redirected to the choroidal venous circulation, resulting in dilation of these collateral vessels.

Papilledema

Neuro-ophthalmology tends to have some of the more challenging questions, depending on your level of knowledge or comfort with these topics.  One of the important things to recognize and evaluate is the swollen optic nerve.

The 8 Causes of Tunnel Visual Fields

There are relatively few causes for tunnel visual fields (or “gun barrel” visual fields), which is a relatively common finding in neuro-ophthalmology.  There are 8 major categories of tunnel visual fields, which can be determined systematically through careful history and examination.  This differential diagnosis is adopted from Duane’s Clinical Ophthalmology.