The Neuro-Ophthalmic History





As in any field of medicine, the neuro-ophthalmic history guides the physician’s examination and differential diagnosis. From the beginning of the history taking, the physician should attempt to categorize the patient’s problem. Table 1.1 , which mirrors the organization of this book, classifies neuro-ophthalmic disorders into three groups: afferent disorders, efferent disorders, and headache and abnormal facial sensations. It can be used as a guide in generating a differential diagnosis. Then, influenced by the patient’s age, gender, underlying illnesses, and disease risk factors, the physician can narrow the list of potential diagnoses and shape the examination to confirm or eliminate each disorder.



Table 1.1

Categorization of Neuro-Ophthalmic Disorders



























































Chapter
VISUAL LOSS AND OTHER DISORDERS OF THE AFFERENT VISUAL PATHWAY
Visual loss: retinal disorders 4
Visual loss: optic neuropathies 5
Optic disc swelling: papilledema and other causes 6
Visual loss: chiasmal disorders 7
Visual loss: retrochiasmal disorders 8
Disorders of higher cortical visual function 9
Transient visual loss 10
Functional visual loss 11
Visual hallucinations and illusions 12
EFFERENT NEURO-OPHTHALMIC DISORDERS
Pupillary disorders 13
Eyelid and facial nerve disorders 14
Eye movement disorders: third, fourth, and sixth nerve palsies and other causes of diplopia and ocular misalignment 15
Eye movement disorders: gaze abnormalities 16
Eye movement disorders: nystagmus and nystagmoid eye movements 17
Orbital disease 18
HEADACHE, FACIAL PAIN, AND DISORDERS OF FACIAL SENSATION 19

These three major groups reflect the table of contents and organization of this book. During the history taking, the examiner should attempt to categorize the patient’s problem into one of these groups.


As the clinician gains experience and sophistication, he or she can frequently diagnose the correct neuro-ophthalmic disorder based on the history alone. For instance, an otherwise healthy young woman with sudden vision loss in one eye with pain on eye movements probably has optic neuritis. An elderly man with hypertension, new binocular horizontal double vision worse at distance and in right gaze, and right periorbital pain most likely has a vasculopathic right sixth nerve palsy.


This chapter reviews the various elements of the neuro-ophthalmic history ( Box 1.1 ) in the context of neuro-ophthalmic disorders. Electronic medical record (EMR) technology allows templates to be constructed using these elements to guide the history taking. However, clinicians should avoid simply cutting and pasting, which is tempting with EMRs, and ensure that the history tells a story.



Box 1.1

The Neuro-Ophthalmic History





  • Chief complaint




    • Age, gender, and major complaint




  • History of present illness




    • Detailing the problem



    • Temporal profile of symptoms



    • Associated symptoms




  • Past neurologic and ophthalmic history



  • Past medical and surgical history



  • Review of systems



  • Family history



  • Social history


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Dec 26, 2019 | Posted by in OPHTHALMOLOGY | Comments Off on The Neuro-Ophthalmic History

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