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301 Optic NeuropathiesRosa A. Tang, MDOptic atrophy might be a false-localizing sign of optic nerve disease, as retinal disease may secondarily produce optic atrophy. In retinitis pigmentosa, for example, patients may exhibit a waxy disc palor. Fundus imaging. Anatomy: Retina. Disease/Diagnosis: Retinitis pigmentosa; Optic atrophy.
302 Acquired Disc ChangesRosa A. Tang, MDOptociliary shunt vessels are venous collaterals that form after chronic venous obstruction. The presence of optic atrophy, progressive visual loss, and optociliary shunt vessels may indicate a compressive optic nerve lesion such as meningioma.
303 Ocular Manifestations of Systemic DisordersRosa A. Tang, MDThyroid eye disease may result in proptosis and restrictive external ophthalmoplegia. The extracoular muscles are often diffusely enlarged with sparing of the tendons.
304 Ocular Manifestations of Systemic DisordersRosa A. Tang, MDThyroid eye disease may cause proptosis and extraocular muscle enlargement that may be seen on orbital imaging studies. In general, coronal images allow the best visualization of the extraocular muscle enlargement. Pair with 94_45 and 94_46.
305 Ocular Manifestations of Systemic DisordersRosa A. Tang, MDThyroid eye disease can result in significant upper eyelid retraction and axial proptosis resulting in exposure keratopathy.
306 Isolated Congenital Optic Disc AnomaliesRosa A. Tang, MDNormally, there is no visible myelination of the nerve fiber layer in the retina. Occasionally, visible myelination occurs that takes on a characteristic white, arcuate, feathery appearance that follows the contour of the nerve fiber layer. Disease/Diagnosis: Myelinated Nerve Fiber.
307 Acquired Disc ChangesRosa A. Tang, MDAlthough optociliary shunt vessels are venous collaterals that form in response to chronic venous obstruction, they may occur in patients with chronic open-angle glaucoma.
308 Neuro-Ophthalmic Imaging-MRIScott Forman, MDThis 23-year-old right-handed man had a history of idiopathic recurrent optic neuritis. The patient presented with acuity of 20/400 OD and 20/100 OS, with a central scotoma OD and a complete temporal defect OS. MRI with fat suppression and gadolinium revealed enhancement of the intracranial nerve an...
309 Neuro-Ophthalmic Imaging-MRIScott Forman, MDThis 23-year-old right-handed man had a history of idiopathic recurrent optic neuritis. The patient presented with acuity of 20/400 OD and 20/100 OS, with a central scotoma OD and a complete temporal defect OS. MRI with fat suppression and gadolinium revealed enhancement of the intracranial nerve an...
310 Neuro-Ophthalmic Imaging-MRIScott Forman, MDThis 23-year-old right-handed man had a history of idiopathic recurrent optic neuritis. The patient presented with acuity of 20/400 OD and 20/100 OS, with a central scotoma OD and a complete temporal defect OS. MRI with fat suppression and gadolinium revealed enhancement of the intracranial nerve an...
311 Chiasmal SyndromesShlomo A. Dotan, MDA 52-year-old, morbidly obese man with a past medical history that included ischemic cardiac disease with a history of angioplasty, COPD, hypertension, and NIDDM, presented with a severe headache. The next day he had a frozen OD, complete right ptosis, and an unreactive middilated right pupil with V...
312 Chiasmal SyndromesShlomo A. Dotan, MDA 52-year-old, morbidly obese man with a past medical history that included ischemic cardiac disease with a history of angioplasty, COPD, hypertension, and NIDDM, presented with a severe headache. The next day he had a frozen OD, complete right ptosis, and an unreactive middilated right pupil with V...
313 Chiasmal SyndromesShlomo A. Dotan, MDA 52-year-old, morbidly obese man with a past medical history that included ischemic cardiac disease with a history of angioplasty, COPD, hypertension, and NIDDM, presented with a severe headache. The next day he had a frozen OD, complete right ptosis, and an unreactive middilated right pupil with V...
314 Chiasmal SyndromesShlomo A. Dotan, MDA 52-year-old, morbidly obese man with a past medical history that included ischemic cardiac disease with a history of angioplasty, COPD, hypertension, and NIDDM, presented with a severe headache. The next day he had a frozen OD, complete right ptosis, and an unreactive middilated right pupil with V...
315 Chiasmal SyndromesShlomo A. Dotan, MDA 52-year-old, morbidly obese man with a past medical history that included ischemic cardiac disease with a history of angioplasty, COPD, hypertension, and NIDDM, presented with a severe headache. The next day he had a frozen OD, complete right ptosis, and an unreactive middilated right pupil with V...
316 Neuro-Ophthalmic Vascular DiseaseSteven A. Newman, MDOcclusion of a branch or central retinal artery may result in acute visual loss. The ophthalmoscopic findings are retinal whitening due to ischemic retina in the distribution of the occluded artery. Sparing or selective involvement of cilioretinal artery branches may occur. Patients with a central r...
317 Neuro-Ophthalmic Vascular DiseaseSteven A. Newman, MDOcclusion of a branch or central retinal artery may result in acute visual loss. The ophthalmoscopic findings are retinal whitening due to ischemic retina in the distribution of the occluded artery. Sparing or selective involvement of cilioretinal artery branches may occur. Patients with a central r...
318 Neuro-Ophthalmic Vascular DiseaseSteven A. Newman, MDOcclusion of a branch or central retinal artery may result in acute visual loss. The ophthalmoscopic findings are retinal whitening due to ischemic retina in the distribution of the occluded artery. Sparing or selective involvement of cilioretinal artery branches may occur. Patients with a central r...
319 Neuro-Ophthalmic Vascular DiseaseSteven A. Newman, MDOcclusion of a branch or central retinal artery may result in acute visual loss. The ophthalmoscopic findings are retinal whitening due to ischemic retina in the distribution of the occluded artery. Sparing or selective involvement of cilioretinal artery branches may occur. Patients with a central r...
320 Traumatic Internal Carotid Artery DissectionSteven Galetta, MDTraumatic dissection of the carotid artery may result in neck pain, an ipsilateral Horner's syndrome (disruption of the pericarotid sympathetic fibers), or ipsilateral arterial occlusions from embolic disease. Pair with images 91_18 and 91_20.
321 Traumatic Internal Carotid Atery DissectionSteven Galetta, MDTraumatic dissection of the carotid artery may result in neck pain, an ipsilateral Horner's syndrome (disruption of the pericarotid sympathetic fibers), or ipsilateral arterial occlusions from embolic disease. Pair with images 91_19 and 91_20.
322 Traumatic Internal Carotid Artery DissectionSteven Galetta, MDTraumatic dissection of the carotid artery may result in neck pain, an ipsilateral Horner's syndrome (disruption of the pericarotid sympathetic fibers), or ipsilateral arterial occlusions from embolic disease. Pair with images 91_18 and 91_19.
323 Ocular Manifestations of Congenital/Inherited DiseasesSteven Galetta, MDThis patient is a 40-year-old man with a history of abetalipoproteinemia (Bassen-Kornweig syndrome), diagnosed at age 9. Neurologic complications have included ataxia, retinal degeneration, peripheral neuropathy, progressive leg weakness, dysarthria, and intermittent bladder incontinence. On his neu...
324 Ocular Manifestations of Congenital/Inherited DiseasesSteven Galetta, MDThis patient is a 40-year-old man with a history of abetalipoproteinemia (Bassen-Kornweig syndrome), diagnosed at age 9. Neurologic complications have included ataxia, retinal degeneration, peripheral neuropathy, progressive leg weakness, dysarthria, and intermittent bladder incontinence. On his neu...
325 Ocular Manifestations of Congenital/Inherited DiseasesSteven Galetta, MDThis patient is a 40-year-old man with a history of abetalipoproteinemia (Bassen-Kornweig syndrome), diagnosed at age 9. Neurologic complications have included ataxia, retinal degeneration, peripheral neuropathy, progressive leg weakness, dysarthria, and intermittent bladder incontinence. On his neu...
326 Ocular Manifestations of Congenital/Inherited DiseasesSteven Galetta, MDThis patient is a 40-year-old man with a history of abetalipoproteinemia (Bassen-Kornweig syndrome), diagnosed at age 9. Neurologic complications have included ataxia, retinal degeneration, peripheral neuropathy, progressive leg weakness, dysarthria, and intermittent bladder incontinence. On his neu...
327 Ocular Manifestations of Congenital/Inherited DiseasesSteven Galetta, MDThis patient is a 40-year-old man with a history of abetalipoproteinemia (Bassen-Kornweig syndrome), diagnosed at age 9. Neurologic complications have included ataxia, retinal degeneration, peripheral neuropathy, progressive leg weakness, dysarthria, and intermittent bladder incontinence. On his neu...
328 Ocular Manifestations of Congenital/Inherited DiseasesSteven Galetta, MDThis patient is a 40-year-old man with a history of abetalipoproteinemia (Bassen-Kornweig syndrome), diagnosed at age 9. Neurologic complications have included ataxia, retinal degeneration, peripheral neuropathy, progressive leg weakness, dysarthria, and intermittent bladder incontinence. On his neu...
329 Neuro-Ophthalmic Manifestations of Brain TumorsSteven Galetta, MDThe patient is a 45-year-old recluse found to harbor this frontal lobe mass. Remarkably, this patient had only mild bilateral optic neuropathies with visual acuities in the 20/25 range. This right disc was mildly swollen and the left mildly pale. He could not fit into the fundus camera for disc phot...
330 Neuro-Ophthalmic Manifestations of Brain TumorsSteven Galetta, MDThe patient is a 45-year-old recluse found to harbor this frontal lobe mass. Remarkably, this patient had only mild bilateral optic neuropathies with visual acuities in the 20/25 range. This right disc was mildly swollen and the left mildly pale. He could not fit into the fundus camera for disc phot...
331 Ocular Manifestations of Congenital/Inherited DiseasesSteven Galetta, MDThis 21-year-old woman had a 2-year history of blurred vision. A computerized visual field demonstrated a temporal defect OS. MRI confirmed a chiasmal mass lesion. The pathology was consistent with hemangioblastoma. Further workup revealed retinal angiomas and multiple other hemangioblastomas of the...
332 Neuro-Ophthalmic Manifestations of Brain TumorsSteven Galetta, MDThe patient is a 45-year-old recluse found to harbor this frontal lobe mass. Remarkably, this patient had only mild bilateral optic neuropathies with visual acuities in the 20/25 range. This right disc was mildly swollen and the left mildly pale. He could not fit into the fundus camera for disc phot...
333 Neuro-Ophthalmic Manifestations of Brain TumorsSteven Galetta, MDThe patient is a 45-year-old recluse found to harbor this frontal lobe mass. Remarkably, this patient had only mild bilateral optic neuropathies with visual acuities in the 20/25 range. This right disc was mildly swollen and the left mildly pale. He could not fit into the fundus camera for disc phot...
334 Neuro-Ophthalmic Manifestations of Brain TumorsSteven Galetta, MDThe patient is a 45-year-old recluse found to harbor this frontal lobe mass. Remarkably, this patient had only mild bilateral optic neuropathies with visual acuities in the 20/25 range. This right disc was mildly swollen and the left mildly pale. He could not fit into the fundus camera for disc phot...
335 Neuro-Ophthalmic Manifestations of Brain TumorsSteven Galetta, MDThe patient is a 45-year-old recluse found to harbor this frontal lobe mass. Remarkably, this patient had only mild bilateral optic neuropathies with visual acuities in the 20/25 range. This right disc was mildly swollen and the left mildly pale. He could not fit into the fundus camera for disc phot...
336 Ocular Manifestations of Congenital/Inherited DiseasesSteven Galetta, MDThis 21-year-old woman had a 2-year history of blurred vision. A computerized visual field demonstrated a temporal defect OS. MRI confirmed a chiasmal mass lesion. The pathology was consistent with hemangioblastoma. Further workup revealed retinal angiomas and multiple other hemangioblastomas of the...
337 Ocular Manifestations of Congenital/Inherited DiseasesSteven Galetta, MDThis 21-year-old woman had a 2-year history of blurred vision. A computerized visual field demonstrated a temporal defect OS. MRI confirmed a chiasmal mass lesion. The pathology was consistent with hemangioblastoma. Further workup revealed retinal angiomas and multiple other hemangioblastomas of the...
338 Systemic Disorders With Optic Nerve and Retinal FindingsSteven Galetta, MDThis fondus image shows a white-centered hemorrhage in a leukemia patient with orbital aspergillosis.
339 Isolated Congenital Optic Disc AnomaliesThomas R. Wolf, MDAn optic pit is a small defect in the optic disc that may be asymptomatic in isolation. Patients may develop an associated serous detachment of the macula. The condition is usually unilateral but may be bilateral. A fluorescein angiogram may demonstrate the serous detachment, and laser photocoagulat...
340 Optic Disc Drusen With AutofluorescenceThomas R. Wolf, MDThis photograph of optic disc drusen demonstrates autoflourescence with flourescein barrier filters in place. Imaging: flourescein barrier filters.
341 Isolated Congenital Optic Disc AnomaliesThomas R. Wolf, MDBenign tumors of blood vessels (hemangiomas) may occur on the optic nerve and may mimic optic disc edema. Disease/Diagnosis: Optic Nerve Hemangioma.
342 Isolated Congenital Optic Disc AnomaliesThomas R. Wolf, MDPatients with hypoplasia of the optic nerve may have normal or subnormal visual acuity or visual field. The condition may be unilateral or bilateral. Optic nerve hypoplasia is usually idiopathic, but maternal diabetes, or maternal use of anti-epileptic drugs or alcohol are predisposing factors. Opti...
343 Isolated Congenital Optic Disc AnomaliesThomas R. Wolf, MDOptociliary shunt vessels are venous collaterals that form in response to chronic venous obstruction, shunting the venous blood from the retinal circulation into the choroidal circulation. Although they may be congenital, they may occur in patients with chronic disc edema, following central retinal ...
344 Isolated Congenital Optic Disc AnomaliesThomas R. Wolf, MDThis optic disc displays multiple drusen. Note the pseudopapilledema here. One can differentiate this from true papilledema in that there is no obscuration of the vessel by the peripapillary nerve fiber layer as they cross the disc margin. This photograph was taken with barrier filters in place, but...
345 Isolated Congenital Optic Disc AnomaliesThomas R. Wolf, MDAn optic pit is a small defect in the optic disc that may be asymptomatic in isolation. The pit can be small or large, and central or peripheral. Disease/Diagnosis: Optic Pit.
346 Optic Disc Drusen Visual FieldsThomas R. Wolf, MDThis is the visual field of patient with optic nerve drusen. Whereas they typically do not cause central field loss, optic disc drusen may cause nerve fiber bundle layer defects and, thus, peripheral field defects, including altitudinal defects (seen inferiorly in the left eye) or arcuate defects (s...
347 Retinal Coloboma Underneath a Relatively Normal Optic NerveThomas R. Wolf, MDOptic nerve colobomas appear as enlarged, white optic discs that are deeply excavated, often with some sapring of the superior rim. They result from an abnormal fusion of the proximal embryonic fissure. Optic nerve colobomas occur unilaterally or bilaterally with a similar frequency and can result i...
348 Isolated Congenital Optic Disc AnomaliesThomas R. Wolf, MDPatients with midline closure defects may exhibit abnormalities in the optic nerve, choroid, retinal pigment epithelium or retina. Anterior closure defects may result in colobomas of the structures of the anterior segment, such as the iris. Disease/Diagnosis: Coloboma.
349 Peripapillary StaphylomaThomas R. Wolf, MDPatients with ectasia of the outer layers of the eye may exhibit a posterior protrusion that appears on funduscopy as an area of deep excavation of the retina (posterior staphyloma). When it occurs around the optic disc, as in this case, it is termed a peripapillary staphyloma. This may occur in ass...
350 Motility DisturbancesThomas R. Wolf, MDThe patient is a 53-year-old man with diplopia from right oculomotor nerve palsy and left hemiparesis (Weber's syndrome), with associated left lung hilar mass. The spinal tap showed pleocytosis consistent with carcinomatous meningitis. This image demonstrates oculomotor nerve metastatic carcinomatos...
351 Ocular Manifestations of Congenital/Inherited DiseasesWilliam Fletcher Hoyt, MDTuberous sclerosis is an autosomal dominant phakomatosis characterized by astrocytic hamartomas of the retina or optic nerve, adenoma sebaceum of the face, periungual fibromas, and astrocytic hamartomas of the brain, with secondary seizures and mental retardation. Disease/Diagnosis: Tuberous Scleros...
352 Isolated Congenital Optic Disc AnomaliesWilliam Fletcher Hoyt, MDThis patient demonstrates bilateral tilted optic discs. Patients with this congenital optic disc anomaly may be asymptomatic or have bitemporal visual field defects that do not respect the vertical midline. Disease/Diagnosis: Tilted Discs.
353 Isolated Congenital Optic Disc AnomaliesWilliam Fletcher Hoyt, MDThis patient demonstrates bilateral tilted optic discs. Patients with this congenital optic disc anomaly may be asymptomatic or have bitemporal visual field defects that do not respect the vertical midline. Disease/Diagnosis: Tilted Discs.
354 Isolated Congenital Optic Disc AnomaliesWilliam Fletcher Hoyt, MDThis patient demonstrates bilateral tilted optic discs. Patients with this congenital optic disc anomaly may be asymptomatic or have bitemporal visual field defects that do not respect the vertical midline. Disease/Diagnosis: Tilted Discs.
355 Isolated Congenital Optic Disc AnomaliesWilliam Fletcher Hoyt, MDThis patient demonstrates bilateral tilted optic discs. Patients with this congenital optic disc anomaly may be asymptomatic or have bitemporal visual field defects that do not respect the vertical midline. Disease/Diagnosis: Tilted Discs.
356 Ocular Manifestations of Congenital/Inherited DiseasesWilliam Fletcher Hoyt, MDImage shows a patient with the Laurence-Moon-Biedl syndrome, an autosomal recessive syndrome characterized by obesity, mental retardation, retinitis pigmentosa (see Image 91_07), polydactyly, and hypogonadism. Pair with 91_07.
357 Ocular Disease With Retinal FindingsWilliam Fletcher Hoyt, MDChoroidal folds may result from choroidal tumors, compression on the eye wall from thyroid ophthalmopathy, orbital pseudotumor, orbital tumor, posterior scleritis, hypotony, scleral laceration, retinal detachment, marked hyperopia, or secondary to papilledema. Intraocular pressure measurements, refr...
358 Isolated Congenital Optic Disc AnomaliesWilliam Fletcher Hoyt, MDThis patient demonstrates bilateral tilted optic discs. Patients with this congenital optic disc anomaly may be asymptomatic or have bitemporal visual field defects that do not respect the vertical midline. Disease/Diagnosis: Tilted Discs.
359 Ocular Manifestations of Congenital/Inherited DiseasesWilliam Fletcher Hoyt, MDImage shows a patient with the Laurence-Moon_Biedl syndrome, an autosomal recessive syndrome characterized by obesity, mental retardation, retinitis pigmentosa, polydactyly, and hypogonadism. Pair with 91_06.
360 Isolated Congenital Optic Disc AnomaliesWilliam Fletcher Hoyt, MDThis patient demonstrates bilateral tilted optic discs. Patients with this congenital optic disc anomaly may be asymptomatic or have bitemporal visual field defects that do not respect the vertical midline. Disease/Diagnosis: Tilted Discs.
361 Ocular Manifestations of Congenital/Inherited DiseasesWilliam Fletcher Hoyt, MDNeurofibromatosis, type 1, is an autosomal dominant phakomatosis characterized by Lisch nodules of the iris (hamartomas) plexiform neurofibromas, café-au-lait spots on the skin, and axillary freckling. Intracranial tumors such as optic pathway gliomas may occur. Disease/Diagnosis: Neurofibromatosis...
362 Ocular Manifestations of Congenital/Inherited DiseasesWilliam Fletcher Hoyt, MDTuberous sclerosis is an autosomal dominant phakomatosis characterized by astrocytic hamartomas of the retina or optic nerve, adenoma sebaceum of the face, periungual fibromas, and astrocytic hamartomas of the brain, with secondary seizures and mental retardation. Disease/Diagnosis: Tuberous Scleros...
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