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1 OpsoclonusExample of patients with opsoclonus, a saccadic abnormality. Discussion of characteristics of opsoclonus, such as involuntary, rapid, brief, random, conjugate saccades. Discussion of possible causes, including brain stem encephalitis (as in first patient), a paraneoplastic effect, tumors, and drug t...Image/MovingImage
2 Spasm of the Near ReflexExample of patient with spasm of the near reflex and voluntary nystagmus. Discussion of similar-looking conditions (e.g. six nerve palsy, limitation of abduction, lateral rectus muscle problems) and how to tell them apart from spasm of the near reflex by observing the myosis evoked by the near respo...Image/MovingImage
3 Duane's Retraction Syndrome Type 3Example of a patient with Type 3 Duane's Retraction Syndrome, as well as bilateral Duane's Syndrome. Shows limitation of abduction in both eyes and adduction in the left eye. Also shows side-view of globe retraction in abduction.Image/MovingImage
4 Internuclear Ophthalmoplegia (2 examples)Two examples of patients with internuclear ophthalmoplegia. First patient has a right internuclear ophthalmoplegia. Patient had subacute bacterial endocarditis with a bacterial abscess in the brain stem. Ductions and gaze to the right look good, but when gazing to the left, the right eye does not ad...Image/MovingImage
5 Progressive Supranuclear PalsyExample of patient with progressive supranuclear palsy. Discussion of difference between saccadic movement in supranuclear palsy and nystagmus. Shows saccadic intrusions in forward gaze, pursuit, saccades, and doll's head maneuver.Image/MovingImage
6 Ocular Lateropulsion (Wallenberg's Syndrome)Example of patient with ocular lateropulsion. Patient also has central Horner syndrome and nystagmus in right gaze. When shifting gaze back to forward, eyes overshoot their mark. Eyes laterally deviate to the right upon opening.Image/MovingImage
7 Aberrant Regeneration of the Third and Sixth NervesImage/MovingImage
8 Rebound NystagmusExample of a patient with rebound nystagmus, where the oscillations alternate direction as the patient shifts gaze in different directions. Discussion of relationship to disease and disorders of the cerebellum, including degenerations of the cerebellum, infarction, and demyelination.Image/MovingImage
9 Monocular Pendular NystagmusExample of a patient with monocular pendular nystagmus, with discussion of situations in which this condition is seen: acquired disorder of the visual-sensory pathway, and acquired disorder of the brain stem (e.g. multiple sclerosis).Image/MovingImage
10 Duane's Syndrome Type 2: Aberrant Regeneration of the Third and Sixth NervesExample of a patient with Type 2 Duane's Syndrome. Demonstrates limitation of adduction in left eye with normal abduction. Discussion of limited pathological cases.Image/MovingImage
11 How to Measure the RAPDThis clip demonstrates the examination technique for measuring the Relative Afferent Pupillary Defect (RAPD). Demonstration of balancing an afferent papillary defect using filters in a patient with a resolving optic neuritis and an afferent papillary defect on the left.Image/MovingImage
12 Aberrant Regeneration of Third Nerve, Bilaterally (1 degree OD, 2 Digrees OS)Example of patient with bilateral aberrancy of the third nerve. Shows lids popping up (synkinetic) with adduction. Patient had bilateral internal carotid artery aneurisms with third nerve compression.Image/MovingImage
13 Superior Oblique MyokymiaExample of patients with superior oblique myokymia, a saccadic intrusion. First patient is seen to have intermittent, intorting movements with superimposed slight vertical deviations in right eye. Discussion of disorder as benign, but frequently disabling, as patients experience episodes of diplopia...Image/MovingImage
14 Binocular Pendular NystagmusExample of a patient with binocular pendular nystagmus. Patient has somewhat dissociated nystagmus, with nystagmus seen more prominently in the left eye. Patient shows an occasional jerk nystagmus to the right in the right eye. Left eye oscillations are mostly pendular.Image/MovingImage
15 Periodic Alternating NystagmusExample of a patient with periodic alternating nystagmus, showing an alternation between left-beats and right-beats as the patient maintains forward gaze. Nystagmus maintain horizontal direction regardless of position of gaze.Image/MovingImage
16 Vestibular NystagmusDiscussion of vestibular nystagmus. Seen with peripheral disorders and central disorders, and in two varieties: spontaneous and positional. Horizontal jerk with small amplitude.Image/MovingImage
17 Ocular FlutterTwo examples of patients, the first with rotary, flutter-like movements, but not ocular flutter, and the second with genuine ocular flutter. Discussion of difference between ocular flutter and nystagmus, and how to elicit ocular flutter.Image/MovingImage
18 Physiologic (End-Gaze) NystagmusDemonstration of physiological nystagmus, where oscillations do not represent pathology, but occur when the patient's gaze is drawn too far laterally.Image/MovingImage
19 Rotary NystagmusExample of a patient with rotary nystagmus, showing occasional counterclockwise rotary movements of both eyes. Seen more in intrinsic disorders of the brainstem.Image/MovingImage
20 Brun's NystagmusObservation of patient with Brun's Nystagmus. Shows patient gazing to the right and the nystagmus beating in the direction of the gaze.Image/MovingImage
21 Dissociated NystagmusExample of a patient with dissociated nystagmus. Demonstrates difference in movements between each eye.Image/MovingImage
22 Before TensilonExample of patient with myasthenia gravis. Demonstration of baseline examination, followed by administration of 2mg of tensilon, which is a test dose. Procedure for administration of tensilon test is described, including variations. Patient is then shown after being given 4mg of tensilon, with very ...Image/MovingImage
23 Transillumination - Lisch nodulesDemonstration of transillumination of the Lisch nodules on a patient with neurofibromatosis. Shows how Lisch nodules that were not very visible in slit-lamp examination are better seen with transillumination, which may therefore be useful in detecting Lisch nodules earlier in children where they are...Image/MovingImage
24 Sector Palsies and Light-Near DissociationExample of patient with bilateral Adie's pupils. Exam is performed with a slit-lamp. Shows iris stroma and focal segments of iris sphincter that retain their contractilty. Suggests post-ganglionic parasympathetic denervation.Image/MovingImage
25 Paradoxical Constriction of Pupils to Darkness (Flynn Phenomenon)Example of patients both with and without paradoxical constriction of pupils. Observed in many congenital retinal disorders, such as achromatopsia, congenital stationary night-blindness, and Leber's congenital amaurosis. Sometimes seen in optic nerve disorders, such as dominant optic atrophy.Image/MovingImage
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