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1 1-1How 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.Relative Afferent Pupillary Defect (RAPD); Examination, Pupillary
2 1-10Duane's Retraction Syndrome Type 1; Lid retractionExample of patients with Duane’s Retraction Syndrome, Type 1. Description of components of Duane’s Syndrome: limitation of abduction, variable limitation of adduction, and palpebral fissure narrowing and globe retraction with attempted adduction. Type 1 includes limited or absent abduction with ...Duane's Retraction Syndrome Type 1; Duane's Syndrome
3 1-11Duane'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.Aberrant Regeneration of the Third and Sixth Nerves; Duane's Syndrome
4 1-12Duane'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.Duane's Retraction Syndrome Type 3; Lid retraction
5 1-13Spasm 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...Spasm of the Near Reflex; Spasm of the near triad; Voluntary Nystagmus
6 1-14Progressive 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.Progressive Supranuclear Palsy
7 1-15OpsoclonusExample 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...Opsoclonus
8 1-15bOpsoclonusExample of patients with opsoclonus, a saccadic abnormality.Opsoclonus
9 1-16Parinaud's SyndromeTwo examples of patients with Parinaud’s syndrome, a dorsal midbrain syndrome. Discussion of hallmarks of this syndrome, including convergence retraction nystagmus, vertical gaze palsies, light-near dissociation, and Collier’s Sign. Discussion of age-dependent disorders associated with this synd...Parinaud's Syndrome; Dorsal Midbrain Syndrome
10 1-17Congenital Ocular Motor ApraxiaTwo examples of congenital ocular motor apraxia. Patients have trouble initiating saccades, and compensate with head movement. Discussion of how to distinguish this condition from simply not seeing well.Congenital Ocular Motor Apraxia
11 1-18Hemifacial SpasmExample of patients with hemifacial spasm. First patient has a sequela of Bell’s palsy, and is seen to have mainly clonic movements around the eye, with occasional tonic movements around the mouth. Second patient has a cerebellopontine angle epidurmoid tumor, and is seen to have movements around t...Hemifacial Spasm
12 1-19Aberrant Regeneration of the Seventh NerveExamples of patients with aberrant regeneration of the seventh nerve. First example is a patient with contractions around the mouth and dimpling, demonstrated with slow and rapid eye blinking. Second example shows contraction around nose with eye blink.Aberrant Regeneration of the Seventh Nerve; Aberrant Regeneration
13 1-2Dilation LagTwo examples of dilation lag (Horner’s syndrome). In the first example, the right pupil dilates much faster than the left pupil when the light is turned out. In the second example, the left pupil dilates much faster than the right pupil when the light is turned out. Discussion of methods of docume...Dilation Lag; Horner Syndrome; Horner's Syndrome
14 1-20Facial Myokymia UnilateralExample of patient with facial myokymia, a disorder of the seventh nerve, probably due to brain stem involvement. Patient has multiple sclerosis. Discussion of characteristics, such as continuous, undulating, contractions in the distribution of the seventh nerve, and a spreading of these movements t...Superior Oblique Myokymia; Facial Myokymia Unilateral; Facial Myokymia
15 1-21Bilateral Facial MyokymiaExample of a patient with a brain stem glioma. Shows bilateral facial myokymia.Bilateral Facial Myokymia; Facial Myokymia
16 1-22Pulsating ExophthalmosExample of a patient with neurofibromatosis with an absent sphenoid wing. Shows left eye pulsating back and forth with the pulse from front and side views.Pulsating Exophthalmus
17 1-23Ocular MyastheniaExample of patient with myasthenia gravis. Demonstration of tensilon test. Patient shown to have bilateral ptosis, bilateral duction deficits, and left hypertropia. Discussion of techniques to observe subtle changes, such as bringing in a neutral observer or taking still photographs. Shows split-scr...Ocular Myasthenia; Myasthenia gravis; Ptosis -- Myasthenic; Tensilon Test
18 1-24Before 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 ...Myasthenia gravis; Tensilon Test
19 1-25Cogan's Lid TwitchExample of a patient with Cogan’s lid twitch, with discussion of how to detect it in an exam.Cogan's Lid Twitch; Lid Twitch
20 1-26Levator DisinsertionExample of patient with levator disinsertion, a lid disorder. Patient is pregnant and wears poorly fitting contacts. Discussion of characteristics, such as lid ptosis (shown in the left eye of patient), but with full levator function.Levator Disinsertion; Levator dehiscence
21 1-28Transillumination - Ciliary Body Neurofibromas1Example of transillumination on a patient with neurofibromatosis, but without Lisch nodules. Shows suspected neurofibromas in the ciliary body.Transillumination; Examination, Ocular; Ciliary Body Neurofibromas1; Neurofibromatosis1
22 1-29Transillumination - 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...Transillumination; Examination, Ocular; Lisch nodules; Neurofibromatosis1
23 1-3Sector 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.Sector Palsies; Light-Near Dissociation; Bilateral Adie's Pupil; Adie's Tonic Pupil
24 1-3_5Light-Near DissociationExample of patient with Argyll Robertson pupil with neurosyphilis. Shows a lack of pupillary response to light and some pupillary response to nearness of finger.Light-Near Dissociation; Argyll-Robertson Pupil
25 1-4Paradoxical 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.Pupil; Flynn Phenomenon
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