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Introduction of the Ophthalmic Examination

A major role of the central nervous system is in visual perception and co-ordination of eye movement. Hence, disorders of the central nervous system may present with visual signs including: drop in visual acuity, constriction of visual field and binocular diplopia.

The neuro-ophthalmic examination involves assessment of both anatomical and functional elements of the visual and oculo-motor systems. The aim is to identify signs of potentially vision- or life-threatening disorders of the central nervous system.

Presenting conditions can be divided into three main categories:

  • Disorders of the visual pathway
  • Disorders of pupil size and reaction
  • Disorders of ocular motility

Together with video tutorials, the following sections aim to familiarize the reader with a complete neuro-ophthalmic examination as well as equip him or her with a methodical approach to assessing patients in the primary-care setting. Described techniques do not require specialized instruments and hence can be easily performed by every medical practitioner. The following examination skills will be assessed in the junior clerkship, senior clerkship and specialty clerkship clinical assessments. Common pitfalls from students of previous years are discussed to enlighten readers.

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