The Neuro-Ophthalmic Examination

The neuro-ophthalmic examination combines ophthalmic and neurologic techniques to assess the patient's vision, pupillary function, ocular motility, eyelids, orbits, fundus appearance, and neurologic status. In most cases, after obtaining the history, the examiner should have already formed an opinion regarding the possible localization and differential diagnosis. The examination then either supports or refutes these initial impressions; examination findings may also prompt consideration of other diagnoses. In this chapter, the major elements of the neuro-ophthalmic examination are reviewed, and in each section, disorders that affect them are mentioned briefly. The neuro-ophthalmic examination in comatose patients is also reviewed. The reader should then refer to the appropriate chapters for more detailed differential diagnoses and discussions of the pathologic disorders.