Tonic Pupil

A tonic pupil is caused by a lesion affecting the postganglionic parasympathetic innervation of the pupil. It can be an incidental finding on examination or associated with visual symptoms, such as photophobia or blurred vision at near. We discuss the common causes and diagnostic evaluation of a tonic pupil in this chapter.

Physiologic Anisocoria

A difference in the size of the pupils (anisocoria) is a frequent finding on physical examination. While often a cause for alarm, it is not uncommonly physiologic and of no concern. In this chapter, we summarize the approach to the patient with anisocoria.

Infantile Nystagmus Syndrome

Formerly known as congenital nystagmus, this form of nystagmus can occur in isolation or in association with other ophthalmic, neurologic, or endocrine abnormalities. While it does not usually cause oscillopsia, it can cause blurred vision. Consequently, affected patients sometimes request treatment. We review the clinical features of infantile nystagmus syndrome and present a contemporary approach to treatment.

Gaze-Evoked Nystagmus

Gaze-evoked nystagmus is the most common type of nystagmus encountered in clinical practice but is poorly localizing. It is often confused with “end-point” nystagmus, which is physiologic and of no concern. In this chapter, we discuss the approach to the patient with gaze-evoked nystagmus.

Migraine Aura

Migraine aura is a common cause of transient positive and negative visual phenomena. Similar symptoms can occasionally occur with occipital lesions or as a manifestation of occipital seizures. In this chapter, we review the clinical features of migraine aura, with specific reference to those features that help distinguish it from occipital seizures.

Disorders of Higher Visual Function

A disorder of higher visual function should be considered when visual complaints are out of proportion to examination findings. Such disorders can remain undiagnosed until other cognitive deficits develop. In this chapter, we review common disorders of higher visual function, with specific reference to the visual (posterior) variant of Alzheimer’s disease.

Pseudopapilledema

A diagnostic dilemma often arises when a patient with headaches is found to have optic nerve head elevation. Anomalous optic nerve head elevation often mimics papilledema and is therefore known as pseudopapilledema. In this chapter, we review the features that help to distinguish pseudopapilledema from papilledema and we discuss common causes of pseudopapilledema, such as optic nerve head drusen.

Compressive Optic Neuropathy

Optic nerve compression results in progressive, and often painless, monocular vision loss. In this chapter, we review the clinical signs and common causes of compressive optic neuropathy. We discuss in more detail the imaging characteristics and management of optic nerve sheath meningioma.

Thyroid Eye Disease

Thyroid eye disease is the most common cause of orbital disease encountered in clinical practice. It often occurs in patients with Graves’ disease, but it is not always associated with abnormal thyroid function. In this chapter, we review the clinical signs, investigation, and treatment of thyroid eye disease.

Benign Essential Blepharospasm

Blepharospasm is an involuntary closure of the eyes that is caused by spasm of the orbicularis oculi. It can be isolated or associated with certain ophthalmic and neurologic disorders. We review the approach to the patient with blepharospasm in this chapter, with emphasis on treatment strategies.