Two causes of divergence insufficiency – ‘sagging eye’ syndrome and cerebellar dysfunction: This is a 70-year-old patient who was orthophoric at near with a comitant esotropia at distance without abduction paresis, consistent with divergence insufficiency (DI). Walsh & Hoyt’s clinical neuro-ophthalmology: the essentials. Neuro-ophthalmology: diagnosis and management. Carotid-cavernous fistula: current concepts in aetiology, investigation, and management. An update on eye pain for the neurologist. Lee AG, Al-Zubidi N, Beaver HA, Brazis PW. Update on the clinical assessment and management of thyroid eye disease. A new era in the treatment of thyroid eye disease. The other Babinski sign in hemifacial spasm. Practice guideline update summary: botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: report of the guideline development subcommittee of the American Academy of Neurology. Simpson DM, Hallett M, Ashman EJ, Comella CL, Green MW, Gronseth GS, et al. International consensus guidance for management of myasthenia gravis: 2020 update. Narayanaswami P, Sanders DB, Wolfe G, Benatar M, Cea G, Evoli A, et al. Underdiagnosis of posterior communicating artery aneurysm in noninvasive brain vascular studies. Evaluation of Horner syndrome in the MRI era. Treatment of ptosis using brimonidine tartrate for anterior laminectomy-induced Horner syndrome. Or, if your patient has anisocoria and/or ptosis and you do not know where to start and do not have the time to read through the individual sections, begin with the “Help me now!” tables for a symptom (or sign)-based approach. This chapter covers each of these anatomic regions individually, first with an emphasis on the focused history and examination, followed by a case-based approach to the most common disorders. Therefore, the clinician must be able to recognize the most dangerous etiologies, but also those benign etiologies that may only require reassurance. Patients presenting with disorders affecting the pupils, eyelids, or orbits may have a relatively benign etiology (e.g., tonic pupil, levator dehiscence, mild thyroid eye disease), or symptoms/signs may signify a potentially life-threatening disorder (e.g., aneurysmal third nerve palsy, Horner’s syndrome from carotid artery dissection, aggressive orbital fungal infection).
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