Ophthalmology clinical videos

SOURCE:mrcophth.com

Ocular motility examinations and abnormalities
Nystagmus examination File size: 1.5MB This video shows the basic technique for examining a patient with nystagmus. The patient has bilateral pendular nystagmus due to congenital macular scars possibly caused by toxoplasmosis. Ocular movement (basic examination) File size: 2.8MB Unless told otherwise begin with a cover and alternate cover test for near and distant fixation. Examine the eye in the nine cardinal positions of gaze. Do not forget to perform horizontal and vertical saccades. Special thanks to Miss D. Louis FRACO for the demonstration. Prism cover test (right esotropia) File size: 3.4MB This is a common request in part II OSE. Before carrying out the test, perform the cover/uncover test and alternate test to ascertain if the patient has eso- or exo- tropia or phoria. The prism cover test is carried out with the apex pointing in the direction of the tropia or phoria. Performed the prism cover tests for near (using a fixation target) and distant. The end point of the test occurs when there is no eye movement on alternate cover test. This patient has a right esotropia. Abnormal cover/uncover tests File size: 3.4MB Three patients with abnormal cover/uncover tests. First patient had had surgery for infantile esotropia which recurs. The second patient has consecutive exotropia following surgery for esotropia; cover test shows latent nystagmus. The third patient has a left sixth nerve palsy, however; cover/uncover test in the primary shows a right esotropia because the patient is fixating with her left eye. Fourth nerve palsy File size: 3.3MB Fourth nerve palsy may present as cover/uncover test or ocular motility examination. The patient in this video has a right fourth nerve palsy and had had previous right eye surgery. In the primary position, the eyes are orthophoric but not so on lateral gaze and head tilt. Aberrant third nerve regeneration File size: 1.7MB This patient who had had a left third nerve palsy following road traffic accident develops aberrant regeneration resulting in eyelid elevation during downgaze and adduction. Chronic progressive external ophthalmoplegia File size: 2.7MB Two patients with chronic progressive external ophthalmoplegia showing bilateral ptosis and symmetrial ophthalmoplegia.

(basic) File size: 2.9MB
A popular clinical examination. The majority of cases relate to thyroid eye disease.
Special thanks to Mr. Q. Mohammed MRCOphth and Dr. E. Jones MRCP for the demonstration.

Thyroid status examination File size: 2.2MB
This request usually follows orbit examination of a patient with thyroid eye disease. The aim is to look for signs of hyperthyroidism and less commonly hypothyroidism.
Special thanks to Mr. Q. Mohammed MRCOphth and Dr. E. Jones MRCP for the demonstration.

**Eyelid examination and related topics**
Ptosis examination (basic examination) File size: 2.6MB Begin with observation. Measure the palpebral fissure, MRD (margin reflex distance), the skin crease, levator function (by stabilizing the frontalis), Bell's phenomenon and corneal sensation. Special thanks to Mr. N.Glover MRCOphth for the demonstration. Abnormal eyelid position File size:2.5MB Four patients with eyelid malposition are shown. Three cases of ptosis File size: 3.5MB Three patients with ptosis: congenital ptosis, Marcus Gunn jaw-winking ptosis and myotonic dystrophy.

**Pupil examination and abnormalities**
Pupil examination (basic examination) File size: 1.5MB Begin with observation followed by direct and consensual light test. Perform the swinging light test to look for relative afferent pupillary defect. Complete the examination with accommodation test. Special thanks to Miss L.W. Voon FRCS for the demonstration. Pupil examination (abnormal pupil reaction) File size: 1.7MB In this video, a left RAPD, a traumatic right third nerve palsy and a patient with Parinaud's syndrome (with light-near dissociation, the patient also has problem with convergence) are shown.

**Miscellaneous**
Examination of an enucleated socket File size: 2.2 MB Examination of a patient with post-enucleation socket syndrome. Examination of rheumatoid hands File size: 1.9MB This examination usually follows slit-lamp examination in a patient with cornea sign of rheumatoid arthritis. In the examination, find out if the patient can perform common hand functions such as writing, unscrewing bottles and unbuttoning shirt.

NEXT section shows short videos of abnormal facial and ocular movement .

1. Facial nerve synkinesis 446KB ( The patient develops a right facial nerve synkinesis after
recovering from Ramsey-Hunt's syndrome. Note the winking of the right eye with mouth movement.)

2. Hemifacial spasm 183KB ( This patient develops a left hemifacial spasm after recovering from a left
facial nerve palsy. She is also known to suffer from sarcoidosis. Note the contraction of the facial
muscles and eyelid closure. The patient has difficulty in opening the right eye.)

3. Blepharospasm. 1,488KB ( This patient complains of a two-year history of recurrent spasmodic
contraction of both eyelids which has got worse over the year. Slit-lamp examination of the anterior
segment is normal. The spasm is reduced with pre-tarsal botulinum toxin injection.)

4. MÃ¶bius's syndrome 608KB ( The patient has expressionless face and is unable to blow her
cheeks or frown. There is poor eyelid closure despite lateral tarsal strips and medial canthoplasties in
both eyes. The horizontal eye movement is restricted as shown by the need of the patient to move her
head in order to follow the finger. Vertical eye movement is normal. There is also wasting of the tongue
muscles.)

5. MÃ¶bius's syndrome and Poland's anomaly 640KB ( The patient has features similar to video 2.
In addition, she has micrognathia and Poland's anomaly which consists of congenital distal limb
abnormalities with syndactylism and amputation).

6. Congenital exotropia 570KB ( The patient has congenital exotropia with visual acuities of 6/60
in the right eye and 6/6 in the left. She had has two previous operation to correct the right exotropia.
Cover tests show bilateral latent nystagmus worse in the right eye. The left eye also shows DVD -
dissociated vertical deviation. Ocular motility reveals A-pattern exotropia and right superior oblique
underaction.)

7. Partial third nerve palsy 722KB ( This patient developed a sudden onset right ptosis and diplopia.
The pupil was spared. The third nerve palsy was attributed to her diabetes mellitus).

8. Third nerve palsy1,427KB(This patient who suffers from diabetes mellitus and hypertension develops
a sudden onset right ptosis. Examination reveals that the right eye has limited movement in those muscles
supplied by the third nerve. The pupil is not involved. The appearance is that of a medical thrid nerve
palsy.)

9. Left fourth nerve palsy 880 KB(This young girl has a abnormal head posture. The cover/uncover tests
are normal with the head tilted. But with the head in the primary position, there is a
left over right. Ocular motility shows left inferior oblique overaction and poor depression of
the left eye in adduction.)

Ophthalmology clinical videos

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