Series Editors Ashok Garg MS PhD FIAO (Bel) FRSM FAIMS ADM FICA
International and National Gold Medalist Chairman and Medical Director Garg Eye Institute and Research Centre 235-Model Town, Dabra Chowk
Hisar-125 005, India
Emanuel Rosen MD
Medical Director Rosen Eye Associates Harbour City, Salford Quays
M50 3 BH United Kingdom
Editors Arturo Perez Arteaga MD
Medical Director Centro Oftalmologico Tlalnepantla Dr Perez-Arteaga Vallarta No. 42 Tlalnepantla, Centro Estado de Mexico
54000, Mexico
Jawahar Lal Goyal MD DNB
Professor of Ophthalmology Guru Nanak Eye Centre Maulana Azad Medical College (MAMC)
New Delhi 110 002 India
Foreword Marcel PM Ten Tusscher
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Instant Clinical Diagnosis in Ophthalmology—Neuro-ophthalmology
© 2009, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2009
9788184486636
Typeset at JPBMP typesetting unit
Printed at Ajanta Press
4To
- My Respected Param Pujya Guru Sant Gurmeet Ram Rahim Singh Ji for his blessings and motivation
- My Respected Parents, Teachers, my wife Dr Aruna Garg, son Abhishek and daughter Anshul for their constant support and patience during all these days of hard work
- My dear friend Dr Amar Agarwal, a renowned International Ophthalmologist for his constant support, guidance and expertise
—Ashok Garg
- The memory of my step daughter Nicola Ross who enjoyed benefits from refractive surgery were cut short by a tragic fatal illness.
—Emanuel Rosen
- I dedicate my work to all the people in the world having ophthalmic diseases, with the best wishes that we can improve our quality of care. I also dedicate this opus to Prof Ashok Garg, because he has trusted in my work many times.
—Arturo Perez Arteaga
- Dedicated to my parents, my wife Kusum and my children Roopali and Nikhil.
—Jawahar Lal Goyal
5Contributors
- Amar Agarwal ms, frcs, frcophth
- Consultant
- Dr Agarwal's Eye Hospital
- 19, Cathedral Road
- Chennai-600 086, India
- Ankur Sinha md
- Senior Registrar
- Strabismology, Glaucoma and Neuropthalmology Services
- Dr RP Centre for Ophthalmic Sciences
- All India Institute of Medical Sciences (AIIMS)
- New Delhi-110 029, India
- Arturo Perez Arteaga md
- Medical Director
- Centro Oftalmologico Tlalnepantla
- Dr Perez-Arteaga Vallarta No. 42
- Tlalnepantla, Centro
- Estado de Mexico 54000
- Mexico
- Ashok Garg ms, phd, fiao (bel), frsm faims, adm, fica
- Chairman and Medical Director
- Garg Eye Institute and Research Centre
- 235-Model Town, Dabra Chowk
- Hisar-125 005, India
- Athiya Agarwal md, do, frsh
- Consultant
- Dr Agarwal's Eye Hospital
- 19, Cathedral Road
- Chennai-600 086, India
- Emanuel Rosen md, frcs
- Rosen Eye Associates
- Harbour City, Salford Quays
- M50 3 BH, United Kingdom
- Eva Moreno md
- Clinica Moreno Alguacil
- San Pascual 47
- Aranjuez 28300, Spain
- Federico Moreno md
- Clinica Moreno Alguacil
- San Pascual 47
- Aranjuez 28300, Spain
- Garrett Smith md
- Moran Eye Center
- University of Utah
- 50, North Medical Drive
- Salt Lake City, Utah-84132, USA
- Hemalini P Samant ms, doms, mrf
- Pediatric Ophthalmologist
- Jaslok Hospital
- Conwest Jain Clinic Group of Hospitals, Mumbai, India
- Jasneet Kang ms
- Senior Resident
- Guru Nanak Eye Center
- Maulana Azad Medical College (MAMC)
- New Delhi-110 002, India
- JL Goyal md, dnb
- Professor of Ophthalmology
- Guru Nanak Eye Center
- Maulana Azad Medical College
- Joao Nassaralla md
- Goiania Eye Institute
- Department of Retina and Vitreous Surgery, Goiania
- GO, Brazil
- Kirit K Mody ms, frcs, frco
- Consulting Eye Surgeon
- Salil Eye Clinic and Contact Lens Centre
- 506, Om Chambers, Kemps Corner
- 123, August Kranti Marg
- Mumbai-400 036, India
- Marcel PM Ten Tusscher md, phd
- Professor of Neuro Ophthalmology
- University Hospital Antwerp
- Belgium
- Maria T Depena md
- Clinica Moreno Alguacil
- San Pascual 47
- Aranjuez 28300, Spain
- Maria T Iradier md
- Clinica Moreno Alguacil
- San Pascual 47
- Aranjuez 28300, Spain
- Mayur Moreker ms
- Fellow
- LV Prasad Eye Institute
- Banjara Hills
- Hyderabad, India
- Nick Mammalis md
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City
- Utah 84132, USA
- Priya Narang ms
- Consultant
- Narang Eye Clinic
- Ahmedabad, India
- P Ramesh dmrd, mnams
- Director
- Liberty Scans
- Chennai, India
- Rajeev Gupta ms
- Grewal Eye Institute and Research Center, SCO 168–169
- Sector 9-C
- Chandigarh, India
- Ritika Sachdev ms
- Senior Resident
- Dr RP Centre for Ophthalmic Sciences
- All India Institute of Medical Sciences (AIIMS)
- Ansari Nagar
- New Delhi-110 029, India
- Rohit Saxena md
- Additional Professor of Ophthalmology
- Dr RP Centre for Ophthalmic Sciences
- All India Institute of Medical Sciences (AIIMS)
- New Delhi-110 029, India
- Sachin Mehta ms
- Guru Nanak Eye Center
- Maulana Azad Medical College (MAMC)
- New Delhi-110 002, India
- Sameer Narang md
- Consultant
- Narang Eye Clinic
- Ahmedabad, India
- SH Lee md, frcs, faao
- Consultant Ophthalmologist
- Central Square Unit 255–4231
- Hazel Bridge Way
- Richmond
- SK Narang md
- Consultant
- Narang Eye Clinic
- Ahmedabad, India
- SPS Grewal md
- Director
- Grewal Eye Institute and Research Center, SCO 168–169
- Sector 9-C
- Chandigarh, India
- Sneha Kataria md
- OD Class 2012
- New England College of Optometry
- Boston, USA
- Sunil Moreker md
- Consultant Ophthalmologist
- PD Hinduja National Hospital and Medical Research Centre
- Veer Savarkar Marg, Mahim
- Mumbai-400 016, India
- Sunita Agarwal ms, do, psvh
- Dr Agarwal's Eye Hospital
- 19, Cathedral Road
- Chennai-600 086, India
- 15, Eagle Street
- Langford Town
- Bengaluru, India
- Swati Phuljhele ms
- Registrar
- Dr RP Centre for Ophthalmic Sciences
- All India Institute of Medical Sciences (AIIMS)
- New Delhi-110 029, India
- Vishram Sangit ms
- Department of Ophthalmology
- Guru Nanak Eye Center
- Maulana Azad Medical College (MAMC)
- New Delhi-110 002, India
About half of the afferent fibers carrying information about the external world enter the human brain via the visual system. This shows the remarkable importance of the perception of sight. We all know the comparison between the eye and a camera, suggesting that the eye feeds the brain with detailed pictures of the external world. Immanuel Kant, however, already knew that we cannot know for certain what actually is out there. Our senses react to stimuli that come from the outside world, but we only have knowledge of how they appear to us after processing by our senses and brain.
Kant distinguishes between the world of noumena, which is the world of things—as they are, and the world of phenomena, which is the world of things—as it appears to us. What the eye forwards to the brain, indeed are mere aspects and hints of impressions that make our vivid visual experience all the more amazing. The brain interprets many rough parallel representations of the world in such a way that it apparently can provide us with the information we seem to need. The visual system is one of the best studied areas of the human brain and every year thousands of newspapers concerning the visual system and Neuro-ophthalmology are published. Besides the progress in knowledge of sensory information processing, the increasing knowledge of the control of eye movements also contributes to the understanding of how the brain works. This progress in Neuroscience has been matched by a comparable increase in research and understanding of pathological conditions. Furthermore, understanding the systems itself and its diseases, Neuro-ophthalmological disorders often are an important clue to the localization of a disease process. Therefore, Neuro-ophthalmology covers an enormously broad range of physiology and pathology of the brain and the eye.
The present book on Neuro-ophthalmology contains 5 sections which subsequently deal with anatomy and physiology, clinical investigations, pathology of the sensory visual pathways, eye movement disorders, non-organic diseases and the autonomic nervous system. All these aspects are covered by several experts in the field of Neuro-ophthalmology. Dr Ashok Garg from India has teamed up with several experts from all over the world to realize this ambitious project.9
The resulting book edited by Dr Ashok Garg, Dr Emanuel Rosen, Dr Arturo Perez Arteaga and Dr Jawahar Lal Goyal will help the clinicians diagnose many often challenging and hard to diagnose disorders.
I am sure it will be of interest to ophthalmologists, neurologists and residents in training and I do hope that more and more clinicians are stimulated to be interested in Neuro-ophthalmology and that this book will trigger their curiosity in the subject.
Marcel PM Ten Tusscher md phd
Consultant, Laurentius Hospital Roermond
The Netherlands Consultant in Neuro Ophthalmology
University Hospital Antwerp, Belgium
Professor in Neuro Ophthalmology
University Hospital Antwerp
Wilrijkstraat 10
2650 Edegem, Belgium
Tel. +31-475382606
Fax +31-475382659
email: m.tentusscher@lzr.nl
email: marcel.ten.tusscher@uza.be
10Preface
In modern day, busy and fast life ophthalmologists are glued to their clinical and surgical practice and have little time to read large volume books. The need of the hour is to have pocket size ready reckoner enriched with complete and uptodate information of the diseases in a most comprehensive manner. At present, very few quality Ready Reference books are available at an International level.
After detailed research and according to the need of ophthalmologists, we have developed a series of 10 Volume Ready Reference Books termed as Instant Clinical Diagnosis in Ophthalmology. This series covers Oculoplastic and Reconstructive Surgery, Retina, Lens, Glaucoma, Refractive Surgery, Pediatric Ophthalmology, Strabismus, Anterior Segment Diseases, Cornea and Neuro-ophthalmology. This present series has been designed to provide uptodate information of concerned disease in a comprehensive and lucid manner along with high quality clinical photographs in an easy-to-read format. International Masters of concerned subject have contributed chapters in this series covering pathophysiology, clinical signs and symptoms, investigations, differential diagnosis, treatment and prognosis in a simiplified manner.
The present volume provides complete insight into clinical neuro-ophthal-mology, the knowledge of which is essential for every ophthalmologist in their day-to-day practice. This book gives complete information about diagnosis and management of neuro-ophthalmological conditions in a comprehensive manner and covers anatomical, physiological and neurological aspects of various clinical neuro-ophthalmological diseases. It shall serve as ready reference for ophthalmologists worldwide.
We are highly thankful to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, especially Shri Jitendar P Vij (Chairman and Managing Director), Mr Tarun Duneja (Director-Publishing) and all staff members for their dedication and hard efforts put in the preparation of high quality series of Instant Clinical Books.
We hope this 10 volume set of ready reference pocket size books shall provide complete and useful clinical information to ophthalmologists all around the world and shall help them to accurately and precisely diagnose, treat and manage their clinical cases confidently to the satisfaction and expectations of their valued patients. We also hope this Ready Reckoner shall serve as useful companion on every clinician's desk.
Editors