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Acetylcholine receptor antibodies in the diagnosis of ocular myasthenia gravis at the Manchester Royal Eye Hospital
Myasthenia gravis (MG) is the commonest autoimmune condition to affect the neuromuscular junction. In the UK, its prevalence is 15 per 10,000 [1,2] and recent studies have shown that rates are steadily increasing [3,4]. Aims of this audit The aim...
Demyelinating optic neuropathy
Introduction Optic neuritis (ON) is an inflammatory process affecting the optic nerve. After glaucoma, it is the most common optic neuropathy affecting patients under the age of 50. The usual presentation of typical ON is unilateral subacute loss of vision...
Supranuclear ocular motility disorders
Figure 1: Bilateral INO Introduction Complex ocular motility disorders are a diagnostic challenge. These patients come with very complex ocular motility presentations and require a careful and detailed assessment in order to find the correct diagnosis and arrange appropriate investigations....
Traumatic optic neuropathy
In neuro-ophthalmology we get asked a lot about management of patients who suffered significant trauma and presented with loss of vision secondary to presumed traumatic optic neuropathy (TON). TON happens usually in the context of significant craniofacial trauma. The incidence...
Idiopathic intracranial hypertension (IIH)
IIH is a medical condition where the intracranial pressure (ICP) is raised without an obvious cause. The cerebrospinal fluid (CSF) is produced in by the choroid plexus in the lateral ventricles and the roof of the third and fourth ventricles,...
Cavernous sinus syndrome
Anatomically the cavernous sinus is a plexus of multiple veins that are connected and within this plexus there are several important vascular and neurological structures. These include cranial nerves III, IV, V1 (and sometimes V2), VI as well as the...
It’s not always GCA
Giant cell arteritis (GCA) is an immune mediated granulomatous inflammatory disease that affects muscular middle or large sized arteries. It is considered as a continuation of polymyalgia rheumatica (PMR) when the severity of the disease has increased. It is the...
Ophthalmology in the COVID-19 pandemic
The novel coronavirus pandemic has affected the whole world and forced all of us to think of new ways to manage our day to day personal as well as professional life. I am not going to talk about the clinical...
Non-organic visual loss
Patients can present to eye departments with various signs and symptoms (mostly symptoms) with no obvious organic cause. These patients can be labelled with any of a wide range of diagnoses such as functional visual loss, functional overlay, psychosomatic reaction...
Sixth nerve palsy versus decompensating distance esophoria
Orthoptists see a wide range of conditions that can range from reduced binocular single vision (BSV) that may be solved with exercises, to more extreme neurogenic cases requiring further intervention. Because of this variety, it is important to be able...
Typical or surprisingly uncharacteristic presentations of neuro-ophthalmic emergencies
Irrespective of geographical location or patient cohort, emergency departments are high risk locations capable of inspiring extreme anxiety and dread in patients and doctors alike. The stress multiplies when a walk-in or referred case is suspected of underlying neurological pathology....
Headaches in ophthalmology (part 2)
Ophthalmologists see a large number of patients with headaches or facial pain in the ophthalmic outpatient clinics or in emergency clinics. Over two articles, I will discuss several causes of headaches, ocular manifestations and proposed management and referral options. It...
