Ophthalmic Education:

International Curriculum Guidelines on Medical Student Education in Ophthalmology: 4. Neuro-Ophthalmology

On this page:

• i) Anatomy**
  
  
• ii) Neuroimaging**
  
  
• iii) How to examine the patient*
  
  
• iv) How to interpret findings
  
  
• Competencies*
  
  
• Educational Priorities

The International Council of Ophthalmology Task Force on Medical Student Education in Ophthalmology

Draft, September 16, 2003

I. Anatomy**

1. Bony Anatomy
   
2. Vascular Anatomy
   
3. Afferent Visual Pathways
   
4. Ocular Motor Pathways
   
5. Facial Motor and Sensory Anatomy*
   
   1. Trigeminal Nerve*
      
   2. Facial Nerve*
6. Ocular Autonomic Pathways
   1. Sympathetic Pathways
      
   2. Parasympathetic Pathways

II. Neuroimaging**

1. Glossary
   
2. History
   
3. Basics of MRI
   
4. Fundamental Concepts in Localization

III. How to examine the patient*

1. Visual acuity testing*
   
2. Visual field testing ? confrontation*
   
3. Extraocular motility*
   1. strabismus
      
   2. limitation movement of one eye
      
   3. limitation of gaze (both eyes affected similarly)
      
   4. nystagmus (spontaneous jerking eye movements)
4. Direct Ophthalmoscopy*

IV. How to interpret findings

1. Pupillary disorders
   1. dilated pupil*
      
   2. tonic pupil**
      
   3. afferent pupillary defect*
      
   4. unilateral small pupil**
2. Neuro- motility abnormalities
   1. cranial nerve palsies*
      (1) III nerve
      (2) IV nerve
      (3) VI nerve
   2. other cranial nerve palsies**
      (1) V cranial nerve
      (2) VII cranial nerve
   3. Myasthenia Gravis**
      
   4. Intranuclear ophthalmoplegia**
      
   5. Nystagmus**
3. Optic nerve disease
   1. Optic disc elevation
      (1) Congenital anomalous disc elevation**
      (2) Papilledema*
      (3) Papillitis**
      (4) Ischemic optic neuropathy**
   2. Amaurosis fugax**
      
   3. Optic atrophy**
      
   4. Visual field defect **
4. Glossary
   1. Scotoma***
      
   2. Hemianopia*
      
   3. Homonomous hemianopia*
      
   4. Bi-temporal hemianopia*

Competencies*

• Student should
  • Measure visual acuity with near card
    
  • Perform confrontation visual field testing in four quadrants in each eye
    
  • Test pupillary function and be able to recognize afferent pupillary defect
    
  • Perform ductions and versions and recognize cranial nerve palsies III, IV, VI
    
  • Recognize and diagnose nystagmus
    
  • Exam the optic disc with the direct ophthalmoscope and recognize optic nerve pallor and papilledema

Educational Priorities

In the listing above, essential ophthalmic knowledge and clinical eye care skills are marked with a single asterisk *. This material is basic for all international medical student education.

Information that reflects a greater level of understanding is marked with two asterisks**.

Areas of cognitive and clinical skills that are more appropriate for students who seek further training in ophthalmology are marked with three asterisks***.

While important to ophthalmic care, the Task Force does not regard the cognitive or skill set designated ** or *** as essential to the basic curriculum of most international medical students.

Next: 5. Retina Vitreous

Also see:

• Introduction to the "International Curriculum Guidelines on Medical Student Education in Ophthalmology"
  
  
• Table of Contents for the Curriculum
  
  
• Education of Medical Students in Ophthalmology