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Four lines got crossed and snarled in the air above our heads, and one dug itself cruelly His thin, brown hair fell in front of big blue eyes that looked at me with.
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The exam takes about one minute per eye. The OCT provides a beautiful cross-section view of the retina, so the doctor can assess its structure and see whether any fluid has leaked from abnormal vessels and accumulated in the retina. These tests involve injection of a dye into an arm vein followed by timed photographs of each eye at intervals for about 15 minutes following the injection.

This enables the doctor to see if any dye is leaking out of the abnormal blood vessels in the retina that might require treatment to protect your vision. These tests are generally very safe, but occasionally some of the dye leaks out of the vein and into the area under the skin near the injection site. This can cause arm pain that is managed with an ice pack.

People, who tend to be allergic to many things, including shellfish, may have an allergic reaction to the dye.


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The fluorescein angiogram will cause your urine to turn a very bright yellow for about one day, as the fluorescein is eliminated from your body. If you have dry macular degeneration, the treatment recommendations may include vitamins, dietary modification, and follow-up visits to monitor your retinal health. It is important to remember that with modern exam techniques and treatments, many people with macular degeneration keep good vision for their entire lives.

This content was last updated on: December 3, The information provided here is a public service of the BrightFocus Foundation and should not in any way substitute for personalized advice of a qualified healthcare professional; it is not intended to constitute medical advice. Please consult your physician for personalized medical advice.

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BrightFocus Foundation does not endorse any medical product, therapy, or resources mentioned or listed in this article. All medications and supplements should only be taken under medical supervision. Also, although we make every effort to keep the medical information on our website updated, we cannot guarantee that the posted information reflects the most up-to-date research.


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These articles do not imply an endorsement of BrightFocus by the author or their institution, nor do they imply an endorsement of the institution or author by BrightFocus. Currently, many patients with wet age-related macular degeneration AMD require monthly injections into the eye to preserve their vision. Those with advanced dry AMD, also called geographic atrophy GA , have no effective treatments available to them. Fortunately, AMD research and drug developments are advancing rapidly to bring patients better treatments. Learn about lifestyle changes that may help prevent age-related macular degeneration.

Learn more about macular edema and how it is related to macular degeneration. As many as 11 million people in the United States have some form of age-related macular degeneration. This number is expected to double to nearly 22 million by We're the leading nonprofit funder of research for the advanced form of macular degeneration.

The first few weeks after a diagnosis can be overwhelming, and leave you with many questions and concerns. If you are managing a new diagnosis, we have a Getting Started Guide that will help you understand and manage your disease. Are you a generous person? The olfactory nerve fibers convey the smell information to the olfactory bulb cells, which then relay the signal via the olfactory tract. The second cranial nerve - also known as the optic nerve - is responsible for the visual information transmission from retina to the brain.

In addition, this nerve constitutes the afferent limb of the pupillary light reflex. The efferent limb of this reflex is composed by the parasympathetic fibers travelling with the cranial nerve III, also known as the oculomotor nerve. The parasympathetic axons synapse at the ciliary ganglion, and the postganglionic fibers innervate the sphincter pupillae muscle.

Thus, both the cranial nerves II and III are required for the pupillary constriction in response to light. This oculomotor nerve also controls the levator palpabrae superioris - a muscle that lifts the upper eyelid. Furthermore, this nerve controls four extraocular muscles - the superior, medial, and inferior recti and the inferior oblique, that function together to move the eyes medially and in the vertical plane.

Cranial nerve IV, the trochlear nerve, innervates the superior oblique muscles, which move the eye downward and outward. And cranial nerve VI, the abducens nerve, innervates the lateral rectus muscles, which are responsible for ocular abduction. Together, these muscles and nerves regulate the movement of the eyes in the six cardinal directions of gaze. Lastly, we will discuss cranial nerve V, also known as the trigeminal nerve. This nerve has three major divisions-ophthalmic, maxillary and mandibular.

The ophthalmic and maxillary branches have purely sensory function, whereas the mandibular nerve is formed by both sensory and motor fibers. The sensory fibers of all three branches relay facial sensation, and the ophthalmic branch also mediates the corneal reflex. The motor fibers of the mandibular division supply the muscles of mastication. After this brief introduction, let's review how to assesses these nerves during a clinical encounter.

As the cranial nerves are symmetrical, every test should be performed on both sides and the findings should be compared. We will start with the examination of the cranial nerve I, the olfactory nerve. Instruct the patient to occlude one nostril with their index finger and close their eyes. Then, hold an odorant, such as coffee granules, beneath the patient's nose, and ask them to identify the smell. Repeat the test on the other side using a different odorant, like mint toothpaste. Next, examine the cranial nerve II, the optic nerve. This part of the examination includes ophthalmoscopy, visual field examination, visual acuity assessment, and testing the pupillary responses, which are also controlled by the cranial nerve III.

Start with the ophthalmoscopic examination. Ask the patient to look across the room at a slightly upward angle. As the patient is doing so, examine their right fundus with your right eye, and note any optic nerve or fundus abnormalities. Similarly, use your left eye to visualize the patient's left fundus. The technique and the potential findings on ophthalmoscopic exam are covered in detail in a separate JoVE Clinical Skills video. Next, perform the visual field test. This term describes the entire area that can be seen during steady fixation of gaze in one direction.

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The visual field for each eye can be roughly divided into four quadrants by the vertical and the horizontal meridians. The upper and lower quadrants are referred to as the superior and inferior quadrants, outer two are the temporal, and inner two are the nasal quadrants.

Start by evaluating the peripheral vision using the direct confrontation technique. Stand about three feet away from the patient, and ask them to fixate their gaze on your nose. Then extend your arms forward and to the sides, such that your hands are in patient's superior and inferior temporal quadrants.

During this test, your hands should be barely visible in your own peripheral vision. Now ask the patient to cover their left eye and continue to fixate their gaze at your nose.

Extraocular Movements (CN III, IV, VI)

Then cover your right eye and quickly wiggle your left index finger in all four quadrants of the patient's open eye, and ask them to identify where the movement occurs. Use your open eye as the control throughout this test. Repeat the same procedure on the other side. Subsequently, assess for the loss of double simultaneous stimulation. Ask the patient to keep both eyes open and let you know if they see one or both fingers moving.

Present to the patient moving fingers in multiple visual fields simultaneously, such as in either upper temporal fields or bilateral inferior fields.

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Next, check the visual acuity using a hand-held card. Ask the patient to wear corrective lenses or non-reading glasses, if normally used. For the test, have the patient cover one eye and read the smallest line they can with the card held about 14 inches away. Record the finding and repeat the same step for the other eye. Next, test the pupillary responses, which can be affected by both-the optic and the oculomotor nerve dysfunction.

Before this test, reduce the room illumination. Then shine a penlight in the direction of the patient's nose taking care not to illuminate the eyes directly. This is done for observing the pupils at rest, for size, shape and equality. Next ask the patient to look across the room and shine bright light directly into each eye. Look for a brisk constriction of the illuminated pupil - the direct response.

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Also observe the simultaneous constriction of the contralateral pupil - the consensual response. If the patient has a disorder such as optic neuritis-as may be seen in multiple sclerosis-the affected eye may have a decreased direct response, but the consensual response is preserved. Next, perform the swinging flashlight test by moving the flashlight between the pupils every two to three seconds and observing for direct and consensual response.

The paradoxical dilation of the illuminated pupil seen during these tests indicates an afferent pupillary defect, also known as a Marcus-Gunn pupil. Subsequently, turn the room lights back on to observe the response to accommodation.

Ask the patient to look into the distance and then focus on your thumb placed closer to their face. Repeat this a couple of times to check for the normal constriction of pupils in response to focusing on an object relatively near to the eyes. To test the eyeball movement in the six cardinal directions of gaze, ask the patient to keep their head steady, and follow your finger with their eyes as you trace an imaginary letter "H" shape.

Normally, the eyes should move together throughout all planes of vision and there should not be any observed eye muscle weakness or development of any double vision. Next, instruct the patient to follow your finger as you move it slowly towards the patient's eyes. Check for convergence by noting if restriction of gaze is present.

After that, move your finger in vertical, and then in horizontal directions and tell the patient to follow your finger with their eyes. Observe for nystagmus - the rapid rhythmic jerking movements of the eye. This may be normal sometimes on the horizontal gaze or as effect of certain medications, but it can also be associated with cerebellar or vestibular dysfunction. Since cranial nerve III also controls the levator palpebrae superioris muscle, ask the patient to focus on a spot and observe the position of the eyelids.

Note if ptosis, which is drooping of the upper eyelids, is present. Ptosis can be associated with lesions of the third nerve, Horner's syndrome, and neuromuscular diseases, such as myasthenia gravis. Next, assess the function of cranial nerve V, the trigeminal nerve. Lightly touch the patient's skin in each of the three areas innervated by trigeminal nerve divisions.