Algorithm of the Neuro-ophthalmological Examination Used in the International Practice

Abstract

A neuro-ophthalmological examination is usually required for patients with severe or chronic and/or multiple injuries. This is why the first encounter with the patient is so important. A key part of it is making contact with the patient before the neuro-ophthalmological examination, that is, taking the past medical history, anamnesis. The practical importance of taking the past medical history in neuroophthalmological patients is as high as in any field of clinical medicine. In addition to the conventional ophthalmological examination procedures (e.g., visual acuity, accurate fundoscopy, etc.), patients must always be asked about their visual symptoms. A detailed assessment of the visual symptoms often orients the examiner already in this phase as to which disease group the patient should be investigated for, and it helps clarify the symptoms and determine immediate actions. Unilateral loss of vision, for example, may present with various subjective symptoms, the type and intensity of which may be important information. The history of systemic diseases is just as important, since an underlying medical disease may often be the cause of unilateral loss of vision or sudden-onset double vision. Even with the results of the latest test procedures, the principle is that the test results of dysfunctions due to eye symptoms must be evaluated together, in synthesis, i.e., clinical and test results must be assessed together with the symptoms reported by the patient and the supplementary consultation results, taking their evolution into account, and the patient must always be guided and examined in a target-oriented way during the differential diagnostic process.