In Eye Movement Disorders in Clinical Practice, Shirley Wray MD, PhD presents a skillful clinical treatise. This single-authored book shares over 40 years of clinical acumen and expertise garnered by a distinguished clinician and teacher. It is part historical treasure, presenting a personalized account of patients seen by neurology masters and index cases of now widely recognized clinical entities, such as anti-Ri–associated paraneoplastic opsoclonus and part textbook, uniquely presented with practical clinical application.
The 10 chapters are mainly organized by anatomic localization and abnormalities of eye movements or eyelids that result from lesions at that location. For example, the first chapter “How the Brain Moves the Eyes” covers cortical and brainstem control of the various functional classes of eye movements. Case vignettes in this chapter include patients with Alzheimer disease, Balint syndrome, progressive supranuclear palsy, and selective saccadic palsy after cardiac surgery. A chapter entitled “Cranial Nerves Three, Four, Six, and Their Syndromes” systematically describes the anatomy and clinical appearance of lesions of each nerve and a section on multiple cranial nerve syndromes. Cases in this chapter include patients with nuclear third nerve palsy from a midbrain infarct; oculomotor nerve palsies from syphilitic meningitis, microvascular ischemia, and pituitary apoplexy; Duane syndrome; and abducens palsy from a chordoma. Other chapters deal with horizontal gaze and the pons, vertical gaze and the midbrain, vertigo and the medulla, and the cerebellum. All include ample case studies and videos. The last chapter covers nystagmus and ocular oscillations, including upbeat nystagmus from Wernicke encephalopathy, acquired pendular nystagmus in MS, and paraneoplastic ocular flutter and opsoclonus.
Overall, there is emphasis on simplifying each eye movement disorder to an elemental level through exemplary cases analyzing historical and examination components piece by piece. The reader almost achieves the sense of being in the room with Dr Wray examining the patient, getting an individualized teaching session, and solving each case 1 step at a time.
The strength of this book lies in the richness and immediate accessibility of its clinical content, including 56 eye movement videos and frequent use of breakout boxes that summarize clinical points. Navigating the overall structure and format of the book initially proved challenging. However, a few minutes spent on reviewing the layout quickly remedied this.
The clear priority of educating the reader on how to take the most pertinent history, how to examine eye movements, and how to interpret clinical signs in eye movement disorders ensure that this book will prove valuable to all students and practitioners of eye movements from the uninitiated medical student on neurology rounds for the first time to the skilled neuro-ophthalmologist.
Dr Wray concludes the book by emphasizing the importance of the watchful and thorough examiner, which has, and I quote from the book, “in the case of the eye… a special relevance: an eye must meet an eye and understand it more clearly than itself. There is a wonderful paradox in the challenge.”