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Super Eye Palsies (Video)

This video shows the cranial nerve palsies that affect the eye … specifically third nerve palsy, fourth nerve palsy, and sixth nerve palsy. You can watch this presentation in full screen and high-definition by clicking the appropriate buttons. If you have problems you can also watch directly at Vimeo, Youtube, or download the video file directly to your computer (links below).

length: 29 minutes

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SuperPalsies.m4v (234 MB)
SuperPalsies720p.m4v (790 MB)

(comments below)

The lecture begins with a review of basic eye anatomy

We then discuss each cranial nerve and their presentation. A blown pupil is always concerning as the parasympathetics travel on the outside of the nerve and are affected by mass lesions and aneurysms.

The sixth nerve innervates only the lateral rectus muscle. High cranial pressure can create a crossed eye.

The superior oblique is particularly confusing. Fourth palsies can create head tilt and are also associated with trauma and congenital agenesis.

Ischemic damage to the peripheral nerves can regenerate because the underlying structure of the nerve is intact. With compressing lesions and trauma, this nerve structure is damaged and aberrant regeneration can occur.

Patient examples are given. In addition, temporal arteritis should be considered in patients over 60-65 years of age.

High intracranial pressure, such as from pseudotumor cerebri, can cause a 6th nerve palsy.

The subjective maddox rod test is demonstrated. Useful for detecting subtle vertical deviations.

The fourth nerve is sensitive to damage because it is long and exits from the dorsal side of the brainstem. Long standing vertical problems can sometimes be detected with an increased vertical fusion amplitude.


Awesomeness! Thanks a bunch!

Comment by Tom — February 10, 2013

Preciously well delivered! Thanks so very much sir! Pls kindly consider doing a video on HOW TO USE THE BINOCULAR INDIRECT OPHTHALMOSCOPE! This is one area that you have NOT touched on in terms of instrumentation usage. Pls sir counting on you so very much as we enjoy all your educative videos. God bless you sir and thanks once again for sharing your knowledge!!!!

Comment by Ozone — February 10, 2013

Excellent as usual. Thanks for sharing such a nicely presented video.

Comment by John Y. Mvula — February 11, 2013

The video being a mix of opthalmo-knowledge and super powers, is awesome way of learning, keep it up sir, its very unique ways of learning difficult things so easily

Comment by Ali Sajjad — February 11, 2013

Thanks for your great effort at this work

Comment by Wael Refaat — February 11, 2013

very nice sir

Comment by rohit — February 11, 2013

Saw this lecture LIVE in Daytona and it was wonderful – best and most concise explanation I’ve heard for these 3 motility disorders.

Comment by Sue — February 11, 2013

This so amazing. I love the effort you put in to simplifying the eye. I was just searching for a good web to understand the eye muscles and I get your email.

This is well explained and has definetly opened the pandoras box on palsies and cranial nerves.

you rock Dr Tim

Comment by maureen — February 11, 2013

Absolutely superb. So easy to understand. It is a pity I could not have seen a lecture like this when I was a student some 50 years ago.
It is a must for any college student.

Comment by Michael Blackstone — February 11, 2013

Thank you very much Dr. Root,
This video is the most interesting the way to learn the nerves and palsies.
I always had struggle to learn and memorize them BUT with this video like every thing were engraved into my brain and will remember them always.

Thank you very much.

Comment by atosa namvar — February 11, 2013

Thank you Dr. Root! Your online book & videos are great, easy to remember lectures! Thank you, thank you, thank you!!!!

Comment by Kym — February 11, 2013

…Well,I can not find the right words for that kind of education. It is great ; it is fun ; it is effective and for me it will be more and more a “addiction” – again – THANK YOU !!

Comment by Peter — February 12, 2013

Dear Dr.Timm thank you very much for your effort to make ophthalmology better and easier, I wish that someday I will be like You, again thanks .

Comment by eyad — February 13, 2013

super LIKE!!!

Comment by pinay_od — February 13, 2013

Thank you for so creative , positiv and interesting Lectures Dr. Root. So easy to learn! i enjoy it!

Comment by afet — February 14, 2013

thank you
your videos are very helpfull for me at my work
as an optician i am often the one that see s the customers for appointments
and many times we need to know if we have and ermegency in front of us
to have the patient seen more quikly
Sight can be dammaged so fast that timming is important

question when dammage has occured the option of working with prismes may be a possibility to use on a portion of the retina that is not dammaged
by making glasses will you treat of that subject in the futur

sorry for my english

again thank you for the help you are spreading


Comment by andrée — February 14, 2013

Love your lectures and have even used one in my lecturing to Medical residents. I am an ophthalmologist. The most recent video “Super Eye Palsies” has a small error when you mention that the 3rd nerve innervates the Lateral Rectus. Thank you for all that you are doing and please don’t stop.
Bob Morello

Tim Root: Thanks Dr. Morello. I picked up on the typo before I uploaded the lecture. This is one of the difficulties with video lectures … it is hard to retract or “fix” these typos as I can’t simply delete that portion of the video. You’ll see that I inserted a “verbal typo” notice hovering over the animation at the moment I made the mistake. Thanks for commenting!

Comment by Robert Morello MD — February 17, 2013

thank for sharing your knowledge.God bless you.

Comment by Papa Mouhamadou — February 17, 2013

thnx a lot ,great lecture,i also find humor a useful way to pass pretty much every thing.

Comment by faten — February 18, 2013

dr roots,
i was n will remain ur biggest fan. u really made ophthalmo an easy subject.
thanks a lot!

Comment by dr. saad bin saif — February 20, 2013

thank you..
feed me more

Comment by mohammed suleiman — February 21, 2013

Thank you for an amazing lecture. I’ve never EVER understood eye palsies as I’m now. Thank you again.

Comment by gader — February 24, 2013

thank you so much

Comment by ati — March 3, 2013

Really good lecture, makes everything so much easier to grasp.

Comment by Arifa — March 14, 2013

Your videos has and continue to make me understand and retain immensely especially difficult and boring topics which are so important as this as mentioned can be life threatening ones. You have out done yourself ones more. So grateful, at the same time you are enjoying yourself too!

Comment by Maria Evangelista — March 15, 2013

I quite apreciate ur contribution in d development of d eye sector.try & upload Neuro-Ophthalmology lecture 2. Tanx

Comment by Dr.Kenneth Nkuche — April 4, 2013

This was fabulous. Thanks a lot.

Comment by Sauradeep Sarkar — June 7, 2013

Thanks a lot. The effect of learning is great.

Comment by Melanie Müller — June 9, 2013

just amazing
your work is soooooooooooooo great really thanks

Comment by magda — June 12, 2013

it is of great help.. thnx a lot

Comment by Ayman — June 14, 2013

you r d best….

Comment by Harbhajan Kaur — June 24, 2013

Not only you are a great teacher, you are also a great videographer! Looking forward to more of your great works.

Comment by Sel — July 1, 2013

You are a very impressive and good teacher….would love to have more tutorial videos from you…yes, indirect ophthalmoscopy is another topic which I am awaiting….Thanks.

Comment by Shuchi — July 7, 2013

With vertical deviations, is a Right Hyper the same as a Left Hypo during cover test? If so, how would you know which eye has the actual palsy?

Comment by Pablo — August 26, 2013

Pablo, you are correct … with small vertical deviations, it is hard to tell which eye has the problem. Using cover-uncover testing, however, you can sometimes tell which eye is deviated (because it is the one that moves to refixate). You may want to watch my tropia/phoria video to see examples of this.

In real life, I’ll often just document what the right eye is doing vertically (hyper,hypo) on paper … and try to figure out the pattern later.

Comment by Timothy Root, M.D. — August 27, 2013

Best lecture ever!
Best regards

Comment by Jonas Upphagen — September 28, 2013

THINK YOU; It’s really great.

Comment by Selmane TA — September 29, 2013

with a trauma injury that is suspected of causing my fourth nerve palsy….does the double vision, etc happen right after the accident or can it get worse over time?

Comment by Cindy — December 8, 2013

thank you so much sir.. awesome work!!!!!!!!

Comment by natasha — February 7, 2014

Fantastic videos! Where have you find the masks?

Comment by Jonas Upphagen — April 7, 2014

ur an actual legend

Comment by Farah — November 10, 2014

Thank you very much!! Great viedo!

Comment by Amy — November 26, 2014

Simple and clear. Thanks.

Comment by Dr Srinivas D R — January 3, 2015

Learning muscles has always made me squeamish. Thank you for providing a go-to.

Comment by Amy — January 7, 2015

Great job!! When will you be adding more topics?
Where do you typically lecture?
Thank you

Comment by Jim — March 31, 2015

Thanks a lot, that was the most interesting eye nerve palsy lecture I’ve seen! Thank you.

Comment by leiluccia — July 30, 2015

great lectures, thanks for this kind of contribution !!!

Comment by dr tiber — October 7, 2015

This is great! Do more! Med.students in Sweden love this!

Thank you sooo much!

Comment by Wilhelm — January 4, 2016

Excellent lecture.
Really enjoyed it.
Great graphics.

Comment by John Grylls — December 22, 2016

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