The neuro-ophthalmological examination is one of my personal favourites.

Afferent neuro-ophthalmology - CN 2 and its connections

Visual acuity - distant and near
Colour vision 
Contrast sensitivity
Automated perimetry 
IOP assessment 

I rely on ophthalmology for all this.

Personally I only do direct fundoscopy to look at the optic discs and the macula +/- dilated study to look at the retina and confrontation perimetry to since the automated variety does not go beyond the central 30 degrees of vision.

Efferent neuro-ophthalmology - CN 3,4 and 6 and their connections

Ductions of each eye (by closing the other eye) to assess for supraduction, infraduction, abduction, adduction, extorsion and intorsion.

Then I check the primary position for saccadic intrusions like square wave jerks.

Versions (where each eye moves together) are tested by making the patient look at the 6 cardinal positions of gaze (see picture) using the H method. If I add the primary position and vertical up and down gaze to the H method, it becomes the 9 cardinal positions of gaze.

Then a test of the supranuclear control systems of gaze.

Saccades - I test the onset, latency and accuracy of volitional saccades. I check reflex/memory guided and antisaccades as needed. If I am pressed for time, I test the versions with volitional saccades only.

Smooth pursuit - this needs a target and I use the H method. 

Vestibulo-ocular reflex - I test the angular horizontal visually guided VOR rapidly using the bedside HIT +/- slow VOR or oculocephalic response if I am thinking of CANVAS

Optokinetic nystagmus - OKN without a full field stimulus is basically smooth pursuit and hence you need an OKN drum. I will have to buy one.

Lastly I finish off with an examination for nystagmus. It is often visible during the rest of the examination but I devote special attention to it since it is so important in neurology.

How do you do it?
Is there a way to streamline this?
Any tips and tricks?

Let me know in the comments below!

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