Neuro-ophthalmology is a subspecialty of ophthalmology which focuses on disorders involving the eye and the brain. Almost half of the brain is used for vision-related activities including sight and eye movement. Neuro-ophthalmologists diagnose and treat visual problems related to disorders involving the nervous system, that is, visual problems that do not come from the eyes themselves.
Neuro-ophthalmologists have unique experience and training in evaluating patients from the neurologic, ophthalmologic and medical standpoint in order to diagnose and treat a wide variety of problems.
Some of the common problems evaluated by neuro-ophthalmologists include: optic nerve disease, unexplained loss of vision, loss of peripheral vision, transient visual loss, double vision, abnormal eye movements, thyroid-related eye disease, unequal pupils, abnormalities of the eyelids and unexplained eye pain.
Common Conditions| • Anisocoria |
| • Anterior Ischemic Optic Neuropathy (AION) |
| • Benign Essential Blepharospasm (BEB) |
| • Hemifacial Spasm |
| • Microvascular Cranial Nerve Palsy |
| • Migraine |
| • Optic Nerve Diseases |
| • Pseudotumor Cerebri |
| • Thyroid Eye Disease |
1. Anisocoria is a condition in which the pupils in the right eye and left eye are not the same size. A small difference in pupil size is normal however, more than a small difference may indicate there is a neurologic problem.
2. Benign Essential Blepharospam(BEB) is a condition in which uncontrolled blinking, squeezing and eyelid closure occur in both eyes without outside stimulation or other apparent cause. It occurs in middle age and affects more women than men.
Symptoms
As the condition progresses, spasms occur more often throughout the day. Although vision is not compromised, frequent spasms may interfere with the patient’s ability to do ordinary tasks such as driving, reading, walking and shopping.
Treatment Options
The most effective treatment for blepharospasm is therapeutic botulinum toxin, called BOTOX. A small quantity is injected under the skin, on both sides of the face, to relax and weaken the muscles in order to prevent spasms. The effect usually wears off in 3 to 6 months and injections may be repeated.
3. Hemifacial spasm is a chronic condition in which patients experience involuntary spasms on one side of the face.
Symptoms
The affected side of the face seems to “scrunch up” while the other side remains normal. These spasms may occur during the night and interrupt sleep. Middle aged men and women are affected equally.
Causes
Spasms can be brief or sustained and sometimes are triggered by facial movement.
Treatment Options
Botulinum toxin, called BOTOX, is an effective treatment for hemifacial spasm. A small amount of BOTOX is injected under the skin at each affected site. Within a few days the BOTOX takes effect, relaxing and weakening the facial muscle and preventing spasm. The injections are done in the doctor’s office and take only 5 or 10 minutes. The effect of the BOTOX usually lasts between 3 and 6 months after which the injections may be repeated.
4. Microvascular cranial nerve palsy is one of the most common causes of acute double vision in older adults.
Causes
It occurs more often in patients with diabetes and high blood pressure.
Symptoms
Symptoms usually result from problems with eye movement and in serious cases the affected eye may not be able to move at all in one or more directions. If the eyes aren’t moving together, the patient experiences blurred or double vision.
Treatment Options
Microvascular cranial nerve palsies recover without medical intervention although anti-inflammatory drugs, such as ibuprofen, may help with any associated pain. Until the double vision resolves, it may be alleviated by patching either eye.
Optic Nerve Diseases(Optic Neuropathy)
The optic nerve is the only nerve in the body that can be directly examined by a doctor. It connects the eye to the brain. The optic nerve can be affected by:| • Inflammation is normally indicated by the rapid onset of the loss of vision and colour vision associated with pain behind the eyes occurring especially during eye movements. Blood investigations and a MRI may be necessary to rule out connective tissue disease and multiple sclerosis. Treatment is with steroids. |
| • Ischaemia (a stroke of the optic nerve) manifests with the rapid onset of painless visual loss. It is most commonly related to hypertension, diabetes, hyperlipidaemia and smoking and treatment is usually directed at controlling them. |
| • Compression occurs due to a tumor or an aneurysm and exhibits slow, progressive, painless visual loss which is usually apparent on CT scan or MRI. |
| • Raised intracranial pressure can occur as a headache with early morning nausea or vomiting, transient loss of vision, or weakness or loss of balance. A CT Scan or MRI imaging and a lumbar puncture to obtain cerebrospinal fluid is usually necessary for analysis |
| • Trauma |
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