What is Neuro-ophthalmology?

Neuro-ophthalmology is the sub- specialty of ophthalmology that deals with diseases causing visual problems related to the nervous system. Neuro-ophthalmology, a subspecialty of both neurology and ophthalmology, requires specialized training and expertise in problems of the eye, brain, nerves and muscles. We use almost half of the brain for vision-related activities, including sight and moving the eyes.

In this branch, the patient is evaluated from the neurologic, ophthalmologic and medical aspect to diagnose and treat problems. Costly medical testing is often avoided by seeing a neuro-ophthalmologist. Some of the common problems evaluated by neuro-ophthalmologists include: optic nerve problems (such as optic neuritis, ischemic optic neuropathy, optic disc edema), visual field loss, unexplained visual loss, transient visual loss, visual disturbances, double vision, abnormal eye movements, thyroid eye disease, myasthenia gravis and pupillary abnormalities.


Diplopia

Diplopia is double vision caused by a problem with the muscles that control the eye movements or the nerves that control these muscles. Many conditions can cause diplopia. Diplopia can be a consequence of strabismus especially in adults. Two common conditions that can cause diplopia are cranial nerve palsy and myasthenia gravis. Cranial nerve palsy is more common in diabetics or individuals with high blood pressure, when the blood supply to the nerves controlling the eye muscles is interrupted. Normally the blood supply is restored by the development of collateral vessels and the double vision improves.

Treatment is to patch one eye to relieve the double vision. If the double vision persists, prism glasses are prescribed, or botulinum toxin may be injected into the extraocular muscles. If there is no improvement, eye muscle surgery can be performed.

Myasthenia gravis is an autoimmune disorder where the eye muscles fatigue easily. It is most common in the muscles of the face, eyes, arms, and legs, and in the muscles used for chewing, swallowing, and talking. The common symptoms include drooping of the lids and double vision. Treatment for myasthenia gravis includes, medication, surgery and other procedures. Early detection and treatment of myasthenia gravis is crucial to control the symptoms and preventing serious problems with breathing or swallowing, which require emergency care.


Headache

Headache is one of the most common health complaints. Headaches can include symptoms that may affect vision or your eyes, but they are not directly caused by eyestrain. A thorough examination by the physician is recommended for any chronic or recurring headache. An eye exam by an ophthalmologist may be helpful in some situations. Headaches are caused by a variety of factors and can be divided into the following categories:

Tension headaches

This is the most common type of headache. The pain may be felt in the forehead, temples, neck, or around the eyes. The presumed cause for this type of headache is stress, sleeping or working in unusual positions, clenching jaws, grinding teeth, or chewing gum. While this headache is temporary and can be relieved by usual headache medicines.

Optic neuritis

Optic neuritis is inflammation of the optic nerve. The optic nerve carries impulses from the retina in the back of the eye to the brain and enables the brain to interpret images. This nerve is crucial for vision development. This condition may affect one or both eyes, and symptoms may appear slowly or over a few days. Some of these symptoms include blurred or dim vision, abnormal color vision, or pain in the back of the eye socket or when moving the eyes. These symptoms may get worse with heat or exhaustion. The causes of optic neuritis include multiple sclerosis, viral infections, and Leber’s optic neuropathy. Steroids are sometimes used to treat optic neuritis. In most patients, vision will significantly improve or return to normal with or without treatment.

Eye problems in children are unique and need specialized management. The problems affecting children are quite distinct from those affecting adults.

Every child should undergo an eye examination by the age of 3 years or before attending school as advised by the American Association of Pediatric Ophthalmology and Strabismus (AAPOS).

An eye examination is surely recommended if the child has

  • crossed eyes
  • cannot see the board clearly in class
  • holds objects close to the face
  • has itchy eyes
  • child is premature
  • there is a family history of eye problems


FAQ

1AT WHAT AGE SHOULD CHILDREN HAVE THEIR FIRST EYE EXAMINATION?

It is recommended by the American Academy of Pediatric Ophthalmology and Strabismus, that children should undergo their first eye examination by the age of 3 years. Dr Kulkarni is a chosen member of the American Association of Pediatric Ophthalmology and Strabismus.

2HOW SHOULD I PREPARE FOR THE NEURO-OPHTHALMOLOGY EVALUATION?

When one is going for the evaluation, one should carry all relevant reports, reports of CT and MRI scans and the actual films. Take the complete list of medications to show the neuro-ophthalmologist. Most probably pupils will be dilated to examine the optic disc and fundus.

3WHAT HAPPENS DURING THE EVALUATION?

A thorough history and examination is performed. Complete eye examination is performed followed by special tests like visual field assessment to ascertain the cause of the eye problem.