Neuro-ophthalmology specializes in the intricate relationship of the brain and the visual system. Five of the 12 major nerves in the brain play a role in vision. Nerve diseases and other problems can affect the optic nerve and other pathways that carry vision signals to the brain, or compromise vision by affecting tissues around the eye itself.

OPTIC NEURITIS

Optic neuritis is a condition characterized by inflammation of the optic nerve. This nerve is the pathway that carries impulses from the retina in the back of the eye to the brain and enables the brain to interpret the impulses as images. If the nerves are damaged, vision is greatly affected.

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. If you are experiencing any of these symptoms, see your ophthalmologist for an eye examination.

The causes of optic neuritis are known to be associated with various diseases such as mumps, influenza, measles, multiple sclerosis, Leber’s optic neuropathy (a rare eye condition), or vascular occlusions. However, in many cases, optic neuritis occurs with no known cause.

Steroid drugs are sometimes used to treat optic neuritis. In most patients, vision will significantly improve or return to normal with or without treatment. However, those with a pre-existing condition like multiple sclerosis may not recover their normal vision.

GIANT CELL ARTERITIS (TEMPORAL ARTERITIS)

Giant cell arteritis (GCA), also known as temporal arteritis, is a chronic inflammation of the lining of medium- and large-sized arteries. The cause of giant cell arteritis is unknown. Left untreated it can lead to blindness. Treatment should be initiated as soon as the diagnosis is suspected.

Giant cell arteritis rarely occurs in people below 50 years of age, and it typically begins at around age 70. Women are more likely to develop GCA than men, and Caucasians are affected at a much higher rate than people of other races. People of Scandinavian ancestry are at particular risk. If you have polymyalgia rheumatica, you have an increased risk of having GCA as well.

Symptoms to look for include:

  • flu-like symptoms including headache, fatigue, and fever;
  • blurred vision;
  • double vision;
  • scalp tenderness;
  • jaw pain when chewing food;
  • stiffness or pain in the neck, hip, or arms; and
  • unexplained weight loss

If blood flow to the eyes is restricted by GCA, it can lead to a condition called arteritic ischemic optic neuropathy, which can cause sudden blindness in one or sometimes both eyes. When treated quickly with high doses of corticosteroids (anti-inflammatory medications) before you experience loss of vision, your symptoms will be relieved and chances are excellent that your eyes will not be affected. For this reason, your ophthalmologist may begin treatment before a biopsy can confirm your diagnosis. You may need to take corticosteroids for as long as a few years, though at lower dosage levels.

Major side effects of corticosteroids include:

  • osteoporosis;
  • high blood pressure;
  • muscle weakness; and
  • cataracts.

You should discuss the possible complications of taking corticosteroids and alternative treatment options with your ophthalmologist.

BELL’S PALSY (FACIAL NERVE PALSY)

Bell’s palsy is a disorder of the facial nerve, the seventh cranial nerve. This condition causes partial paralysis on one side of the face, affecting the muscles of facial expression. Bell’s palsy usually occurs in adults and develops suddenly.

Symptoms of Bell’s palsy include the inability to smile on one side or close one eyelid completely, decreased tear production and sense of taste, blurry vision, and distorted hearing.

The causes of Bell’s palsy are varied. In most cases, the cause is never identified, but it is believed that Bell’s palsy often develops secondary to a viral inflammation. Other causes include activation of the body’s immune system and changes in blood flow. Bell’s palsy is more common in patients with diabetes and in pregnant women.

Most of the time, Bell’s palsy disappears on its own after a few months. Eye lubricants may be used to prevent complications. In some cases, corticosteroid or antiviral drugs may be used to help in the treatment of this condition.

DIPLOPIA (DOUBLE VISION)

Diplopia is double vision caused by a problem with the muscles that control the eye or the nerves that stimulate those muscles.

Many conditions can cause diplopia. Double vision is usually a symptom of strabismus (misalignment of the eyes), due to the improper movement of one or more eye muscles. Strabismus is most often found in children, but it can develop later in life. A growth in the eyelid pressing on the front of the eyeball can also cause temporary double vision. Rarely, double vision arises because of an abnormality within the eye, such as a dislocation of the eye’s natural lens.

The onset of double vision in adulthood should be brought to the attention of your ophthalmologist immediately to exclude the possibility of a tumor, aneurysm, or neurological problem. Two of the primary neurological conditions that could cause diplopia are microvascular cranial nerve palsy (MCNP) and myasthenia gravis (MG).

Microvascular cranial nerve palsy, or “diabetic palsy,” is one of the most common causes of double vision in older people. It occurs more often in patients with diabetes and high blood pressure, when blood flow is blocked to one or more of the six eye muscles that control eye movement. Although there is no known treatment for MCNP, the double vision may be treated by patching either eye. If the double vision persists, prism eyeglasses or eye muscle surgery may be prescribed.

Myasthenia gravis is a disorder characterized by muscle weakness, caused by a communication breakdown between the nerves and the muscles due to an autoimmune condition. It is most common in the muscles of the face, eyes, arms, and legs, and in the muscles used for chewing, swallowing, and talking. Double vision is one of the common indicators of myasthenia gravis. Though there is no known cure for myasthenia gravis, there are a number of treatment options to manage the condition, including medication, surgery, and other procedures. If you have MG, physical therapy can help, and you can learn specific coping skills for improving your daily life. Early detection and treatment of MG is crucial to managing the condition and preventing serious problems with breathing or swallowing, which require emergency care.

HEADACHES

Headaches are one of the most common health complaints. They are caused by a variety of factors and can be divided into the following groups:

Tension Headaches

This is the most common type of headache. The pain may be felt in the forehead, temples, neck, or around the eyes. Doctors are uncertain about the cause of this type of headache but believe they are due to stress, sleeping or working in unusual positions, clenching jaws, grinding teeth, or chewing gum. These kinds of headaches are usually temporary and can be relieved by an over-the-counter pain reliever.

Migraine

Migraine headache is a common neurological condition that occurs in about 20% of the population and in 50% of women. Migraine pain is related to activity in the brain that swells blood vessels of the scalp, causing throbbing pain, nausea, sensitivity to light, sounds, or odors, and pain that increases with movement. Migraines can run in families and can affect young children as well. It is not clear how a migraine works, but it is believed that the basic cause is an abnormality of serotonin, which is a chemical used by the brain cells. During a migraine, changes in serotonin levels cause the blood vessels in the brain to constrict. This decreases oxygen supply in the brain. In rare cases, a stroke is possible.

Certain foods like aged cheese, chocolate, red wine, and caffeine may trigger migraines. Hormonal changes during pregnancy, menopause, and menstrual periods also are associated with migraines. People with migraines often have a family history of headaches or prior histories of motion sickness.

Symptoms of migraines include nausea, sensitivity to light or sound, pounding pain, and some visual symptoms, including a blurring spot, an expanding border often described as zigzag lines or shimmering, and vision loss in only one eye. Rare symptoms include double vision or a change in pupil size.

Treatments first seek to avoid any known factors that precipitate a migraine attack, including environmental factors, medications, and food. Medications for migraines may be prescribed. If migraines are severe, medication on a regular basis may be necessary.

Cluster Headaches

Cluster headaches are less common than migraines and affect more men than women. They are called cluster headaches because they come in daily bouts of 30 minutes to two hours and continue for one to two months. These bouts can occur several times a year. The pain is felt on one side of the head, is very severe, and can be accompanied by tearing or red eye on the affected side, sweating, and stuffy nose.

Eye Disease

Eye disease is the least common cause of headaches. Headaches caused by eye disease are usually felt in the eye or brow on the side where the disease occurs. These headaches are often associated with symptoms like blurred vision, halos, and sensitivity to light. Headaches can also be caused by high blood pressure or brain tumors, although headaches caused by brain disease are rare and become dramatically worse over time.

Headaches in general

Headaches can include symptoms that may affect vision or your eyes, but they are not directly caused by eyestrain. A thorough examination by your primary physician is recommended for any chronic or recurring headache. An eye exam by an ophthalmologist may be helpful in some cases.

MULTIPLE SCLEROSIS

Multiple sclerosis (MS) is an autoimmune disease that causes your body to produce antibodies that mistakenly attack the myelin sheath protecting your nerve tissue. This chronic central nervous system disorder damages the nerves and causes the gradual loss of muscle control, strength, and vision.

MS affects people differently. Some have only mild symptoms, while others are severely debilitated by the disease. Symptoms of MS vary widely and can include the following:

  • numbness, tingling, or weakness in the arms and legs;
  • loss of some or all vision, usually affecting one eye at a time;
  • double vision;
  • blurred vision;
  • pain, including eye pain;
  • tremors;
  • coordination difficulties; and
  • dizziness.

If you are experiencing any of these symptoms, it is important to see your doctor immediately. To determine if you have MS, your doctor will take a complete medical history, and you will be given a neurological examination. You might also need an MRI and other tests to diagnose the cause of your symptoms.

Should your doctor confirm that you have MS, there are a number of treatment options. If your symptoms are mild or infrequent, you may require no treatment other than careful monitoring. For more serious cases, there are several medications that can help, as can physical therapy, occupational therapy, and other treatments.

Though there is no cure for multiple sclerosis, the major causes of vision problems associated with the disease are all treatable, and they often resolve on their own. Three common visual problems associated with MS are:

  • optic neuritis, or inflammation of the optic nerve, causing blurring, pain, and blind spots, among other things;
  • diplopia, or double vision; and
  • nystagmus, or involuntary movement of the eyes.

Steroid medications and other medications are commonly prescribed for all three conditions. Patching, prism eyeglasses, and perhaps surgery are also effective in treating double vision. Nystagmus may respond to some medications other than steroids, as well. Over time, your brain may adjust to the appearance of black spots and wiggly lines associated with nystagmus, restoring much of your normal vision.

STROKE

A stroke is a life-threatening emergency in which the blood supply to the brain is interrupted or severely reduced, depriving it of oxygen and killing brain cells. Quick treatment could save your life and minimize damage to your brain.

Major causes of stroke include:

  • high blood pressure;
  • high cholesterol;
  • diabetes;
  • cardiovascular disease;
  • obesity; and
  • smoking.

Symptoms of stroke include:

  • numbness, weakness, or paralysis of your face, arms, or legs—usually on one side of the body;
  • pain between the eyes;
  • blurred vision, double vision, or decreased vision;
  • dizziness, loss of balance, or loss of coordination;
  • severe headache, stiff neck, or facial pain;
  • difficulty speaking or understanding speech;
  • confusion or problems with memory, spatial orientation, or perception; and
  • nausea and vomiting.

If you are experiencing these symptoms, seek immediate medical attention. Receiving treatment within three hours of suffering a stroke is shown to dramatically improve your chances of a successful recovery. REMEMBER ‘FAST’ – Face, Arms, Speech, Time!

There is no treatment for patients who have lost vision due to a stroke. However, you may regain some of the peripheral vision lost from a stroke. Your ophthalmologist will give you a thorough eye examination to determine how the stroke has affected your vision. He or she will talk to you about what to expect over time and can help you find resources and training to make the most of your remaining vision.