Neuro-ophthalmology is an academically-oriented subspecialty that merges the fields of neurology and ophthalmology, often dealing with complex systemic diseases that have manifestations in the visual system. Neuro-ophthalmologists initially complete a residency in either neurology, neurosurgery, or ophthalmology, then do a fellowship in the complementary field. Since diagnostic studies can be normal in patients with significant neuro-ophthalmic disease, a detailed medical history and physical exam is essential, and neuro-ophthalmologists often spend a significant amount of time with their patients.

Common Problems Evaluated by Neuro-ophthalmologists

Although some problems seen by neuro-ophthalmologists are not worrisome, other conditions can worsen and cause permanent visual loss, or become life threatening. Sometimes the problem is confined to the optic nerve or the nervous system and other times it is related to a general medical condition.

Neuro-ophthalmology symptoms and conditions:

• Abnormal eye movements
• Double vision
• Eyelid abnormalities
• Myasthenia gravis
• Optic nerve problems (such as optic neuritis and ischemic optic neuropathy)
• Thyroid eye disease
• Transient visual loss
• Unequal pupil size
• Unexplained visual loss
• Visual disturbances
• Visual field loss

Types of Eye Diseases treated by a Neuro-Ophthalmologist

The common eye diseases that require attention from a neuro-ophthalmologist include:

Optic Neuritis

It is a condition which presents as a sudden onset loss or decrease in vision due to inflammation of the optic nerve. It can be due to an infection, or an autoimmune response. Optic neuritis is often associated with Multiple Sclerosis(MS).

Papilledema

Papilledema is characterized by the swelling of the optic nerve head (the part of the optic nerve which can directly be seen by your eye doctor during a retinal evaluation) due to increased pressure from inside the brain. It may be due to tumors, infections like meningitis, encephalitis, etc.

Toxic or Nutritional Optic Neuropathy

The optic nerve may be damaged due to toxic substances found in tobacco & alcohol. In fact, the optic nerve damage is often due to lack of nutrients and deficiency of vitamin B-complex and folic acid as well. These diseases also present as decreased vision.

Squint or Strabismus

A misalignment of the eye, especially when sudden in onset, and associated with double vision is often due to paralysis of one or more of the small muscles of the eye, and is called paralytic strabismus. The eye shows limitations of ocular movement as well.

Common Tests for Diagnosis and Management of Neuro-Ophthalmology Diseases

A comprehensive eye examination is always the mainstay of the disease diagnosis. In addition to this, your doctor will also advise one or more of these special tests to conclude to plan your treatment. These tests include:

• Orthoptic evaluation
• Evaluation of ocular movements
• Diplopia charting
• Neurological visual fields screening
• Optical coherence tomography of the optic nerve head
• Evaluation of contrast sensitivity and color vision
• Imaging studies including CT scan, MRI and MR venogram
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• Journal Manager Journal of Eye Diseases and Disorderss
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