Why Do I Need to See a Neuro-ophthalmologist?

These doctors are specialists with expertise in problems of the eye, brain, nerves, and muscles.

Neuro-ophthalmologists are doctors who treat visual problems that are usually related to the nervous system. These doctors or physicians are specialists with expertise in problems of the eye, brain, nerves, and muscles.

A patient may have been advised to see a neuro-ophthalmologist if they have vision loss or vision problems due to optic nerve injury. The optic nerve is a bundle of nerve fibers that are part of the central nervous system. They transfer visual information from the retina to the brain. When the optic nerve is squeezed due to injury or mass/cancers, the blood supply and ability of the nerve to send the signals to the brain may be impaired.

Below are a few common conditions for which neuro-ophthalmologist consultation may be required:

• Papilledema: It is a serious medical condition where the optic nerve at the back of the eye becomes swollen. There is a buildup of pressure in or around the brain, which causes the optic nerve to swell causing visual disturbances, headaches, and vomiting. Medications are used to reduce the pressure inside the skull. Sometimes brain surgery may be required if the increased pressure is due to tumor growth.
• Optic neuropathy: This is a condition in which the optic nerve is damaged leading to a loss of vision. It may be due to diabetes, cancer, toxins, or other causes. The treatment is done to find and eliminate the underlying cause.
• Optic neuritis: This a condition in which swelling near the optic nerve interferes with the function of the optic nerve. Symptoms may include pain with eye movement and temporary vision loss. Antibiotics and corticosteroids are usually prescribed to flush out the infection or suppress the immune disorders from causing further damage.
• Tumors: Brain tumors and orbital tumors that may be causing vision disturbances require consultation with a neuro-ophthalmologist.
• Stroke: A stroke is a medical emergency. It occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells may begin to die in minutes, and this can be fatal if left untreated.
• Seizures: Seizures are characterized by the sudden contraction and stiffening of the muscles. Often a person's eyes may roll back into their head, and as the chest muscles tighten and contract, it may become more difficult to breathe. These seizures are short in duration and usually last less than 20 seconds. Repetitive seizures may be fatal if left untreated.
• Ptosis: Drooping or falling of the upper eyelid is called blepharoptosis or ptosis. The drooping may be worse after being awake for a long time when the individual's muscles are tired.
• Blepharospasm: It is a rare condition in which the eyelid may blink or twitch involuntary. This is usually caused by muscle spasm around the eye.
• Nystagmus: Also called dancing eyes. In this condition, a patient may have involuntary (or voluntary, in some cases) eye movement, acquired in infancy or later in life, that may result in reduced or limited vision.
• Multiple sclerosis (MS): Multiple sclerosis is an autoimmune disease (the immune system mistakenly attacks its own body) in which the immune system attacks the central nervous system (spinal cord and brain) by damaging, sometimes even destroying, the protective sheet (myelin) around the nerve fibers. Due to this condition an individual might develop problems with vision, balance, muscle control, and other bodily functions. Doctors might prescribe pain killers, antidepressants, steroids, and other drugs like muscle relaxants, tranquilizers, or botulinum toxin (Botox), to ease muscle spasms and make MS attacks shorter and less severe.
• Diabetic neuropathy and retinopathy: In this condition, the optic nerve and retina may be damaged due to excessive blood sugar levels or diabetes. As the disease progresses, the blood supply to the retina gets cut off, leading to vision loss. Since the underlying cause is diabetes, it is essential to treat diabetes before it further damages the nerve and other blood vessels.
• Unexplained headaches: Few patients may present with recurrent severe headaches that do not give enough relief with primary treatment.

These conditions are usually diagnosed through physical examination, blood tests, or by various imaging tests, such as CT scans or MRIs.