Neuro-ophthalmology is a subspecialty of ophthalmology that deals with the visual pathways from the eye to the visual cortex of the brain. The optic nerves carry the message of vision from the retina to the occipital cortex of the brain as an electrical current. This pathway, if damaged, results in visual loss. Many processes can affect this visual pathway.

If visual loss cannot be explained with a routine eye exam, it is often the job of the neuro-ophthalmologist to determine if there is a problem with the nerves and visual pathway behind the eye and within the brain. This is a challenging specialty and unique within the domain of ophthalmology.

Neuro-ophthalmology: Conditions

Common conditions treated by neuro-ophthalmologists include:

• Blepharospasm
• Double vision
• Eye movement disorders
• Eye-related migraines
• Multiple sclerosis
• Myasthenia gravis
• Optic neuritis (inflammation of the optic nerves)
• Papilledema (swollen optic nerves due to increased intracranial pressure)
• Pseudotumor cerebri
• Pupil abnormalities
• Thyroid eye disease
• Visual system neoplasia and tumors

Neuro-ophthalmology: Diagnosis

Evaluation includes a detailed history and physical examination. From this initial examination, the neuro-ophthalmologist is often able to formulate a list of possible diagnoses and may order additional testing aimed at identifying a specific disease process or abnormality. Diagnostic tests commonly ordered include:

• Cerebral angiography
• Electrophysiologic testing of the retina or optic nerve
• Laboratory blood studies
• Neuro-imaging (MRI or CT Scan)
• Ocular coherence tomography (OCT) and fundus photography
• Visual field testing

Frequently asked questions

What is papilledema?

Papilledema is a swollen optic nerve due to increased intracranial pressure. Optic nerves can swell for several reasons, including increased pressure, inflammation, infection, trauma and tumors/neoplasia. It is the responsibility of the neuro-ophthalmologist to determine the cause of the swollen optic nerve.

Why does multiple sclerosis cause vision loss?

Multiple sclerosis is a poorly understood disease that causes inflammation of the central nervous system. Since the eyes and visual pathways are part of the central nervous system, they are at risk for problems associated with multiple sclerosis.

What is an optic neuropathy?

An optic neuropathy is damage to an optic nerve from a disease process. A variety of processes can damage the optic nerves, such as genetic or congenital defects, trauma, inflammation, infection and cancer. Depending on the process affecting the optic nerve, treatment options may be available to save vision. If no treatment options are available, it is still useful to understand the diagnosis or cause of nerve damage so that a visual prognosis can be determined.