Home Treatments Neuro-Ophthalmology

What is Neuro-Ophthalmology?

Neuroophthalmology is a specialised field that bridges the gap between neurology and ophthalmology. It primarily focuses on intricate systemic conditions that manifest within the visual system. One of its core concerns is the optic nerve, which transmits optical signals to the brain. This delicate nerve can be susceptible to damage from various factors such as infections, trauma, or other eye disorders impacting both ocular and cerebral functions. The Neuro-ophthalmology service evaluates patients experiencing a range of symptoms, including double vision caused by factors such as stroke, brain compressive lesions, or Myasthenia gravis. Additionally, it addresses visual impairments arising from neurological conditions like optic neuritis, field defects, pupillary abnormalities, and more.

About Neuro-Ophthalmology Eye Surgery

What Conditions Fall Under Neuro-Ophthalmology?

Neuro-ophthalmology encompasses a wide spectrum of conditions, including:

  • Double Vision
  • Eyelid Abnormalities
  • Microvascular Cranial Nerve Palsy (sometimes referred to as "diabetic palsy")
  • Myasthenia Gravis
  • Optic Nerve Disorders (such as optic neuritis, ischemic neuritis, Leber optic neuropathy)
  • Pseudotumor Cerebri
  • Strabismus
  • Thyroid Eye Disease
  • Brain Tumors
  • Stroke
  • Eyelid Spasms, Drooping of Eyelids, or Hemifacial Spasms
  • Unexplained Visual Loss
  • How Are Neuro-Ophthalmology Cases Diagnosed?

    The diagnosis of neuro-ophthalmological cases entails a comprehensive examination, which includes the following key components:

    Visual Acuity Testing

    Visual Field Testing

    Ocular Motility Examination

    Colour Vision Testing

    Diplopia Charting

    Hess Charting

    X-ray of the Skull

    Visual Evoked Potential (VEP) or Visual Evoked Response (VER)

    Electro-Retinography (ERG)

    Electrooculography (EOG)

    CT Scan or MRI

    Signs & Symptoms

    Transient blurring of vision or transient blackouts

    Double vision

    Sudden drooping of eyelid with inability to move eyes in particular direction

    Frequent headaches

    Visual field defects

    Excessive sensitivity to light

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    Examination of Orbit, Eyelids and Pupil

    The orbits should be inspected and auscultated. Proptosis (eye protrusion) can be assessed clinically by estimating the amount of sclera (white part of eye) visible above and below the limbus (the edge of black circle of eye). Lid retraction is assessed by the amount visible above it. More accurately, proptosis is assessed using an exophthalmometer which measures the distance between the front of the cornea (the transparent outer coating of eye) and the orbital rim for each eye. The normal range for this is less than 21–24 mm (depending on race and sex), but the important thing is that the measurements for the two eyes should be within 2 mm of each other. The range of eyelid movement should be assessed by measuring the palpebral aperture with the eyes looking straight ahead, looking up, and looking down. Pupillary assessment involves eliciting direct and consensual responses to light on both sides. The best way to do this is to have the patient fixate on an object at least 3 m away, and then shine a light at one eye, approaching it from slightly below. Neuro-ophthalmologists collaborate with many other subspecialists, including neurosurgeons, medical oncologists and radiation oncologists. They also collaborate with other ophthalmic specialists, such as ocular oncologists, retina specialists, pediatric ophthalmologists, cornea specialists and oculoplastic surgeons.

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