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Nerve-related vision problems

Nerve-related vision problems

  • About
  • Symptoms
  • FAQ

Neurological conditions can affect your eyes and vision and have a big impact on your daily life. Your eyes receive visual information, but it’s actually your brain that interprets the information and allows you to ‘see’ the image. Your brain also controls your eye movements and focus.

A neuro-ophthalmologist performs comprehensive examinations to diagnose and treat a range of conditions that can affect the brain and nervous system. Some of these are listed below.

  • Myasthenia gravis is a chronic autoimmune neuromuscular disease that affects the connection between the nerves and eye muscles.
  • Brain tumours and strokes can damage the blood supply to the eyes or optic nerves. Some brain tumours may put direct physical pressure on the eye or associated structures.
  • Giant cell arteritis is an inflammation of the arteries, which can cause sudden blindness in one or both eyes if the arteries supplying the eyes are affected.
  • Thyroid eye disease is an autoimmune process, where the body’s own antibodies attack the tissue and muscles around the eyes.
  • Optic neuritis occurs when the optic nerve becomes inflamed, interfering with the transmission of signals from the eye to the brain. It is often associated with multiple sclerosis, but may also occur with infectious and other inflammatory disorders.
  • Idiopathic intracranial hypertension (previously known as pseudotumour cerebri) results from a buildup of cerebrospinal fluid around the brain, causing increased pressure in the skull and swelling of the optic nerves. Recent weight gain is strongly associated with this condition, as are antibiotics in the tetracycline family and acne medications derived from Vitamin A.
  • Multiple sclerosis is a progressive disorder of the central nervous system and can affect the optic nerves, resulting in visual distortion and loss.

If you have any of the following symptoms, have your eyes checked by an optometrist or GP:

  • Problems moving your eyes
  • Double vision in one eye (monocular) or both eyes (binocular)
  • Bumping into objects
  • Involuntary shaking of the eyes (nystagmus)
  • Sudden change in pupil size or unequal pupils
  • Loss of vision
  • Sudden onset of headache

What does a neuro-ophthalmologist do?

A neuro-ophthalmologist is an ophthalmologist who has undertaken further specialist training in brain and nervous system disorders that affect the eye and vision.

Why is my vision affected after a stroke?

A stroke can damage the blood vessels that supply the brain and optic nerve, resulting in loss of vision. The nerves that make the eyes move can also be damaged. The type of vision loss depends on the part of the brain affected by stroke. Some people experience blurred vision, double vision or a loss of side (peripheral) vision.

Are blind spots and blurred vision signs of multiple sclerosis?

Blind spots and blurred vision are symptoms of many eye conditions. Multiple sclerosis can only be diagnosed after a range of tests. Consult your optometrist or GP if you have any issues with your eyes or vision.

When should I see a neuro-ophthalmologist?

Your doctor or optometrist may decide to refer you to a neuro-ophthalmologist if they suspect a neurological disorder is contributing to your loss of vision or eye problems.

References

For a full reference list, visit the neuro-ophthalmology FAQ page.

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Initial examination

At the first visit, your neuro-ophthalmologist will conduct a comprehensive examination, which may take more than an hour. The aim is to obtain a detailed history of your problem, any relevant medical conditions, and to conduct neurological and eye tests. If you have had recent CT scans or MRI, please bring your films along.

Depending on your condition, eye drops may be used to dilate your pupils during the examination.

A range of test may be conducted to assess your:

  • Vision and visual fields
  • Eye movements
  • Colour vision
  • Eye pressure and size
  • Retina and optic nerve
  • Other cranial nerves

Vision and visual fields will be checked for each eye. You may be asked to look at an object and describe any missing or blurry areas. A common way to test your peripheral vision is to get you to focus on a target in front of you while a light flashes at your side. One eye is tested at a time and you press a button every time you see the flash.
An ophthalmoscope exam allows your neuro-ophthalmologist to quickly assess the internal structures of your eye, including the optic nerve. More detailed studies may also be performed, such as an optical coherence tomography (OCT) scan.

You may need to have blood tests to check for an underlying medical condition, such as diabetes, high blood pressure, a stroke or a neurological condition (e.g. myasthenia gravis).

A CT or MRI scan may be able to detect a structural cause for your symptoms. An MRI of the brain is often used to check for multiple sclerosis. Sometimes, a lumbar puncture (spinal tap) is required to assess if an infection or inflammation has caused elevated pressure in your brain (e.g. with idiopathic intracranial hypertension).

Treatment options for nerve-related vision problems

The treatment recommended by your neuro-ophthalmologist will depend on your specific condition.

Some recovery may be possible after a stroke.1 Recovery after the removal of a brain tumour depends on the initial vision loss and the extent of the surgery. Visual field deficits due to inflammation may resolve spontaneously or with medication.2
Double vision may also resolve by itself. An eye patch is sometimes used to reduce the occurrence of double vision. If it is a permanent problem, surgery may be suggested.3
Vision loss due to optic neuritis usually reverses within 3 months.4 If appropriate, your neuro-ophthalmologist may prescribe medication to try and reduce the risk of developing multiple sclerosis, which is often associated with optic neuritis.2
Idiopathic intracranial hypertension may require surgery to relieve pressure on the brain. If recent weight gain has contributed to the condition, a weight-loss program may also be advised.5

References

1. Stroke Foundation. Vision loss after stroke fact sheet [Internet]. Melbourne (VIC): Stroke Foundation; [date unknown] [cited 2021 Jan 28]. Available from: https://strokefoundation.org.au/What-we-do/For%20survivors%20and%20carers/stroke-resources-and-fact-sheets/Vision-loss-after-stroke-fact-sheet
2. Johns Hopkins Medicine. Optic neuritis [Internet]. USA: The Johns Hopkins Hospital; [date unknown] [cited 2021 Jan 28]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/optic-neuritis
3. Brigham Health. Double vision [Internet]. Boston (MA): Brigham and Women’s Hospital; [date unknown] [cited 2021 Jan 27]. Available from: https://www.brighamandwomens.org/neurology/neuro-ophthalmology/double-vision
4. Better Health Channel. Eyes – optic neuritis. Available from: http://www.betterhealth.vic.gov.au/health/conditionsandtreatments/eyes-optic-neuritis [Accessed 27 September 2022].
5. Cedars-Sinai. Idiopathic intracranial hypertension [Internet]. USA: Cedars-Sinai; [date unknown] [cited 2021 Jan 28]. Available from: https://www.cedars-sinai.org/health-library/diseases-and-conditions/i/pseudotumor-cerebri.html

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Resources

The information on this page is general in nature. All medical and surgical procedures have potential benefits and risks. Consult your ophthalmologist for specific medical advice.

Date last reviewed: 2024-07-25 | Date for next review: 2026-07-25

Have a question?

IMPORTANT: If you are concerned about your eyes and require an urgent consultation, DO NOT use this form. Please call one of our clinics during office hours or contact your nearest emergency department.

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