About Neuro Ophthalmology
What is neuro-ophthalmology?
Headache, which has existed since the existence of man, is the most common medical complaint and affects more than 80% of the population. One of the causes of headaches is eye-related problems. Patients complaining of headaches are usually referred to an ophthalmologist by another doctor. Neuro-ophthalmology is the branch of science that treats headaches caused by eye diseases and deals with common diseases of the eye and nervous system.
Seeing an object is possible when the image is perceived first in the eye and then in the visual center at the back of the brain. Sudden or progressive vision loss can occur when there is a problem with the visual pathways. In diseases involving eye movements, the main symptom is double vision and the problem may be related to eye muscles, nerves, or control centers in the brain.
- Temporary vision loss
- Double vision
- Sudden vision loss
- Thyroid-related eye disease
- An invisible area in the visual field
- Eye problems due to multiple sclerosis (MS)
- Facial paralysis and facial contractions
- Eye problems due to strokes
- Migraine and similar eye pains
- Droopy eyelid
- Difference in the size of the pupils
Patients with these complaints are in the field of interest of the neuro-ophthalmology department. The patient's medical history is very important for the correct diagnosis of headache and eye pain. Success in treatment is possible with a good relationship between the doctor and the patient and constant monitoring.
MS (Multiple Sclerosis) and eyes
How does MS disease affect the eyes?
Optic nerve inflammation (optic neuritis) is an eye disease that occurs most commonly in women between the ages of 18-45, with unilateral painful vision loss. It occurs in the form of an attack as a result of the deterioration of the immune system. There is also a decrease in color sensation and brightness in the sick eye. In approximately 1/3 of the patients, edema occurs in the anterior side of the optic nerve, and in most cases, involvement of the nerve near the brain (backside) occurs.
With which tests MS disease is diagnosed?
In the diagnosis phase, VEP (Visual Evoked Potential Test), OCT (Optical Coherence Tomography Scanner), nerve fiber view, and computerized visual field examination are used in our clinic. Brain MR imaging reveals an intracranial lesion. The number and shape of these lesions (spots) are important in determining the risk of MS. MS is a chronic brain disorder that continues in attacks.
Optic neuritis may be the first initial manifestation of MS. Optic nerve disease is generally resolved in 3-5 weeks with treatment. However, recurrence can be seen in these optic neuritis attacks. The recurrence rate within 10 years is 35%. Optic neuritis is detected with a probability of 50% at one stage of MS disease and is the first sign of MS in 20% of patients.
The risk of MS after optic neuritis is 30% in the first 5-7 years and 75% in women in the 15-20 years.
MS attacks may occur as optic neuritis, diplopia, loss of balance, numbness in arms and legs, and loss of strength.
In the treatment of optic neuritis, high-dose cortisone application with serum and the use of interferon in cases where the possibility of MS increases are the current approaches.
The course of the disease after optic neuritis can be determined by periodic OCT nerve fiber analysis. If the thinning of the OCT nerve fibers is increasing, the number of plaques in the brain is also increasing. In this disease, follow-up with OCT and VEP tests is very important and instructive.
What are other ocular nerve diseases?
- Vascular occlusion (Intraocular injection can be done)
- Toxication (Ethhambutol and methyl alcohol poisonings are seen most frequently, it can be treated if the patient consults a doctor without delay)
- Hereditary (A new drug has been developed for Leber optic neuropathy)
- Traumatic (It is important to see the patient early)
Alzheimer's and Parkinson's diseases
What is the link between Alzheimer's and Parkinson's diseases and the eye?
Today, Alzheimer's and Parkinson's diseases, which are brain diseases, and glaucoma and macular degeneration (yellow spot disease), which are eye diseases, are considered progressive (neurodegenerative) disorders of nerve tissues. Studies have been started on the common points between them and important information has been reached. OCT examination, which is used in the diagnosis and treatment of glaucoma and macular degeneration, is now also applied in Alzheimer's and Parkinson's diseases.
Which tests are used to diagnose Alzheimer's and Parkinson's diseases?
OCT, which shows diagnostic results in comprehensive eye examinations (for glaucoma, yellow spot, etc.), reveals very specific findings in conditions such as Alzheimer's and Parkinson's diseases and mild unconsciousness. These specific findings are characterized by damage and thinning of certain parts of either the retina or optic nerve fibers. Loss of nerve fibers is important in the early diagnosis of Alzheimer's and Parkinson's diseases. Nerve fiber thinning can be detected by OCT before the deterioration in memory, movement, etc. areas of the brain, and early diagnosis and treatment are possible. OCT imaging of the retina and optic nerve fibers plays an important role in the early diagnosis of the disease in people with certain complaints or a family history of Alzheimer's and Parkinson's disease.
Regular follow-up of diagnosis and treatment with a retinal examination (FAF and OCT) is important for success. Early diagnosis can be made with the retinal examination. In patients who are diagnosed early, treatments to prevent the progression of the disease have been started. Those who have Alzheimer's and Parkinson's diseases in their family history due to genetic factors should have regular eye examinations after the age of 50.
Optic nerve diseases
What are optic nerve diseases?
Optic neuritis (optic nerve inflammation)
Optic nerve inflammation (optic neuritis) is an eye disease that occurs most frequently in women between the ages of 18- 45, usually unilaterally and often with painful vision loss with eye movements. It can occur in the form of attacks as a result of the deterioration of the immune system. There is a decrease in the color sensation and brightness in the sick eye. Edema occurs in the anterior aspect of the optic nerve in approximately 1/3 of the patients. In most cases, involvement of the nerve near the brain (backside) occurs.
In the diagnosis phase, VEP (Visual Evoked Potential Test), OCT (Optical Coherence Tomography Scanner), nerve fiber appearance contrast sensitivity test, and computerized visual field examination are used in our clinic.
Ischemic optic neuropathy
It occurs with edema and blood accumulation in the nerve after capillary occlusions that feed the optic nerve. It is common in patients with hypertension and diabetes. An intraocular injection may be necessary for its treatment.
Optic nerve toxicity
It is most commonly seen in ethambutol (a drug used in the treatment of tuberculosis) and methyl alcohol (cologne, moonshine, etc.) poisonings. If the patient consults a doctor without delay, it can be treated.
Hereditary optic neuropathy
Leber optic neuropathy is maternally inherited bilateral vision loss. A therapeutic or vision-enhancing drug has been put into use for this disease abroad.
Traumatic optic neuropathy
It develops after a direct blow to the eye or head trauma. Early intervention is important for its treatment.
Examinations:
- ELECTROPHYSIOLOGY (VEP, ERG, EOG)
- FFA (Eye angiography)
- OCT (Optical nerve scanning)
- VEP (Visual pathways between brain and eye)
- Computer Vision Field
- Contrast Sensitivity Test
- Color Vision Tests
Prepared by the Dünyagöz Hospital Editorial Board.
*The content of this page is for informational purposes only. See your doctor for diagnosis and treatment.
Last Update Date: 09.06.2023