Neuro-ophthalmology

What is neuro-ophthalmology?

Neuro-ophthalmology is a subspecialty of ophthalmology. It refers to an ophthalmologist who specializes in vision disorders related to the nervous system.

Eye diseases that a neuro-ophthalmologist may encounter are:

• Optic neuritis
• Optic neuropathy
• Papilledema
• Ocular myasthenia gravis
• Brain tumors or stroke affecting vision
• Idiopathic intracranial hypertension (pseudotumor cerebri)
• Unexplained vision loss
• Double vision (diplopia)
• Blepharospasm
• and more…

Training path of a neuro-ophthalmologist

A neuro-ophthalmologist begins with six years of medical studies together with an internship year, like every other doctor in the State of Israel. Afterwards they continue with a residency in ophthalmology that lasts about 5-6 years, and then continue to a subspecialty in neuro-ophthalmology, where the length of study depends on the center in which one studies but usually lasts between one and two years.

Common diseases in the field of neuro-ophthalmology

Optic neuritis

Optic neuritis is a multifactorial disease (having several causes) that manifests as inflammation of the optic nerve, which can lead to partial or complete vision loss.

This is a demyelinating disease of the optic nerve (damage to the myelin layer that envelops the nerve fibers). However, it is possible that damage directly to the nerve itself is also part of the process.

The most common cause of optic neuritis is multiple sclerosis. Up to 50% of patients who suffer from multiple sclerosis will at some point develop optic neuritis. In 20-30% of those suffering from multiple sclerosis, the initial manifestation will be optic neuritis.

Additional causes are infections such as syphilis, Lyme disease, herpes and other infectious diseases. Autoimmune diseases, medications, vascular diseases and diabetes.

The most common ocular symptom is vision loss or blurred vision. Some patients will report loss of red color vision. With a slit lamp, an ophthalmologist can see the optic nerve, but in a large proportion of cases the examination will be normal; in the rest of the cases edema of the optic nerve will be seen.

Possible treatment of the disease includes steroids, which can lower the chance of developing multiple sclerosis in the two years following. In some patients, treatment with steroids can increase the amount and frequency of attacks.

Blepharospasm

Blepharospasm is a name for a condition in which the eye blinks excessively and involuntarily. It usually occurs in people in their 50s or 60s, and it is more common in women, but it can appear in anyone at any age.

While the cause is still unknown, the prevailing opinion is that blepharospasm is caused when there is a short in the communication between the signals between the brain and the eye muscles. Contractions of the facial and neck muscles may also appear. In some people it is a single event or a single period and it passes on its own, while in others recurrences of the phenomenon may occur.

Graves' disease or thyroid eye diseases

Graves' disease develops when the thyroid gland shifts into high gear and produces more hormones than needed. As a result, people with Graves' disease tend to be in a "hyper" state and present a wide range of symptoms: weight loss despite increased appetite, nervousness, heat intolerance, irregular heartbeat, and in women changes in the menstrual cycle may occur. An overactive thyroid gland can also affect the eyes in the form of "eye bulging", eye swelling, double vision and even vision loss.

Hemifacial spasm (spasm of half the face)

Hemifacial spasm is a neuromuscular disorder characterized by frequent involuntary contractions of the muscles on one side of the face. The disorder occurs in men and women, although it is more common in middle-aged and older women. The disease is also very common among Asians. The first symptom is usually intermittent twitching of the eyelid muscle that can lead to forced closure of the eye. The contraction may then spread and involve the muscles of the lower part of the face.