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Neuro-Ophthalmology examines the relationship between the eye and the brain, focusing on the optic nerve, the eye socket (the orbit) and the brain. Some Neuro-Ophthalmic conditions are relatively harmless, while others can be very serious. The Neuro-Ophthalmology specialists at Florida Eye Specialists and Cataract Institute have advanced training and experience to determine what is causing a particular vision problem – is it due to a medical condition or a problem within the nervous system or optic nerve?

If the human eye is like a camera, the process would begin with the optic nerves transmitting the images that people see to the brain’s visual pathways. Finally, they will be processed in the visual processing center located at the back of the brain. All these things consist of the realm of neuro-ophthalmology.


Advances in neuroimaging and interventional techniques have revolutionized the early diagnosis, prognosis, and treatment of neuro-ophthalmic disorders.

Neuro-Ophthalmology Symptoms

  • Sudden loss of vision
  • Blurry or darkened vision
  • Double vision (diplopia)
  • Excessive, involuntary blinking and tightly closing of the eyes
  • Vision disturbance
  • Eyelid and facial spasms
  • Abnormal eye movements
  • Unequal pupil size
  • Unexplained visual loss
  • Visual disturbances
  • Visual field loss

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What is Neuro-Ophthalmology?

An eye specialist known as a neuro-ophthalmologist at Florida Eye Specialists and Cataract Institute has a special interest in the manifestations of eye diseases or injuries. The visual pathways and the optic nerves are the two major concerns in neuro-ophthalmology. Also in this field are the processes and pathways of the brain involved in controlling the movements of the eye.

A neuro-ophthalmologist takes care of visual problems resulting from nervous system conditions. Therefore, this professional is the one to turn to if you have a visual problem that does not come from your eyes themselves.

Neuro-ophthalmologists have specialized training and possess the knowledge in dealing with problems associated with the eyes, brain, and nerves. A subspecialty of neurology and ophthalmology, neuro-ophthalmology requires completion of clinical training, which usually takes another five more years after medical school.

A neuro-ophthalmologist would often diagnose and provide treatments for different vision problems that are linked to the brain, nervous system, and the optic nerves. The specialists utilize a multidisciplinary approach in taking care of the eyes. Often, they work with neurologists, radiologists, neurosurgeons, and other professionals in treating patients.

Neuro-ophthalmology is concerned with symptoms of vision problems that are mostly due to brain diseases. These symptoms are divided into two categories:

  1. Visual loss, which may be due to optic nerve issues and its connections to the brain’s visual portions.
  2. Eye movement problems, which signify the inability of the brain to control preciseness of eye motion.

Both categories are connected to the brain where there are numerous links straight to how the eye functions. If the eye is a camera, the images will be focused on the retina. Meanwhile, the optic nerves work like a cable, which takes the images from the retina to the brain where they will be analyzed.

Several parts of the brain control the movement of the eyes. If there is any difficulty in these regions, it may lead to misalignment. Often, it causes double vision. Certain symptoms of neuro-ophthalmic conditions manifest in diabetes, cardiovascular diseases, hypertension, stroke, and multiple sclerosis among many others.

Conditions and Symptoms

Neuro-Ophthalmic diseases are often the first sign of a more serious neurologic condition and should always be treated immediately.

Some of the most frequent Neuro-Ophthalmic diseases we see at Florida Eye Specialists and Cataract Institute:

  • Optic neuritis is the most common cause of a sudden loss of vision in younger individuals. It is the result of an attack on the optic nerve by the immune system. Optic neuritis can be a difficult condition for anyone except a neruo ophthalmologist to diagnose, since both the inside and outside of the eye typically appear normal. This condition results in an inflammation of one or both optic nerves. It can quickly decrease vision, along with changes in perception of color and sensitivity to contrast or the ability to differentiate an item from its background. The symptoms can take off in a matter of days, progressing fast and can become severe. Optic neuritis often causes eye pain, usually when the eye moves. It is typically associated with multiple sclerosis.
  • Anterior ischemic optic neuropathy is the most common cause of a sudden loss of vision in individuals who are over the age of 50. It takes place when not enough oxygen is reaching the optic nerve, causing a small stroke to occur there. This may result in blurry or darkened vision throughout all or part of the visual field. Sudden vision loss of those who are over 50 is often due to this condition. When there is insufficient oxygen for the optic nerves, a mild stroke occurs. It then leads to blurry vision that can progress to vision loss.
  • Microvascular cranial nerve palsy can precipitate double vision, especially in older patients. It occurs most often in those with diabetes or high blood pressure. Microvascular cranial nerve palsy takes place when there is a disruption of the blood supply to a cranial nerve, causing the eye’s movement to be restricted and producing a double image.
  • Blepharospasm causes sufferers to excessively, involuntarily blink and tightly close their eyes. The response is not due to any particular environmental factor, but can be made worse by exposure to bright light, fatigue and dry eyes. Blepharospasm is more typical in women than men and often begins in middle age. Another symptom is tightly closing the eyes. Although normal to have this problem from time to time, blepharospasm is not due to environmental factors and occurs more frequently. However, it can get worse when the eyes are dry, fatigued, or exposed to bright light.
  • Thyroid orbitopathy is an autoimmune condition often brought on by a thyroid problem. The immune system affects the eye muscles and causes them to increase in size, resulting in the eye being pushed forward. If left untreated, the muscles may begin to compress the optic nerve and damage it. This condition may manifest in the eye even if there is no clinical proof of hyperthyroidism in an individual. Some of the symptoms include eyeballs that seem to pop out of their sockets (proptosis), eyelid retraction, blurred vision, and red eyes, along with double vision
  • Double Vision from Stroke. Muscles control eye movements but they can become weak because of infarction of their nerve supply. It results in muscle imbalance, which also leads to conditions like double vision. Some patients also complain about drooping eyelids. Most of the time, the cases are benign, although they are due to diabetes or hypertension, particularly with microvascular cranial nerve palsy. However, double vision may also be because of another problem.

Symptoms associated with these and other neuro-ophthalmic disorders usually include vision loss, vision disturbance, double vision (diplopia) as well as eyelid and facial spasms. Sudden vision loss can be caused by tumors or aneurysms from an obstruction of blood vessels in the optic nerve or retina and should always be diagnosed and treated immediately.


At Florida Eye Specialists and Cataract Institute, our Neuro-Ophthalmology specialists use the latest technologies to examine, diagnose and treat all types of Neuro-Ophthalmology diseases through a series of tests and therapies. State-of-the art diagnostic services often include fundus photography, MRI, CT scan, ultrasound, cerebral angiography and optical coherence tomography. Neuro-ophthalmologic evaluations are detailed and comprehensive examinations that include a complete medical history. Your Neuro-Ophthalmology specialists examines your visual field and eye movement, and performs a complete neurologic exam as needed.


Treatment depends on the specific type of disorder that is diagnosed, but can include Vision Restoration Therapy (VRT). VRT is a non-invasive treatment that helps to restore vision lost as a result of a traumatic brain injury, such as a stroke. Using a specially-designed computer device, VRT encourages visual stimulation to enhance activity relating to vision in the brain. It has helped some patients regain lost sight.

After setting an appointment, you should be ready to see a neuro-ophthalmologist. The examination will begin with a thorough review of your problems. It will then be followed by checking your vision, which often includes visual acuity, visual field tests, and color vision. Eye movement will also be evaluated using charts and prism lenses.

Your eyes will be examined with special focus on the retina and optic nerves. If required, dilating drops may be used to better see the structure of the eye. The size and pressure of your eyes will be checked as well.

When it is time to see a neuro-ophthalmologist, you may need to bring a few things, including your eyeglasses and its prescription if available. You may also be asked to bring radiology reports and other medical records, including MRI or CT scans depending on your case.

Other methods of treatment often used at Florida Eye Specialists and Cataract Institute include:

  • Medical therapies
  • Optic nerve sheath decompression – used to relieve excessive intracranial pressure. An incision is made in the covering of the optic nerve to allow the buildup of cerebrospinal fluid to drain and taking pressure off the nerve.
  • Temporal artery biopsy.
  • Neurosurgical intervention – minimally-invasive, endoscopic methods of tumor removal.

Talk to our Neuro-Ophthalmology Specialists

The eye and brain are both extremely important organs of the body, so their care should be handled by specially-trained professionals. If you or your loved one are experiencing vision problems that may require neuro-ophthalmic care, do not hesitate to contact Florida Eye Specialists and Cataract Institute to schedule a consultation and comprehensive exam.

Neuro-Ophthalmic Specialist

Craig E. Munger

Craig E. Munger

M.D., Ph.D.

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