Bell’s palsy is a disorder of the facial nerve, the seventh cranial nerve. This condition causes partial paralysis on one side of the face, affecting the muscles of facial expression. Bell’s palsy usually occurs in adults and develops suddenly. Symptoms of Bell’s palsy include the inability to smile on one side or close one eyelid completely, decreased tear production and sense of taste, blurry vision, and distorted hearing. The causes of Bell’s palsy are varied. In most cases, the cause is never identified, but it is believed that Bell’s palsy often develops secondary to a viral inflammation. Other causes include activation of the body’s immune system and changes in blood flow. Bell’s palsy is more common in patients with diabetes and in pregnant women. Most of the time, Bell’s palsy disappears on its own after a few months. Eye lubricants may be used to prevent complications. In some cases, corticosteroid or antiviral drugs may be used to help in the treatment of this condition.
Blepharospasm is an involuntary contraction and spasm of the eyelid muscles that causes your eyes to squeeze shut. Blepharospasm is more common in women and usually appears after the age of 50. Generally, one will notice that one’s eyes are blinking and twitching more often. On occasion, it can progress to repeated, forceful, involuntary closing of the eyes.
Bright lights, fatigue, watching television, driving, and stress can all exacerbate your condition. Sleeping, walking, concentrating on a task, and relaxation exercises may provide temporary relief.
The most common treatment for severe blepharospasm is the injection of small amounts of botulinum toxin into the eye muscles to partially paralyze them and return them to normal function. Results are temporary, so treatment must be repeated every few months.
Diplopia is double vision caused by a problem with the muscles that control the eye or the nerves that stimulate those muscles.
Many conditions can cause diplopia. Double vision is usually a symptom of strabismus (misalignment of the eyes), due to the improper movement of one or more eye muscles. Strabismus is most often found in children, but it can develop later in life. A growth in the eyelid pressing on the front of the eyeball can also cause temporary double vision. Rarely, double vision arises because of an abnormality within the eye, such as a dislocation of the eye’s natural lens.
The onset of double vision in adulthood should be brought to the attention of your ophthalmologist (Eye M.D) immediately to exclude the possibility of a tumor, aneurysm, or neurological problem. Two of the primary neurological conditions that could cause diplopia are microvascular cranial nerve palsy (MCNP) and myasthenia gravis (MG).
Microvascular cranial nerve palsy, or ”diabetic palsy,” is one of the most common causes of double vision in older people. It occurs more often in patients with diabetes and high blood pressure, when blood flow is blocked to one or more of the six eye muscles that control eye movement. Although there is no known treatment for MCNP, the double vision may be treated by patching either eye. If the double vision persists, prism eyeglasses or eye muscle surgery may be prescribed.
Myastheniagravis is a disorder characterized by muscle weakness, caused by a communication breakdown between the nerves and the muscles due to an autoimmune condition. It is most common in the muscles of the face, eyes, arms, and legs, and in the muscles used for chewing, swallowing, and talking. Double vision is one of the common indicators of myasthenia gravis. Though there is no known cure for myasthenia gravis, there are a number of treatment options to manage the condition, including medication, surgery, and other procedures. If you have MG, physical therapy can help, and you can learn specific coping skills for improving your daily life. Early detection and treatment of MG is crucial to managing the condition and preventing serious problems with breathing or swallowing, which require emergency care.
Functional visual loss is an apparent loss of vision with no sign of a structural abnormality in the eye. If your ophthalmologist (Eye M.D.) suspects that you have functional visual loss, you will need to have a complete eye examination to rule out possible underlying causes of your vision loss. In addition to the examination in your doctor’s office, you may require, among other things, blood work and imaging with computed tomography (CT) or magnetic resonance imaging (MRI). Should these tests rule out other causes of the vision loss and show indications of functional visual loss, you can begin treatments that will help you regain your sight. Because your ophthalmologist has eliminated the possibility of other underlying causes of your vision loss, you can feel assured that your condition is not serious and that your vision will very likely recover with time.
Giant cell arteritis (GCA), also known as temporal arteritis, is a chronic inflammation of the lining of medium- and large-sized arteries. The cause of giant cell arteritis is unknown. Left untreated it can lead to blindness. Treatment should be initiated as soon as the diagnosis is suspected.
Giant cell arteritis rarely occurs in people below 50 years of age, and it typically begins at around age 70. Women are more likely to develop GCA than men, and Caucasians are affected at a much higher rate than people of other races. People of Scandinavian ancestry are at particular risk. If you have polymyalgia rheumatica, you have an increased risk of having GCA as well.
Signs to look for include:
If blood flow to the eyes is restricted by GCA, it can lead to a condition called arteritic ischemic optic neuropathy, which can cause sudden blindness in one or sometimes both eyes. When treated quickly with high doses of corticosteroids (anti-inflammatory medications) before you experience loss of vision, your symptoms will be relieved and chances are excellent that your eyes will not be affected. For this reason, your ophthalmologist (Eye M.D.) may begin treatment before a biopsy can confirm your diagnosis. You may need to take corticosteroids for as long as a few years, though at lower dosage levels. Major side effects of corticosteroids include:
You should discuss the possible complications of taking corticosteroids and alternative treatment options with your ophthalmologist.
Headaches are one of the most common health complaints. They are caused by a variety of factors and can be divided into the following groups:
Tension-type headaches
This is the most common type of headache. The pain may be felt in the forehead, temples, neck, or around the eyes. Doctors are uncertain about the cause of this type of headache but believe they are due to stress, sleeping or working in unusual positions, clenching jaws, grinding teeth, or chewing gum. These kinds of headaches are usually temporary and can be relieved by an over-the-counter pain reliever.
Migraine headaches
This kind of headache is also common. Migraine pain is related to activity in the brain that swells blood vessels of the scalp, causing throbbing pain, nausea, sensitivity to light, sounds, or odors, and pain that increases with movement. The exact cause of migraines is still unknown. About one in 10 people suffer from migraines, and they affect more women than men. Migraines can run in families and can affect young children as well.
Cluster headaches
Cluster headaches are less common than migraines and affect more men than women. They are called cluster headaches because they come in daily bouts of 30 minutes to two hours and continue for one to two months. These bouts can occur several times a year. The pain is felt on one side of the head, is very severe, and can be accompanied by tearing or red eye on the affected side, sweating, and stuffy nose.
Eye disease is the least common cause of headaches. Headaches caused by eye disease are usually felt in the eye or brow on the side where the disease occurs. These headaches are often associated with symptoms like blurred vision, halos, and sensitivity to light. Headaches can also be caused by high blood pressure or brain tumors, although headaches caused by brain disease are rare and become dramatically worse over time.
In general, headaches can include symptoms that may affect vision or your eyes, but they are not directly caused by eyestrain. A thorough examination by your primary physician is recommended for any chronic or recurring headache. An eye exam by an ophthalmologist (Eye M.D.) may be helpful in some cases.
Hemifacial spasm (HFS) is a condition that causes involuntary contractions of the muscles on one side of the face. The disorder occurs in both men and women, usually beginning in middle age. Symptoms often begin as a twitching of the eyelid and may gradually spread to involve the muscles of the lower face. The condition may be caused by a blood vessel pressing on a facial nerve, a facial nerve injury, or a tumor, or it may have no apparent cause. After your ophthalmologist (Eye M.D.) has ruled out other more serious underlying conditions, the most common treatment for HFS is the injection of botulinum toxin, a neurotoxin, into the affected muscles. In some cases, surgery may be necessary. If botulinum toxin is the best treatment for your condition, your ophthalmologist will inject the drug into the involved facial muscles in a simple, outpatient procedure. Botulinum toxin has proven to be a safe treatment for HFS with few side effects. The injections will probably work for about six months, so repeated treatments are necessary. You should see the full effect of the injection about a week after the procedure.
Ischemic optic neuropathy, a condition caused by restricted blood flow to the optic nerve, is the sudden loss of vision in one or sometimes both eyes. It primarily affects the elderly. There are two forms of ischemic optic neuropathy, caused by differing underlying conditions.
Nonarteritic ischemic optic neuropathy (NAION) is usually painless; it is caused by cardiovascular disease. If you have high cholesterol, high blood pressure, diabetes, or if you smoke, you are at higher risk of developing the condition. Unfortunately, there is no cure, and the central or peripheral (side) vision that you have lost cannot be restored. However, treating the underlying causes of your cardiovascular disease can help control nonarteritic ischemic optic neuropathy and prevent further vision loss.
Arteritic ischemic optic neuropathy(AION) is a condition caused by inflammation of the arteries supplying blood to the optic nerve. This inflammation is known as giant cell arteritis (GCA), and its cause is unknown. Women are more likely to develop GCA than men, and Caucasians are affected at a much higher rate than people of other races. People of Scandinavian ancestry are at particular risk. If you have polymyalgia rheumatica, you have an increased risk of having GCA as well.
Signs to look for include:
When treated quickly with high doses of corticosteroids (anti-inflammatory medications) before you experience loss of vision, your symptoms will be relieved and chances are excellent that your eyes will not be affected. For this reason, your ophthalmologist (Eye M.D.) may begin treatment before a biopsy can confirm your diagnosis. You may need to take corticosteroids for as long as a few years, though at lower dosage levels.
Major side effects of corticosteroids include:
You should discuss the complications of corticosteroid medications and alternative treatment options with your ophthalmologist.
Microvascular cranial nerve palsy (MCNP) is one of the most common causes of double vision in older people. It occurs more often in patients with diabetes and high blood pressure and is often referred to as a “diabetic” palsy.
MCNP occurs when the blood flow is blocked to one or more of the three nerves that control the eye muscles. If the abducens nerve is blocked by improper blood flow, your eye will not be able to move toward the outside, and you will have double vision (see side-by-side images). If the trochlear nerve is affected, you will have vertical double vision (see one image on top of another). And if the oculomotor nerve is affected, you will have limited up and down eye movement. The eyelid may droop, too.
Although it is not clear what blocks the blood flow, diabetes, high blood pressure, or migraines may be to blame. Occasionally, there may be a blocked vessel in the covering of the brain, which can be associated with pain around the eye.
Symptoms of MCNP include weakness in one or more eye muscles, blurred or double vision, drooping eyelid, or enlarged pupil. Although there is no known treatment for MCNP, double vision may be treated by patching either eye. If the double vision persists, prism eyeglasses or eye muscle surgery may be prescribed. Sometimes, anti-inflammatory drugs such as ibuprofen may help with any pain associated with MCNP.
Over a period of six to 12 weeks, normal function and vision should return. Your nerves will not be permanently injured. However, if the double vision does not go away, it is important to tell your ophthalmologist (Eye M.D.).
Migraine headache is a common neurological condition that occurs in about 20% of the population and in 50% of women. It is not clear how a migraine works, but it is believed that the basic cause is an abnormality of serotonin, which is a chemical used by the brain cells. During a migraine, changes in serotonin levels cause the blood vessels in the brain to constrict.
This decreases oxygen supply in the brain. In rare cases, a stroke is possible.
Certain foods like aged cheese, chocolate, red wine, and caffeine may trigger migraines. Hormonal changes during pregnancy, menopause, and menstrual periods also are associated with migraines. People with migraines often have a family history of headaches or prior histories of motion sickness.
Symptoms of migraines include nausea, sensitivity to light or sound, pounding pain, and some visual symptoms, including a blurring spot, an expanding border often described as zigzag lines or shimmering, and vision loss in only one eye. Rare symptoms include double vision or a change in pupil size.
Treatments first seek to avoid any known factors that precipitate a migraine attack, including environmental factors, medications, and food. Medications for migraines may be prescribed. If migraines are severe, medication on a regular basis may be necessary.
Multiple sclerosis (MS) is an autoimmune disease that causes your body to produce antibodies that mistakenly attack the myelin sheath protecting your nerve tissue. This chronic central nervous system disorder damages the nerves and causes the gradual loss of muscle control, strength, and vision.
MS affects people differently. Some have only mild symptoms, while others are severely debilitated by the disease. Symptoms of MS vary widely and can include the following:
If you are experiencing any of these symptoms, it is important to see your doctor immediately. To determine if you have MS, your doctor will take a complete medical history, and you will be given a neurological examination. You might also need an MRI and other tests to diagnose the cause of your symptoms.
Should your doctor confirm that you have MS, there are a number of treatment options. If your symptoms are mild or infrequent, you may require no treatment other than careful monitoring. For more serious cases, there are several medications that can help, as can physical therapy, occupational therapy, and other treatments.
Though there is no cure for multiple sclerosis, the major causes of vision problems associated with the disease are all treatable, and they often resolve on their own. Three common visual problems associated with MS are:
Steroid medications are commonly prescribed for all three conditions. Patching, prism eyeglasses, and perhaps surgery are also effective in treating double vision. Nystagmus may respond to some medications other than steroids, as well. Over time, your brain may adjust to the appearance of black spots and wiggly lines associated with nystagmus, restoring much of your normal vision.
Myasthenia gravis (MG) is a disorder characterized by weakness of the muscles under your voluntary control. MG is caused by a communication breakdown between your nerves and muscles due to an autoimmune condition that has damaged receptors on your muscles. Your autoimmune system is producing antibodies that are adhering to these receptors, blocking chemicals that normally travel from your nerve endings to the receptors.
MG most often affects the muscles of the face, eyes, arms, and legs, as well as the muscles used for chewing, swallowing, and talking. The muscles that control breathing and swallowing can sometimes be involved as well. These are some of the signs of myasthenia gravis:
MG can be made worse by fatigue, stress, illness, and by certain medications. Check with your doctor before taking any new prescription or over-the-counter medications. Extreme difficulty with breathing or swallowing requires emergency care. Your ophthalmologist (Eye M.D.) can test for MG using a number of methods, including:
There is no known cure for MG, but if you seek treatment early when you first experience symptoms, you can manage the condition successfully. Your ophthalmologist has a number of treatment options to manage your condition, including medication and surgery. You can also receive physical therapy and learn specific coping skills to help improve your daily life. Early detection and treatment of MG is crucial to managing the condition and preventing serious problems with breathing or swallowing, which require emergency care.
Optic neuritis is a condition characterized by inflammation of the optic nerve. This nerve is the pathway that carries impulses from the retina in the back of the eye to the brain and enables the brain to interpret the impulses as images. If the nerves are damaged, vision is greatly affected. This condition may affect one or both eyes, and symptoms may appear slowly or over a few days. Some of these symptoms include blurred or dim vision, abnormal color vision, or pain in the back of the eye socket or when moving the eyes. These symptoms may get worse with heat or exhaustion. If you are experiencing any of these symptoms, see your ophthalmologist (Eye M.D.) for an eye examination. If optic neuritis goes untreated, symptoms will get worse. The causes of optic neuritis are known to be associated with various diseases such as mumps, influenza, measles, multiple sclerosis, Leber’s optic neuropathy (a rare eye condition), or vascular occlusions. However, in many cases, optic neuritis occurs with no known cause. Steroid drugs are used to treat optic neuritis. In most patients, vision will significantly improve or return to normal with treatment. However, those with a pre-existing condition like multiple sclerosis may not recover their normal vision.
Orbital inflammatory pseudotumor is characterized by inflammation within the orbit, or eye socket, that mimics symptoms similar to a tumor in the same site. The cause is still unknown. Orbital inflammatory pseudotumor usually occurs in only one eye. Symptoms may include:
Your ophthalmologist (Eye M.D.) will probably order a CT scan to see if there is a thickening of your sclera (the white part of your eye), which is a hallmark of the condition. In order to rule out other conditions, your ophthalmologist may run other tests and biopsy orbital tissues if necessary.
Orbital inflammatory pseudotumor is usually treated with steroid medications. If further treatment is necessary, radiation therapy is another option. In some cases, treatment may fail to eliminate symptoms. In others, treatment will be effective but the symptoms may return, requiring additional treatments as needed.
Posterior occipital neuralgia is pain originating from the base of your skull that often wraps around to the front of the head and behind the eyes. The pain is due to inflamed or damaged occipital nerves in your neck. Pain can be severe and chronic and can affect one or both sides of your head.
Possible causes of posterior occipital neuralgia include:
Symptoms of posterior occipital neuralgia include:
Once the underlying causes of your pain are determined, in most cases your ophthalmologist (Eye M.D.) will prescribe anti-inflammatory medication to reduce inflammation, muscle relaxants to stop spasms, physical therapy, massage, heat, and rest. Patients usually recover fully from posterior occipital neuralgia once the pain has subsided and any damage to the nerves has been reduced or repaired.
Pseudotumor cerebri (PTC) is a condition in which the pressure from the cerebral spinal fluid inside your head is elevated. This can cause problems such as headaches, blurred vision, or loss of vision. The condition is known as pseudotumor cerebri because symptoms can mimic those of an intracranial tumor.
The cerebral spinal fluid (CSF) is a clear fluid that bathes the brain and spinal cord. In cases of PTC, this fluid is blocked from flowing back from the head as it should, leading to high CSF pressure inside the head. The pressure swells the optic disc at the back of the eye, which can damage (sometimes permanently) the optic nerve and cause vision loss. It can also damage the nerves that control eye movement, resulting in double vision.
The causes of PTC are not certain, but they may include the following:
The most common symptoms of PTC are headache and visual loss. The headache can be located anywhere, but is usually in the back of the head. It may wake you in the middle of the night, and it may worsen with bending or stooping. Other symptoms include:
Your ophthalmologist (Eye M.D.) will give you a complete eye examination. It may be necessary for you to have an MRI scan and spinal tap to assure accurate diagnosis and to rule out other CSF abnormalities.
If your symptoms are mild, no treatment other than careful monitoring may be necessary. If you require treatment, certain glaucoma medications and diuretics can help lower CSF pressure. Weight loss is an effective treatment in overweight patients. Pressure can also be lowered by draining CSF through repeated spinal taps.
If your vision continues to deteriorate after you have begun treatment, surgical techniques may be required to protect the optic nerve from any further damage.
A stroke is a life-threatening emergency in which the blood supply to the brain is interrupted or severely reduced, depriving it of oxygen and killing brain cells. Quick treatment could save your life and minimize damage to your brain. Major causes of stroke include:
Symptoms of stroke include:
If you are experiencing these symptoms, seek immediate medical attention. Receiving treatment within three hours of suffering a stroke is shown to dramatically improve your chances of a successful recovery.
There is no treatment for patients who have lost vision due to a stroke. However, you may regain some of the peripheral vision lost from a stroke. Your ophthalmologist (Eye M.D.) will give you a thorough eye examination to determine how the stroke has affected your vision. He or she will talk to you about what to expect over time and can help you find resources and training to make the most of your remaining vision.
Traumatic optic neuropathy is the sudden, severe loss of vision following blunt injury to the eye or areas surrounding the eye. The optic nerve can be damaged by the blow itself, or as a result of other damage sustained by the eye. Vision loss can be immediate or may take days, weeks, or even months to develop.
Your ophthalmologist (Eye M.D.) will give you a thorough eye examination, and you will receive a neurological examination as well, especially if you lost consciousness after the injury. An MRI or CT scan will confirm the diagnosis of traumatic optic neuropathy and verify that no other damage has occurred due to the injury.
If you have mild symptoms, you might only need close observation by your ophthalmologist. Some patients show some improvement with no medical intervention. However, many patients need treatment with corticosteroid medication to reduce the inflammation that is causing vision loss.
Major side effects of corticosteroids include:
Discuss the complications of corticosteroid use with your ophthalmologist.
In some cases, corticosteroids do not fully resolve the condition. In these cases, your ophthalmologist may recommend optic nerve decompression surgery. If your ophthalmologist thinks this a valuable treatment option for you, discuss the benefits and risks together before deciding on surgery
Visual field testing is a critical part of the neuro-ophthalmic exam and is essential for the evaluation of unexplained visual loss. A visual field test measures all areas of your eyesight, including your side, or peripheral, vision. This crucial test helps your ophthalmologist (Eye M.D.) determine whether there are gaps in your vision. It also helps diagnose your condition, as the test can help find certain patterns of vision loss that may rule out certain conditions or help specify the source of your vision loss.
To take this painless test, you sit at a bowl-shaped instrument called a perimeter. While you stare at the center of the bowl, lights flash. Each time you see a flash, you press a button. A computer records the location of each flash and whether you pressed the button when the light flashed in that location. At the end of the test, a printout shows if there are areas of your field of vision where you did not see the flashes of light. This test shows if you have any areas of vision loss.
Regular perimetry tests are a key way to see how, if at all, your vision is changing over time. It can also be used to see if your treatments are successful at improving your vision or preventing further vision loss.