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Neuro Ophthalmology


What is Neuro Ophthalmology?

Neuro Ophthalmology is a specialty that concentrates on the neurological problems related to the eye. Like we all know, the human eye captures the visuals it sees and transmits to the brain to be resolved as images. It is the optic nerve that transmits these visual stimuli and a dysfunction of this entity might cause visual impairment and could even lead to irreparable damage.


Neuro Ophthalmology – When should you visit your eye doctor?

Neuro Ophthalmic issues are quite a concern for doctors; for if not treated on time, it could result in Optic Nerve atrophy (death of the optic nerve).

Some of the most common signs of Optic Nerve Dysfunction include:

  • Reduced visual activity all of a sudden

  • Double vision and headaches

  • A less reactive pupil (pupil is the central part of eyeball that allows light to pass through)

  • Impairment of colour vision (especially inability to identify red & green colours)

  • Difficulty in seeing light (Photophobia)

  • Visual Field Defects (visibility coverage)

Neuro Ophthalmic Conditions – And here come the ‘scary’ words

It’s quite natural that you’ll hear a lot of medical jargons in your doctor’s office. However, your doctor will try and explain the details, so you understand the illness/condition well and proceed with the available treatment options. Here are a few common conditions pertaining to neuro ophthalmology:

Optic Neuritis:

 This is a condition that involves inflammation of the optic nerve. An inflammation could occur due to various reasons – starting from an infection to an autoimmune disorder.


In this case, the optic disc (the circular area where the optic nerve connects to the retina, at the back of the eye) swells up due to an excessive pressure from inside the skull may be due to a tumor for instance.

Nutritional Optic Neuropathy: 

Here the damage to the optic nerve is caused by certain toxic substances found in tobacco & alcohol. This could also occur due to lack of nutrients and deficiency of vitamin B-complex and folic acid.

Diabetic Neuropathy: 

In this, the optic nerve is damaged due to the excessive blood sugar or diabetes. As the disease progresses, the blood supply to the retina gets cut-off, leading to vision loss.

Although each of them attacks the optic nerve in a different way, the final outcome is eventually the death of the optic nerve, if left untreated.

Neuro Ophthalmology Treatments – Pills or prayers?

Your eye specialist will ideally be able to pick up an optic nerve issue during an eye examination. A brain CT scan or an MRI is then typically done to assess whether there is associated damage in the brain as well. While some conditions can be treated with oral medications and injectables, others might require a surgery. Some of the common treatment options would be:

Optic Neuritis: 

Antibiotics and corticosteroids are used to flush out the infection or suppress the immune disorders from causing further damage.


Medications are used to reduce the pressure inside the skull. Might require a brain surgery if the increased pressure is due to a tumorous growth.

Nutritional Optic Neuropathy: 

Lifestyle changes are recommended and vitamin injectables are prescribed.

Diabetic Retinopathy: 

Since the underlying cause is diabetes, it is essential to treat the diabetes before it further damages the nerve and other blood vessels.

If not detected on time, there’s a good chance for complete loss of vision.

Written by: Dr. Preetha Rajasekaran – Consultant Ophthalmologist, Porur


What are optic neuritis causes?

Even though it is true that symptoms of optic neuritis are more complicated, other possible explanations of optic neuritis causes must be examined, such as:

  • Infections:  Optical neuritis can be caused by bacterial illnesses like Lyme disease, cat scratch fever, and syphilis, or viruses like mumps, measles, herpes, and more.
  • Other illnesses: Recurrent optic neuritis can be caused by diseases like lupus, sarcoidosis, Behcet’s illness, etc.
  • Toxins and drugs: The development of diseases like optic neuritis has also been linked to the use of certain medications and poisons. Optic neuritis can take place due to ethambutol, a tuberculosis treatment, and methanol, a frequent element in paints, antifreeze, and solvents.

In most cases, diabetic neuropathy cannot be cured. However, it can be slowed down. The best strategy to avoid developing diabetic neuropathy or slowing its growth is to constantly supervise your blood sugar levels while keeping them within a healthy range. It may also help to alleviate some symptoms.


In addition, a thorough treatment strategy also includes quitting smoking and exercising frequently. Before starting a new workout plan, consult your doctor or healthcare team. You can also inquire about complementary treatments or supplements for diabetic neuropathy with your doctor.

Retrobulbar neuritis is a type of optic neuritis in which the back of the eye’s optic nerve becomes inflamed. This inflamed region lies between the back of the eye and the brain. On the other hand, the optic nerve contains fibres that transport visual information from retinal nerve cells to brain nerve cells.


This usually smooth transmission to the brain is interrupted in this medical condition, and vision is compromised when these fibres become inflamed. A variety of health conditions can produce retrobulbar neuritis, including:


  • Tumours
  • Multiple sclerosis (MS)
  • Sudden reactions due to allergies
  • Meningitis, syphilis, and numerous viral disorders.
  • Having been exposed to certain chemicals or medications

DPN or diabetic polyneuropathy directly or indirectly affects multiple peripheral sensory and motor nerves that branch out from the spinal cord onto the arms, hands, legs, and feet. Nerves that run the longest — from the spine to the feet — are usually the ones that are most damaged.


DPN can lead to:

  • Paresthesias or unusual sensations like tingling, prickling, or burning.
  • Hands, legs, and foot numbness and agony.
  • Muscle aches and pains in the feet and hands.
  • Sharp aches or cramps
  • Heightened touch sensitivity
  • Intolerance to pain and temperature changes.
  • Walking on the uneven ground gets challenging due to a loss of balance or coordination.


Your health care practitioner may perform or prescribe specialised tests to aid the diagnosis of diabetic neuropathy in addition to the physical exam, such as:


Filament evaluation: This is used to assess your sensitivity to touch, a delicate nylon fibre (monofilament) is rubbed over parts of your skin.

  • Sensory evaluation:  This noninvasive test determines how your nerves react to temperature changes and vibrations.
  • Nerve conduction testing: This is a procedure that involves measuring the speed with which nerves carry out the transmission.  This test determines how rapidly your legs and arms conduct electrical signals.
  • Electromyography:  This examination, known as needle testing, is frequently performed in conjunction with nerve conduction investigations. It is primarily used to measure the electrical discharges that your muscles create.
  • Autonomic testing: This refers to a type of special test that may be performed to establish how your blood pressure changes in different situations, as well as whether or not you sweat.

Before consuming any medicine, for any illness, it is best to consult your doctor to ensure the medicines are safe and won’t affect you negatively. Below we have mentioned some of the many pills that are usually prescribed for diabetic neuropathy treatment:


  1. When applied to the skin, Capsaicin cream can help some people feel less pain. A burning sensation and skin irritation are possible side effects.


  1. Lipoic acid (alpha-lipoic acid) is a kind of fatty acid present in a variety of foods. Research has shown that it can prove to be beneficial for some people with nerve pain symptoms.
  2. Acetyl-L-carnitine is a nutrient produced naturally in the body; however, it can also be purchased as a supplement. It may relieve some people with nerve discomfort.


  1. TENS, or transcutaneous electrical nerve stimulation (TENS), is a prescription medication or therapy which aids the prevention of pain signals reaching the brain. TENS uses small electrodes on the skin to transmit tiny electrical impulses to specific nerve pathways. In addition, it does not work for everyone or all forms of pain. One of the biggest advantages of this therapy is that it is safe and painless.


  1. In many cases, acupuncture aids in the process of providing relief to neuropathy discomfort.

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