Glaucoma Information

 

Visual Field Testing (glaucoma)

Because it has no noticeable symptoms, glaucoma is a difficult disease to detect without regular, complete eye exams.

One particular test, called a visual field test (also called perimetry ), measures all areas of your eyesight, including your side, or peripheral, vision. A visual field test can help find certain patterns of vision loss and is a key way to check for glaucoma. It is very useful in finding early changes in vision caused by nerve damage from glaucoma.

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.  Loss of peripheral vision (also known as side vision ) is often an early sign of glaucoma. Regular perimetry tests are an important technique for learning how, if at all, your vision is changing over time. It can also be used to see if treatment for glaucoma is preventing further vision loss.

 

Glaucoma Evaluation

Because it has no noticeable symptoms, glaucoma is a difficult disease to detect without regular, complete eye exams.

During a glaucoma evaluation, your eye doctor will perform the following tests:

• Tonometry . The pressure in your eyes (intraocular pressure, or IOP) is measured using a technique called tonometry. Tonometry measures your IOP by determining how your cornea responds when an instrument (or sometimes a puff of air) presses on the surface of your eye. Eye drops are used to numb the surface of your eye for this test.
• Gonioscopy . For this test, your eye doctor inspects your eye's drainage angle-the area where fluid drains out of your eye. During gonioscopy, you sit in a chair facing the microscope used to look inside your eye. You will place your chin on a chin rest and your forehead against a support bar while looking straight ahead. The goniolens is placed lightly on the front of your eye, and a narrow beam of light is directed into your eye while your doctor looks through the slit lamp at the drainage angle. Drops will be used to numb the eye before the test.
• Ophthalmoscopy . With this test, your eye doctor can evaluate whether or not there is any optic nerve damage by looking at the back of the eye (called the fundus). There are two types of ophthalmoscopy: direct and indirect. With direct ophthalmoscopy, your ophthalmologist uses a small flashlight-like instrument with several lenses that magnifies up to about 15 times. This type of ophthalmoscopy is most commonly done during a routine physical examination. With indirect ophthalmoscopy, the ophthalmologist wears a headband with a light attached and uses a small handheld lens to look inside your eye. Indirect ophthalmoscopy allows a better view of the fundus, even if your natural lens is clouded by cataracts.
• Visual field test . The peripheral (side) vision of each eye is tested with visual field testing, or perimetry. For this test, you sit at a bowl-shaped instrument called a perimeter. While you stare at the center of the bowl, lights will flash off and on. Each time you see a flash, you press a button. A computer records your response to each flash. This test shows if you have any areas of loss of side vision. Loss of peripheral vision is often an early sign of glaucoma.
• Photography . Sometimes photographs or other computerized images are taken of the optic nerve to inspect the nerve more closely for damage from elevated pressure in the eye.
• Special imaging . Different scanners may be used to better determine the configuration of the optic nerve head or retinal nerve fiber layer.

Each of these evaluation tools is an important way to monitor your vision to help ensure that glaucoma does not rob you of your sight. Some of these tests will not be necessary for everyone. Your ophthalmologist will discuss which tests are best for you. Some tests may need to be repeated on a regular basis to monitor any changes in your vision caused by glaucoma.

 

Glaucoma-The Basics

Glaucoma is a disease of the optic nerve, which transmits the images you see from the eye to the brain. The optic nerve is made up of many nerve fibers (like an electric cable with its numerous wires). Glaucoma damages nerve fibers, which can cause blind spots and vision loss.

Glaucoma has to do with the pressure inside the eye, known as intraocular pressure (IOP) . When the aqueous humor (a clear liquid that normally flows in and out of the eye) cannot drain properly, pressure builds up in the eye. The resulting increase in IOP can damage the optic nerve and lead to vision loss.

The most common form of glaucoma is primary open-angle glaucoma , in which the aqueous fluid is blocked from flowing back out of the eye at a normal rate through a tiny drainage system. Most people who develop primary open-angle glaucoma notice no symptoms until their vision is impaired.

Ocular hypertension is often a forerunner to actual open-angle glaucoma. When intraocular pressure is above normal, the risk of developing glaucoma increases. Several risk factors will affect whether you will develop glaucoma, including the level of IOP, family history, and the corneal thickness. If your risk is high, your eye doctor may recommend treatment to lower your IOP to prevent future damage.

In angle-closure glaucoma , the iris (the colored part of the eye) may drop over and completely close off the drainage angle, abruptly blocking the flow of aqueous fluid and leading to increased IOP and optic nerve damage. In acute angle-closure glaucoma there is a sudden increase in IOP due to the buildup of aqueous fluid. This condition is considered an emergency because optic nerve damage and vision loss can occur within hours of the problem. Symptoms can include nausea, vomiting, seeing halos around lights, and eye pain.

Even some people with "normal"  IOP can experience vision loss from glaucoma. This condition is called normal-tension glaucoma . In this type of glaucoma, the optic nerve is damaged even though the IOP is considered normal. Normal-tension glaucoma is not well understood, but lowering IOP has been shown to slow progression of this form of glaucoma.

Childhood glaucoma, which starts in infancy, childhood, or adolescence, is rare. Like primary open-angle glaucoma, there are few, if any, symptoms in the early stage. Blindness can result if it is left untreated. Like most types of glaucoma, childhood glaucoma may run in families. Signs of this disease include:

• clouding of the cornea (the clear front part of the eye);
• tearing; and
• an enlarged eye.

Your eye doctor may tell you that you are at risk for glaucoma if you have one or more risk factors, including having an elevated IOP, a family history of glaucoma, certain optic nerve conditions, are of a particular ethnic background, or are of advanced age. Regular examinations with your eye doctor are important if you are at risk for this condition.

The goal of glaucoma treatment is to lower your eye pressure to prevent or slow further vision loss. Your doctor will recommend treatment if the risk of vision loss is high. Treatment often consists of eye drops but can include laser treatment or surgery to create a new drain in the eye. Glaucoma is a chronic disease that can be controlled but not cured. Ongoing monitoring (every three to six months) is needed to watch for changes. Ask your eye doctor if you have any questions about glaucoma or your treatment.

 

Intraocular Pressure

Elevated intraocular pressure (high pressure within the eye) is the number one risk factor for glaucoma. However, elevated intraocular pressure (IOP) does not always cause glaucoma.

The average eye pressure in adults ranges between 10 mm Hg and 21 mm Hg ("mm Hg" stands for "millimeters of mercury"). There can be a significant difference in your IOP throughout the course of a day. This variation is known as diurnal fluctuation. We know that many patients with IOP in the 20s do not develop glaucoma. Up to 50% of patients diagnosed with glaucoma have an initial pressure reading lower than 22 mm Hg. Intraocular pressure is not a very sensitive tool for diagnosing glaucoma, but it becomes very useful in monitoring treatment for glaucoma.

A variety of methods can be used to check the intraocular pressure, but the most common are applanation tonometry and pneumotonometry. Your eye doctor will often set a "target" pressure for you and will adjust the treatment to keep the pressure close to or below that target to help preserve your vision. 

 

Nerve-Fiber-Layer Analysis

Early in the disease process of glaucoma, individual nerve fibers in the eye's optic nerve are lost, causing an associated pattern of nerve-fiber-layer thinning. This problem can later translate into loss of tissue at the optic nerve head, resulting in visual field defects and, ultimately, loss of vision.

New techniques have been devised to help measure the thickness of the nerve fiber layer, helping eye doctors diagnose glaucoma earlier and monitor progression of the disease.

One technique used to measure the nerve fiber layer is called scanning laser polarimetry , which utilizes a device called a GDx scanner. Another technique uses a low-power laser light and a process called optical coherence tomography (OCT) . These new imaging techniques can help provide an objective measurement of the nerve fiber layer, enhancing the ability to effectively diagnose and monitor glaucoma.

Both tests are done in the doctor's office. During these tests, the patient is required only to remain still while the image is scanned.

 

Peripheral Iridotomy

If your eye doctor suspects that you have "narrow" or "closed" angles, this means that the drainage channel of your eye is blocked or nearly blocked, placing you at high risk for elevated intraocular pressure and vision loss. This is called " narrow angle" or "angle-closure" glaucoma .

An acute attack of angle-closure glaucoma is marked by very high eye pressure and complete blockage of the drainage channel in the eye. Symptoms include pain, red eye, and decreased vision.

To treat angle-closure glaucoma, your ophthalmologist will perform a laser peripheral iridotomy (LPI) , creating a surgical opening within the upper part of the iris (the colored part of the eye) using a laser. This opening is typically so small that it cannot be seen with the naked eye. The opening in the iris allows fluid to flow from behind the iris through the opening, allowing the iris to fall back into a more normal position and opening the drain.

This laser treatment is always performed on an outpatient basis, often in the ophthalmologist's office. The treatment will not improve your vision, but it can help prevent vision loss from a dangerous type of glaucoma. The side effects of the treatment can include the appearance of a "light streak," a temporary rise in intraocular pressure, and inflammation.

 

Pigmentary Glaucoma

Pigmentary dispersion syndrome is a condition in which increased amounts of pigment circulate within the front portion of the eye. This often results in having pigment layered on the back of the cornea, thinning of the iris, and clogging of the ocular drainage system with pigment. This pigment can block the drainage channel enough to cause an increase in intraocular pressure (IOP) .

In cases of pigmentary glaucoma, the IOP often is very high, reaching levels above 40.  Pigmentary dispersion leads to damage from glaucoma in 20% to 50% of patients. It is more common in males and often appears in people under 50 years of age.

Treatment is the same as for other forms of open-angle glaucoma, including medications, laser therapy, or surgery. With adequate treatment, the prognosis for pigmentary glaucoma is good.

 

Pseudoexfoliation Glaucoma

Pseudoexfoliation glaucoma is a relatively common form of open-angle glaucoma that can cause significantly high eye pressures. This condition is marked by a dust-like material that is observed inside the eye on the surface of the iris and lens. This material can clog the ocular drainage system, increasing intraocular pressure (IOP) . It can occur in one or both eyes and is most commonly seen in patients over the age of 70. Pseudoexfoliation glaucoma is found in all ethnic groups, but it is most commonly seen in people of Scandinavian ancestry.

Treatment is often required for pseudoexfoliation glaucoma, consisting of medication, laser treatment, or surgery. Pseudoexfoliation can cause increased complications with cataract surgery. With proper treatment and monitoring, patients with pseudoexfoliation glaucoma tend to do well. Early diagnosis is important.

 

Selective Laser Trabeculoplasty

Selective laser trabeculoplasty (SLT) is a laser surgical procedure used to help lower intraocular pressure (IOP) of patients with open-angle glaucoma. SLT is used to treat the eye's drainage system, known as the trabecular meshwork -the mesh-like drainage canals that surround the iris. Treating this area of the eye's natural drainage system improves the flow of fluid out of the eye, helping to lower the pressure.

The laser used in SLT works at very low levels. It treats specific cells selectively, leaving untreated portions of the trabecular meshwork intact. For this reason, SLT, unlike other types of laser surgery, may be safely repeated many times.

SLT is performed in the ophthalmologist's office or an outpatient surgery center. The procedure usually takes about five to ten minutes. First, anesthetic drops are placed in your eye. The laser machine looks similar to the examination microscope that your ophthalmologist uses to look at your eyes at each office visit.

You will experience a flicker of light with each laser application. Most people are comfortable and do not experience any significant pain during the surgery, although some may feel a little pressure in the eye during the procedure.

Most people will need to have their pressure checked after the laser treatment, since there is a risk of increasing IOP after the procedure. If this does occur, you may require medications to lower the pressure, which will be administered in the office. Rarely, the pressure in the eye increases to a high level and does not come down. If this happens, you may require a surgery in the operating room to lower the pressure.

Most people notice some blurring of their vision after the laser treatment. This typically clears within a few hours. The chance of your vision becoming permanently affected from this laser procedure is very small.

Most patients can resume normal daily activities the day after laser surgery. You may need to use eye drops after the procedure to help the eye heal properly.

Risks associated with SLT include:

• increased pressure in the eye, possibly requiring medication or surgery;
• inflammation in the eye;
• bleeding;
• damage to the cornea, iris, or retina from the laser light;
• failure to adequately lower the eye pressure; and
• need for repeat laser surgery.

It will take several weeks to determine how much SLT will lower your eye pressure. You may require additional laser or glaucoma drainage surgery to lower the pressure if it is not sufficiently lower after the first laser treatment.

Most patients must continue to take medication in order to control and maintain their IOP; however, surgery can lessen the amount of medication needed.

While some people may experience side effects from medications or surgery, the risks associated with these side effects should be balanced against the greater risk of leaving glaucoma untreated and losing your vision.

 

Trabeculectomy

If you have glaucoma, and medications and laser surgeries do not lower your eye pressure adequately, your eye doctor may recommend a procedure called a trabeculectomy.

In this procedure, a tiny drainage hole is made in the sclera (the white part of the eye). The new drainage hole allows fluid to flow out of the eye into a filtering area called a bleb. The bleb is mostly hidden under the eyelid. When successful, the procedure will lower your intraocular pressure (IOP) , minimizing the risk of vision loss from glaucoma. The surgery is performed in an operating room on an outpatient basis.

Some of the risks and complications from trabeculectomy surgery include the following:

• failure to control intraocular pressure, with the need for another operation;
• infection;
• bleeding in the eye;
• swelling in the eye;
• irritation or discomfort in the eye;
• eye pressure that is too low;
• cataract (in cases where cataract has not already been removed); and
• decreased or lost vision.

Antimetabolites  
Certain medications, called antimetabolites, were originally developed to help treat some kinds of cancer. These same medications have also been found to be helpful when used with some types of glaucoma surgery.

These medicines may be applied to the eye during or after the surgery to reduce the growth of scar tissue, a common cause of failure in glaucoma surgery. Mitomycin-C and 5-fluorouracil (5-FU) are the most commonly used antimetabolites for glaucoma surgery. When these antimetabolites are used with other medications that reduce inflammation, the success rate of surgery is greatly improved, especially for patients who are at high risk for excessive scarring.

While some people may experience side effects from medications or surgery, the risks associated with these side effects should be balanced against the greater risk of leaving glaucoma untreated and losing your vision.

 

Traumatic Glaucoma

If your eye is injured, there is a chance you will develop traumatic glaucoma. A direct blow to the eye can cause bleeding or inflammation in the eye, which may lead to an acute rise in eye pressure. This condition can typically be managed with eye drop medication. However, if the intraocular pressure (IOP) is very high or if blood remains in the eye, surgical treatment may be required.

If an eye is hit hard enough to cause bleeding in the front part of the eye, this is called a hyphema . A hyphema increases the possibility of a rise in eye pressure. Various medications can bring the pressure down to a safe zone until the blood decreases or disappears.

In cases of a hyphema, there is also a chance of a future increase in eye pressure. The chance of developing elevated eye pressure and glaucoma following a hyphema is thought to be approximately 8% over a patient's lifetime. Therefore, anyone who has had eye trauma should be sure to have intraocular pressure checks every year. If your eye doctor notes an increase in your eye pressure, he or she can find ways to control it.

 

Visual Field Testing

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 tell 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 facing 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.

 

Microvascular Cranial Nerve Palsy

Microvascular cranial nerve 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 and is often referred to as a "diabetic" palsy.

Microvascular cranial nerve palsy occurs when the blood flow is blocked to one or more of the nerves that control the eye muscles. Injury to the abducens nerve will cause your eye to not be able to move toward the outside. This creates double vision with side-by-side images. If the trochlear nerve is affected the double vision will be vertical (one image on top of another). And if the oculomotor nerve is affected there may be drooping of the eyelid along with double vision.

Although it is not clear what blocks the blood flow, diabetes and high blood pressure are often associated with this condition.

Symptoms of microvascular cranial nerve palsy include blurred or double vision, drooping of an eyelid, or enlarged pupil.

Although there is no known treatment for microvascular cranial nerve palsy, double vision may be treated by patching either eye or placing a prism in the patient's spectacles. If the double vision persists surgery of the eye muscles may be indicated.

In the majority of patients normal function and vision will return in six to twelve weeks.

 

Diplopia (double vision)

Diplopia (double vision) caused by a problem with the muscles that control the movement of the eye or the nerves that stimulate those muscles.

The onset of double vision in adulthood should be brought to the attention of your ophthalmologist 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 and myasthenia gravis .

Microvascular cranial nerve 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 microvascular cranial nerve palsy, the double vision may alleviated by placing a prism on your spectacles or wearing an eye patch.

Myasthenia gravis 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 those involved in 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 medications, physical therapy and surgery. Early detection and treatment of myasthenia gravis is crucial to managing the condition and preventing serious problems with breathing or swallowing, which can require emergency care.

 

Giant Cell Arteritis

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. If you have polymyalgia rheumatica, you have an increased risk of having GCA as well.

Signs to look for include:

• Headache, fatigue, and fever
• Blurred vision
• Double vision
• Scalp tenderness
• Jaw pain
• Weight loss.

The diagnosis of giant cell arteritis is made by blood tests and obtaining a biopsy of the temporal artery which is an outpatient procedure performed with local anesthesia. The condition is treated with steroid (anti-inflammatory) medications. These relieve the symptoms and prevent further loss of vision and other complications of the disease.  

 

Headache

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 causes swelling of blood vessels. This results is throbbing pain, nausea, sensitivity to light, sounds, or odors, and pain that increases with movement. The exact cause of migraines is also unknown. About one in 10 people suffer from migraines, and they affect women more often 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 may be helpful in some cases.

 

Hemifacial Spasm

Hemifacial spasm 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. In most cases there is no apparent cause. However, this condition can also be caused by blood vessels or tumors pressing on the facial nerve.

After your ophthalmologist has ruled out other more serious underlying conditions, the most effective treatment for hemifacial spasm is the injection of botulinum toxin (Botox). 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 hemifacial spasm with few side effects. The effect of the injections lasts for three to six months, so repeated treatments are necessary.

 

Ischemic Optic Neuropathy

Ischemic optic neuropathy, a condition caused by restricted blood flow to the optic nerve causes the sudden loss of vision in one or sometimes both eyes. It primarily affects the elderly. There are two forms of ischemic optic neuropathy.

Nonarteritic ischemic optic neuropathy (NAION) is usually painless. It is commonly associated with diabetes, hypertension and cardiovascular disease. There is no treatment for Nonarteritic ischemic optic neuropathy. It is recommended that patients with this disorder undergo a thorough physical examination with their primary care provider in order to rule-out and treat any of the associated medical conditions.

Arteritic ischemic optic neuropathy (AION) is a condition caused by inflammation of the arteries supplying blood to the optic nerve. This condition is called giant cell arteritis (GCA) or temporal arteritis. Its cause is unknown. Women (and especially Caucasian women) are more likely to develop giant cell arteritis than men. The symptoms of giant cell arteritis include:

• Headache, fatigue, and fever
• Blurred vision
• Double vision
• Scalp tenderness
• Jaw pain
• Weight loss.

The diagnosis of giant cell arteritis is made by blood tests and obtaining a biopsy of the temporal artery which is an outpatient procedure performed with local anesthesia. The condition is treated with steroid (anti-inflammatory) medications. These relieve the symptoms and prevent further loss of vision and other complications of the disease. 

 

Migraine

Migraine headache is a common neurological condition that occurs in about 20% of the population. 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.

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 blurred spot in the field of vision,  seeing zigzag lines or shimmering lights.

Treatment is first aimed at determining the factors that may precipitate a migraine. These include environmental factors, medications, and food. There are medications available that will help mitigate the symptoms of a migraine. If migraines are occurring frequently then medication may be prescribed that is taken on a regular basis.

 

Multiple Sclerosis

Multiple sclerosis 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.

Multiple sclerosis affects people differently. Some have only mild symptoms, while others are severely debilitated by the disease. Symptoms of multiple sclerosis vary widely and can include the following:

• Numbness, tingling, or weakness in the arms and legs
• Loss of vision
• Double vision
• Blurred vision
• Eye pain
• Tremors
• Difficulties with coordination
• Dizziness.

If you are experiencing any of these symptoms, it is important to see your doctor immediately. To determine if you have multiple sclerosis you will be given a neurological examination and, possibly, an MRI scan and other tests to diagnose the cause of your symptoms.

Should your doctor confirm that you have multiple sclerosis there are a number of treatment options. There are several medications that can help, as can physical therapy, occupational therapy, and other treatments.

Although there is no cure for multiple sclerosis the major causes of vision problems associated with the disease are all treatable and often resolve on their own. Three common visual problems associated with MS are:

• Optic neuritis , or inflammation of the optic nerve, causing blurring, pain, and blind spots, among other things
• Diplopia , or double vision
• Nystagmus , or involuntary movement of the eyes.

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.

 

Myasthenia Gravis

Myasthenia gravis is a disorder characterized by weakness of the muscles that are under your voluntary control. Myasthenia Gravis is characterized by a communication breakdown between your nerves and muscles. It can be caused by an autoimmune condition that has damaged the receptors on your muscles. Patients with myasthenia gravis produce antibodies that adhere to the muscle receptors and prevent nerve impulses from getting to the muscle. This causes the muscle to become weakened.

Myasthenia 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. Some of the signs of myasthenia gravis include:

• Drooping eyelids
• Double vision
• Weakness in the arms or legs
• Difficulty breathing, talking, chewing, or swallowing.

The symptoms of myasthenia can worsened by fatigue, stress, illness, and certain medications. Check with your doctor before taking any new prescription or over-the-counter medications.

Your ophthalmologist can test for myasthenia using a number of methods, including:

• Blood tests to look for abnormal antibodies
• Neurological examination
• Nerve conduction testing and single-fiber electromyography, which test the electrical activity in your muscles
• Edrophonium injection testing, to look for immediate, temporary improvement in your muscle strength.

There is no known cure for myasthenia, 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 myasthenia is crucial to managing the condition and preventing serious problems with breathing or swallowing (which require emergency care).

 

Optic Neuritis

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 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, or vascular occlusions. However, in many cases, optic neuritis occurs with no known cause.

Steroid drugs are sometimes used to treat optic neuritis. In most patients, vision will significantly improve or return to normal without treatment.

 

Orbital Inflammatory Pseudotumor

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 unknown.

Orbital inflammatory pseudotumor usually occurs in only one eye. Symptoms may include:

• Redness
• Bulging of the eye
• Pain in the eye.
• Double vision
• Blurred vision.

Your ophthalmologist will probably order a scan to confirm the diagnosis 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 the symptoms may return so regular monitoring of the condition is necessary.

 

Pseudotumor Cerebri (or Idiopathic Intracranial Hypertension)

Pseudotumor cerebri (PTC) or idiopathic intracranial hypertension (IIH) 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 a tumor.

The cerebral spinal fluid (CSF) is a clear fluid that bathes the brain and spinal cord. In cases of PTC, the pressure in this fluid is elevated. The pressure causes swelling of the optic nerve (in the back of the eye) which can lead to loss of vision. 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:

• Obesity
• Hormonal influences, in young women
• Certain antibiotics
• Steroids
• High doses of vitamin A.

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:

• Dimming, blurring, or graying of vision;
• Difficulty seeing to the side;
• Brief visual disturbances;
• Double vision;
• Rushing noise in the ears; and
• Nausea and vomiting.

Your ophthalmologist 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 abnormalities of the cerebrospinal fluid.

If your symptoms are mild, no treatment other than weight loss and careful monitoring may be necessary. Often medications (diuretics) can help lower CSF pressure.

If your vision continues to deteriorate after you have begun treatment, surgical procedures may be undertaken in order to protect the optic nerves from any further damage.

 

Stroke

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:

• high blood pressure;
• high cholesterol;
• diabetes;
• cardiovascular disease;
• obesity; and
• smoking.

Symptoms of stroke include:

• numbness, weakness, or paralysis of your face, arms, or legs-usually on one side of the body;
• pain between the eyes;
• blurred vision, double vision, or decreased vision;
• dizziness, loss of balance, or loss of coordination;
• severe headache, stiff neck, or facial pain;
• difficulty speaking or understanding speech;
• confusion or problems with memory, spatial orientation, or perception; and
• nausea and vomiting.

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 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

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 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:

• osteoporosis;
• high blood pressure;
• muscle weakness; and
• cataracts.

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.