Eye symptoms of neurological origin

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What is it about ?

Eye symptoms of neurological origin are abnormalities of the eyes or visual disturbances due to a disorder of the nervous system. It may be a disease of the central nervous system (brain and spinal cord), for example multiple sclerosis (MS), or a disease of the optic nerve, such as inflammation of the nerves (neuritis). Some symptoms can also be caused by eye disease (called ophthalmia), such as cataract

(crystalline which becomes opaque). This condition causes blurry eyesight.

In the eye symptoms of neurological origin, there is nothing abnormal with the eye itself, but rather with the optic nerves or the brain centers responsible for vision.

How to recognize them?

This is usually a change in the ability to see image details (visual acuity), field of vision, eye movements, pupil size, and their response to light. It can also be a kind of eyelid palsy :

  • Decreased visual acuity: the sight is cloudy and we no longer perceive a clear image. The problem may affect only one eye or both. Sometimes we realize this by chance: we cover one eye and notice that the other sees cloudy.
    • The onset can be sudden. The cause of the problem is usually damage to the optic nerve due to poor blood circulation.
    • It can also gradually get worse over a few days, suggesting infection instead. The cause of very gradually worsening vision is often a compression of the optic nerve, for example by a tumor.
  • Unequal pupil size : we can clearly see that the person has a larger pupil than the other. When there is no affection causing the problem, it is called physiological anisocoria. This is the case in 2 out of 10 people in the general population. Normally, sending light into the eye causes the pupil to narrow. This is called the pupillary reflex. Normally, this reflex should be the same for both pupils. In the event of an uneven pupillary reflex, one pupil reacts well while the other reacts little to light. One of the pupils may also not react to it at all. An uneven reaction may indicate a circulation disorder, nerve damage, or damage to the brain that causes increased pressure in the brain. This problem is often accompanied by double vision (diplopia). Some eye drops (eye drops) and plant toxins can affect the pupillary reflex.
  • Double vision : the person sees everything twice. The problem may be with seeing in one or both eyes. It is possible to distinguish by successively covering one of the eyes. Some people also have double vision due to fatigue. It is not always present.
  • Ocular paralysis : it is caused by the failure of one of the optic nerves responsible for eye (and eyelid) movement and pupil contraction. The problem is usually due to a small heart attack or a sore.
  • Papillary edema : the papilla is the protrusion of the optic nerve at the back of the eye. Fluid can build up in nerve fibers due to increased pressure (e.g. caused by a tumor), lack of oxygen (e.g. due to circulation problems) or infection , causing the papilla to swell. This is called papillary edema. Blurred vision is the main symptom of the condition. The patient may also have headaches, nausea, or decreased level of consciousness. But it also happens that the slightest symptom is not observed, so that the condition will not be diagnosed until late.

How is the diagnosis made?

In the event of eye symptoms of neurological origin, the ophthalmologist and sometimes the neurologist will examine the patient. They will carefully examine the eyes and their movements as well as pupillary reflexes. In some cases, the doctor will put drops in the eye to dilate the pupil so that he can look at the papilla. If necessary, the doctor will also have a CT scan or MRI of the brain performed.

Want to know more?

Source
Foreign clinical practice guide ‘Neurological eye symptoms’ (2000), updated on 24.04.2016 and adapted to the Belgian context on 20.07.2019 – ebpracticenet

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