Neuro-ophthalmic Symptoms

Neuro-ophthalmology is a specific branch of eye care that addresses vision issues related to disorders of the nervous system. Many neuro-ophthalmic disorders affect the optic nerve, which transmits signals to the brain and allows us to perceive images. Other conditions can impact the nerves that control movement of the eye and eyelid. Neurological vision disorder symptoms can include double vision and vision loss. Our neuro-ophthalmologists have undergone specialized training in the diagnosis and treatment of these conditions, and can help you maintain your vision if you suffer from MS or other neurological disorders.

Common Neuro-ophthalmic Symptoms

Depending on the specific neurological disorder affecting the eyes, patients may experience one or more of the following symptoms:

  • Double vision: There are two types of double vision: monocular diplopia and binocular diplopia. Monocular diplopia occurs when the eye does not refract light properly. This type is not actually caused by a neurological condition. Binocular diplopia, on the other hand, occurs when the nerves do not allow the eyes to move at the same time, causing each eye to focus on a slightly different point.
  • Sudden vision loss: Sudden vision loss can result from optic neuritis, ischemic optic neuropathy, macular degeneration, closed-angle glaucoma, and other disorders. The degree of severity will depend on the cause, and can range from a partial loss of vision to complete vision loss. In all cases, it should be treated as a medical emergency, and patients should seek immediate treatment.
  • Unequal pupils: Unequal pupils can result from neurological and systemic conditions such as cranial nerve palsy, Horner syndrome, glaucoma, or Adie’s tonic pupil. Sometimes, uneven pupils may indicate a life-threatening condition, so it is important for patients experiencing this symptom to contact a doctor as soon as possible.
  • Nystagmus: Rapid uncontrolled eye movement can be present at birth, or it may be a symptom of a condition such as cataracts, optic nerve hypoplasia, multiple sclerosis, stroke, and medication toxicity. Nystagmus can cause blurred vision. In severe cases, patients may experience jumping images and an inability to focus their eyes.
  • Drooping of the eyelids: Also called ptosis, drooping eyelids is a common condition that typically occurs as the facial skin and muscles lose elasticity with age. However, in some cases, ptosis can indicate a neurological condition such as Horner syndrome, myasthenia gravis, cranial nerve palsy, or an aneurysm. By itself, ptosis does not actually threaten a patient’s ocular health, although a severely drooping eyelid may physically obstruct vision.
  • Bulging of the eye: Typically, in a healthy eye, the white part of the eye should not be visible above the iris. If this area does show, it could indicate a serious condition such as Graves’ disease, pseudotumor cerebri, or a tumor around the eye. Bulging eyes occur gradually, so patients may not even notice the symptom for several months.


The doctors at SightMD are trained and equipped to care for vision issues caused by neurological disorders. In many cases, the symptoms can be controlled, if not completely cured. Of course, the specific treatment for these symptoms will depend on the underlying cause. Treatment options typically include:

  • Eye drops: Medicated eye drops are especially helpful in treating bulging eyes, glaucoma, and unequal pupils.
  • Oral medications: When symptoms are caused by neurological conditions such as MS, steroids can help to control all symptoms, including those that affect the eye.
  • Corrective lenses: Though not a cure, corrective lenses can help patients with nystagmus.
  • Surgery: Although we prescribe non-invasive treatment options first, surgery may be the best solution for ptosis, double vision, and other symptoms.
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