Neuro-Ophthalmology Examination

Abstract

Many neurological diseases affecting the eye have their origins in the central nervous system (CNS). The ocular symptoms more often than not is secondary to a diffuse neurological problem like a demyelinating disease or a localised lesion in the brain or meninges. A neurologist or a neurosurgeon will also be needed to co-manage the cases seen in the clinic. The ophthalmologist role is primarily to understand and interpret the ophthalmic symptoms and signs we see. The first thing an ophthalmologist needs to do is to rule out an ophthalmic cause for the symptoms and signs before the neurologist can intervene. Referring an uncorrected hypermetrope with headache to a neurologist would be a big disservice to the patient. Ophthalmologists have to make sure the patient does not have an ocular condition like amblyopia before referring him to the neurologist for evaluating the visual symptoms. The neurologist relies on an ophthalmologist to monitor the patients while on treatment. The ophthalmologists are in the unique position to see the nerves and vessels of the CNS in vivo (the optic nerve is an extension of the brain and the central retinal artery has all the characteristics of CNS vessels including having a blood brain barrier).