Neuroophthalmic

Neuro-ophthalmic, or neuro-ophthalmology, is a medical subspecialty that investigates visual problems arising from disorders of the nervous system. It combines neurology and ophthalmology and focuses on the afferent and efferent visual pathways, including the optic nerve, optic chiasm and tracts, occipital cortex, and the cranial nerves that move the eyes and regulate pupil responses. Common presenting features include vision loss or field loss, double vision, ptosis, abnormal pupil reactions, and papilledema. The discipline emphasizes integrated clinical assessment and targeted investigations to diagnose neurologic causes of visual symptoms.

Neuro-ophthalmic disorders include optic neuropathies (ischemic, inflammatory such as optic neuritis, compressive from mass lesions, hereditary forms), papilledema from raised intracranial pressure, and cranial nerve palsies (oculomotor, trochlear, abducens) causing diplopia. Pupil abnormalities (anisocoria, light-near dissociation, Horner syndrome, Adie’s pupil) and ocular motility disorders frequently occur. The field also overlaps with demyelinating diseases, inflammatory or infectious disorders, vascular disease, tumors, and glaucoma-related neuropathies.

Evaluation typically includes visual acuity, color vision, visual fields, dilated fundus examination, and optical coherence tomography; imaging with MRI of the brain and orbits with contrast; and sometimes CT or MR angiography. Lumbar puncture or blood tests may be pursued for suspected demyelinating, infectious, or inflammatory etiologies. Management targets the underlying cause, ranging from urgent corticosteroids for optic neuritis or giant cell arteritis to therapy for intracranial hypertension, diplopia rehabilitation, and multidisciplinary care to preserve or optimize vision.