Neuro Ophthalmology
Neuro-ophthalmology addresses the relationship between the eye and the brain, specifically disorders of the Optic Nerve, Orbit, and Brain that impact our vision. Board certified, fellowship trained and a member of North American Neuro-Ophthalmology Society, Dr. Schlessinger is a Neuro-Ophthalmologist specifically trained to diagnose and treat patients with difficult and rare visual disorders, including: double vision, headaches, unexplained vision loss,spasms and twitching of the eyelid and face, disorders of the optic nerve and thyroid related eye problems.
Double vision, also called Diplopia, causes a person to see two images of a single object. There are two types of double vision: monocular and binocular. Monocular Diplopia is double vision in only one eye. The double vision continues even when the other eye is covered. The doubling does not go away when you look in different directions. Binocular Diplopia is double vision related to a misalignment of the eyes. The double vision stops if either eye is covered. Any problem that affects one or more of the muscles around the eyeball that control the direction of the gaze can cause binocular diplopia. These are called extraocular muscles.
Ischemic optic neuropathy [or "stroke of the optic nerve"] is one of the most common causes of loss of vision in persons past middle age, although younger people can get it as well. It occurs when the blood supply to the optic nerve is interrupted, thus causing vision loss. There are two types of Ischemic optic neuropathy, depending upon the part of the optic nerve involved, anterior and posterior. Early diagnosis, recognition of various risk factors, and carrying out the treatment and follow-up visits, as recommended, are the most important aspects of care for persons with ischemic optic neuropathy.
Optic neuritis is the inflammation of the optic nerve that may cause a complete or partial loss of vision. Major symptoms are sudden loss of vision (partial or complete), or sudden blurred or "foggy" vision, and pain on movement of the affected eye. Many patients with optic neuritis may lose some of their color vision in the affected eye, with colors appearing subtly washed out compared to the other eye. In many cases, only one eye is affected and patients may not be aware of the loss of color vision until the doctor asks them to close or cover the healthy eye.
Sudden loss of vision can be total (which is fortunately quite rare), partial, transient or permanent, involving either one or both eyes. The sudden loss of vision in one or both eyes is a frightening occurrence, and if it occurs you should see your ophthalmologist as soon as possible. Don't delay, because depending on the specific cause, early treatment may well be the only way to prevent permanent blindness.
A migraine headache is a form of vascular headache. Migraine headache is caused by a combination of enlarged blood vessels and the release of chemicals from nerve fibers that coil around the blood vessels. The chemicals cause inflammation, pain, and further enlargement of the artery which magnifies the pain. Migraine attacks commonly activate the sympathetic nervous system in the body. The sympathetic nervous system is often thought of as the part of the nervous system that controls primitive responses to stress and pain, the so-called "fight or flight" response. The increased sympathetic activity also contributes to the sensitivity to light as well as blurred vision.
With some of our patients, we have had excellent results successfully relieving migraine headaches with Botox® Injections. There are certain foods that may act as a trigger that can and should be avoided. All treatment plans are tailored to each patient’s specific needs.
Thyroid Eye disease [Graves’ disease] is an auto-immune disease that causes inflammation of the Thyroid gland. It is frequently associated with inflammation of the extraocular muscles and orbital fat. The effects on the eye may be temporary and reversible. Some patients however have severe and permanent orbital inflammation. This can cause proptosis (a forward displacement of the eye). The upper and lower eyelids may become retracted causing exposure of the cornea and conjunctiva. Symptoms can range from tearing, corneal dryness and irritation (in mild cases) to double vision, corneal scarring, vision loss and possibly blindness (in the severest of cases).
Treatment of thyroid eye disease depends on the severity of the disease. Many patients do well with simple measures such as frequent use of lubricants and topical anti-inflammatory drops. If the eyelid is retracted without significant proptosis, eyelid lengthening procedures may be performed. In cases of severe proptosis treatment options vary from radiation therapy (a controversial therapy) to surgical orbital decompression.
A blepharospasm is any abnormal tic or twitch of the eyelid. Symptoms sometimes last for a few days then disappear without treatment, but in many cases the twitching is chronic and persistent. Lifelong challenges including the ability to work, drive a car and can even result in a diagnosis of Functional Blindness. The patient’s eyelids feel like they are clamping shut and will not open without great effort. Patients have otherwise “healthy” eyes, but for periods of time are effectively blind due to their inability to open their eyelids.
Although strides have recently been made in early diagnosis, blepharospasm is often initially mis-diagnosed as allergies or "dry eye syndrome". It is a fairly rare disease, affecting only one in every 20,000 people in the United States.
Hemifacial spasm or HFS is a neurological disorder in which blood vessels constrict the seventh cranial nerve and cause varying degrees of facial spasming, typically originating around the eye of the afflicted side of the face. Because the nerve directs muscular activities in a particular region, interference will create involuntary contractions. Severe forms of HFS will contort an entire side of the face.
For some patients, Botox® injections [also used for cosmetic purposes] have been successful in temporarily alleviating these spasms.
Bell's palsy is a unilateral facial nerve paralysis, usually self-limiting, resulting in inability to control facial muscles on the affected side. Symptoms include a rapid onset of partial or complete palsy, usually in a single day. Named after Scottish anatomist Charles Bell, who first described it, Bell's palsy is the most common acute disease involving only one nerve, and is the most common cause of acute facial nerve paralysis.
Although it is rare, tumors, either malignant or benign, can occur in the tissue behind the eye. Tumors can form within this tissue, or cancerous tumors from elsewhere in the body can spread (metastasize) to these tissues. These tumors can push the eye forward (a condition called proptosis or exophthalmos). Pain, double vision, and vision loss may also occur. Computed tomography (CT), magnetic resonance imaging (MRI), or both are done to obtain an image of the tumor and exclude other abnormalities. Usually a sample taken for examination under a microscope (biopsy) is needed to determine what type of tumor is present, and treatment depends on these results. Treatment may include surgical removal, radiation therapy, chemotherapy, or a combination of these treatments.
