Neuro-Ophthalmology

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Not all eye problems start in your eyes.

Sometimes, when the nerves that connect your eyes to your brain are damaged, they send your brain the wrong visual signals or messages. If that happens, your eyes might cross or move when you don’t want them to. You could have droopy eyelids, double or blurry vision or see flashes of light. You could even lose your eyesight completely.

When you have neuro-ophthalmic vision problems like these, it’s important to get expert care right away. Our skilled providers understand the delicate connection between your brain and your eyes and have experience treating conditions that happen when there’s a disconnect between the two.

Why Choose Cleveland Clinic for Neuro-Ophthalmic Care?

Trusted experts:

Neuro-ophthalmology is a rare specialty — few providers have training and experience in both neurology and ophthalmology, but our team does. And they use their skill and knowledge to pinpoint the cause of your symptoms and find the best way to treat your condition.

Specialized knowledge:

We use the latest imaging tests to evaluate your eyes and nervous system and find out what’s going on. Then, our neuro-ophthalmologists will go over treatment options with you. And they’ll develop a personalized care plan based on your specific vision problems. Meet our team.

Skilled, collaborative providers:

Our team-based approach to care means you’ll benefit from the experience and knowledge of providers from different specialties, like ophthalmology, neurology, rheumatology, endocrinology and more. This team shares knowledge and works together to find out what’s happening so they can provide the best treatment.

Virtual visits:

While eye exams and testing need to be done in person, virtual visits work well for quick check-ins with your providers. You can meet with them one-on-one using an internet connection and a smartphone, computer or tablet from wherever you are.

National recognition:

Cleveland Clinic is a trusted healthcare leader. We're recognized in the U.S. and throughout the world for our expertise and care.

Diagnosing Neuro-Ophthalmology Conditions at Cleveland Clinic

Your eyes collect images. Your brain makes sense of them. You see things because of the connection between your eyes and brain. But sometimes, that communication breaks down, and problems can start.

You could develop double vision (diplopia) or sudden vision loss. One of your pupils (the black center of your eye) could become bigger than the other one (asymmetric). You might notice that part of your peripheral vision (what you can see without moving your head) is missing (visual field loss). Abnormal eye shaking (nystagmus) is another common neuro-ophthalmic problem.

There are many different things that could cause your optic nerves to go haywire. Our job is to find out what’s causing the disconnect between your eyes and your brain and treat that condition.

Strokes, migraine headaches, multiple sclerosis (MS) and brain injuries can trigger neuro-ophthalmic symptoms. Or you may have a condition like:

Neuromyelitis optica (NMO), formerly known as Devic’s disease.
Intranuclear ophthalmoplegia.
Myasthenia gravis (MG).
Optic atrophy.
Optic neuritis.
Retrobulbar neuropathy (a type of optic neuritis).
Strabismus.
Thyroid eye disease.
Visual snow syndrome.

What to expect at your first visit

Your first appointment usually lasts between two and four hours. Your provider will start by getting to know you. Your story’s an important part of your diagnosis. You’ll want to be prepared to answer questions like:

What kind of symptoms have you noticed?
How long have you had these symptoms?
How are these symptoms affecting life?
Have you had any testing for these symptoms?
Have you been diagnosed with any medical conditions?
What kind of health conditions do your family members have, if any?

Then, we’ll do a neuro-ophthalmic exam and some tests to see what’s happening. Your test results help us confirm a diagnosis and craft your treatment plan.

Vision tests

During your appointment, we’ll look at your:

Color vision with a color blindness test.
Eye pressure with tonometry.
Peripheral vision with visual field testing.
How well you can see with a visual acuity test.
Eye movements and the alignment of your eyes.

To see inside your eyes with a slit lamp exam, we use eye drops to widen (dilate) your pupils.

We may also do optical coherence tomography (OCT), which takes pictures of your retina.

Additional tests

Sometimes, our team might decide you need other tests. We may order brain imaging like a CT scan (computed tomography scan) or MRI (magnetic resonance imaging). You may have blood tests to check for inflammatory and autoimmune conditions and other conditions that could affect the connection between your brain and your eyes.

Meet Our Neuro-Ophthalmology Team

Your eyes and brain work closely together and when they stop communicating, it creates a challenging puzzle. That’s why we build a care team of skilled providers from different specialties. Your team could include:

These and other expert providers work together to plan and manage your care so you can get the best possible results.

Providers Who Treat Neuro-Ophthalmology Conditions

Locations

Our healthcare providers see patients at convenient locations throughout Northeast Ohio.

Treating Neuro-Ophthalmology Conditions at Cleveland Clinic

Once we confirm a diagnosis, it’s time to talk about treatment. We treat many conditions in neuro-ophthalmology, so no two care plans are the same. Besides getting regular eye exams, we may recommend:

Medications

Depending on your diagnosis, medications may help your neuro-ophthalmic condition. If inflammation or an autoimmune condition causes your vision problems, we may prescribe corticosteroids or other kinds of anti-inflammatory drugs.

Patches and visual aids

An eye patch or prism can help correct double vision. Prisms help correct double vision problems by changing how light enters your eyes. They do the work your eye muscles can’t.

Surgery

You may need surgery for certain conditions. Eye muscle (strabismus) surgery can improve eye position and movement. A brain tumor or increased intracranial pressure can also cause vision problems. Our many specialists work together to diagnose and treat tumors, with many different types of therapies, including brain surgery (craniotomy).

Taking the Next Step

While it’s easy to blame your eyes for vision problems, they aren’t always at fault. Glitches in your nervous system can damage how your brain and eyes communicate. Our neuro-ophthalmology providers understand the delicate relationship between your brain and your eyes. They’ll figure out what’s causing your vision problems and provide the expert, personalized treatment you need to get the best possible results.