Neurological disease seen in the eye
- Eye and systemic disease
Half the brain helps vision, so many neurological diseases show in the eyes: in the optic nerve, the eye movements, the pupils or the fields.
See it in 3D: Optic nerve · Optic chiasm · Oculomotor nerve (III) · Abducens nerve (VI) · Visual cortex
What it is
The visual system runs from the eye to the occipital lobe and is controlled by several cranial nerves and brainstem centres. Neurological diseases therefore often show in the eye: optic neuritis and internuclear ophthalmoplegia in multiple sclerosis, fatigable ptosis in myasthenia gravis, papilloedema in raised intracranial pressure, field defects in stroke and tumours, and pupil changes in nerve compression.
Eye findings
- Multiple sclerosis: optic neuritis, internuclear ophthalmoplegia, nystagmus, intermediate uveitis.
- Neuromyelitis optica: severe, often bilateral optic neuritis with poor recovery (aquaporin-4 antibodies).
- Myasthenia gravis: fatigable ptosis and diplopia with normal pupils.
- Raised intracranial pressure: papilloedema and sixth nerve palsy.
- Stroke: homonymous field loss; pituitary tumour: bitemporal loss.
- Compressive third nerve palsy: ptosis, eye down and out, dilated pupil.
Screening and follow-up
- Bilateral internuclear ophthalmoplegia in a young adult is almost always multiple sclerosis; in an older adult, stroke.
- Optic neuritis that is bilateral, severe or poorly recovering suggests neuromyelitis optica or MOG antibody disease rather than multiple sclerosis.
- Parkinson disease reduces blinking and convergence and causes dry eye.
Next step / Initial management
- Optic neuritis or internuclear ophthalmoplegia: MRI of the brain and neurology.
- Severe or bilateral optic neuritis: aquaporin-4 and MOG antibodies and urgent neurology.
- Fatigable ptosis or diplopia: myasthenia workup; emergency if breathing or swallowing are affected.
- Papilloedema or a new field defect: urgent brain imaging.
Test yourself
Think of the answer, then tap the question to see it.
What does bilateral internuclear ophthalmoplegia in a young adult suggest?
Multiple sclerosis.
Which optic neuritis suggests neuromyelitis optica?
Severe, often bilateral optic neuritis with poor recovery; aquaporin-4 antibodies confirm it.
Which eye findings point to raised intracranial pressure?
Papilloedema and a sixth nerve palsy.
Elsewhere in DurgiPedia
- The visual pathway, pupillary reflexes and eye movements
- Pupils: light reflex and abnormal pupils (Marcus Gunn, Horner, Argyll Robertson)
Connections
See it in 3D5
The structures of Durgical's 3D anatomy where it is found.
Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.
Sources: Internuclear Ophthalmoplegia (StatPearls Publishing (NCBI Bookshelf), 2023); Multiple Sclerosis (StatPearls Publishing (NCBI Bookshelf), 2024); Neuromyelitis Optica Spectrum Disorder (NMOSD) (StatPearls Publishing (NCBI Bookshelf), 2024).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.