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  • neuro opthamologist

    I was at the cleveland clinic today, trying to get some relief for the constant upper eye pain i am having. The dr. found nothing that could be causing my severe pain, and sent me on my way. Recommended that i see a neuro opthamologist back here in pittsburgh. I have no idea what a neuro opthamologist is or what they do. so far i have been to 9 eye doctors, 5 say i have dry eye and 4 say i dont. i cant figure out what is goin on, and who to believe right now. can someone tell me what a neuro opthamologist is gonna do?

  • #2
    Ronny I went to one and he said nothing was wrong except maybe anxiety. All that it is is nuroligst that specilises in the optic area of nurology. They understand the eye and conditions but not to the extent of the optimoligst. I have been this same route as you and until I was show by the dr I see now what was going on I searched just like you for the pain. How long have oyu had it the pain lasted for me until I did alot of warm compresses used alot of eye drops and used steroid eye drops. I had that same pain you describe and like you dident get any answers. You have to find a dry eye dr that is willing to spend time diagnosing you and listining to you nearly impossible I know but it can be done. I hope you find some luck with it I know hte battle I and many of us have had with dry eyes. I am just glad to have a place like this forum to hear from others and learn so much.

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    • #3
      Wow, Ron, 9 doctors and no answers! That is awful. It sounds like they thought you might have some nerve pain- maybe from another problem. If you go to a neuro- opthamologist make sure it is some one who is well reccommended. An MRI sounds like the next step for you.

      I know that I had facial pain (and lack of pain) that led me on a goose chase for over 6 years. Finally by a fluke I had a functional MRI which revealed a paratoid tumor sitting near my trigeminal facial nerve.

      The ENT thought it was totally unrelated to my facial and jaw pain. After the surgery he told me that it was indeed the cause of my pain. I can not begin to tell you how relieved I was to be validated!!

      Your pain is real (duh!) and there is some logical source for it. Keep us posted. You will be in my prayers today-

      Tigs

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      • #4
        http://www.luhs.org/depts/ophtha/neu...phthalmologist
        What is a Neuro-Ophthalmologist?

        Neuro-ophthalmologists take care of visual problems that are related to the nervous system; that is, visual problems that do not come from the eyes themselves. We use almost half of the brain for vision-related activities, including sight and moving the eyes. Neuro-ophthalmology, a subspecialty of both neurology and ophthalmology, requires specialized training and expertise in problems of the eye, brain, nerves and muscles. Neuro-ophthalmologists complete at least 5 years of clinical training after medical school and are usually board certified in Neurology, Ophthalmology, or both.

        Although some problems seen by neuro-ophthalmologist are not worrisome, other conditions can worsen and cause permanent visual loss, or become life threatening. Sometimes the problem is confined to the optic nerve or the nervous system and other times it is related to a general medical condition. Neuro-ophthalmologists have unique abilities to evaluate patients from the neurologic, ophthalmologic, and medical standpoints to diagnose and treat a wide variety of problems. Costly medical testing is often avoided by seeing a neuro-ophthalmologist.

        Some of the common problems evaluated by neuro-ophthalmologists include: optic nerve problems (such as optic neuritis and ischemic optic neuropathy), visual field loss, unexplained visual loss, transient visual loss, visual disturbances, double vision, abnormal eye movements, thyroid eye disease, myasthenia gravis, unequal pupil size, and eyelid abnormalities.


        PREPARING FOR THE NEURO-OPHTHALMOLOGY EVALUATION

        1. Request that your treating physicians send all relevant information to the neuro-ophthalmologist prior to your appointment, including office notes, results of laboratory tests and reports of CT and MRI scans.
        2. If you have had a CT or MRI scan performed, arrange to pick up the actual films and bring them with you, .
        3. You will probably have your pupils dilated during the visit. The eye drops last about 4 hours and will make things look bright and blurry up close. Have someone else drive you to the appointment and bring your sunglasses.
        4. Ladies, in order for the physician to get a good look at your eyelids, and to avoid ruining your appearance when the eye drops are administered, do not wear eye makeup.
        5. Bring a complete list of medications with you, including the name and dosage of prescription and over-the-counter medications.

        WHAT HAPPENS DURING THE EVALUATION?

        1. The neuro-ophthalmologic evaluation is one of the most comprehensive examinations you will experience. It may take a few hours to complete. You will be asked to give an account of your current problem and relate your entire medical history, including previous hospitalizations, operations, serious illnesses, medical problems in your family members, and medication allergies.
        2. You will have a complete eye examination. This may include testing of your peripheral vision (visual field test).
        3. You may have a partial or complete neurologic exam to test your strength, sensation, and coordination.
        4. The neuro-ophthalmologist will review the records and scans from previous evaluations, if applicable.
        5. After the examination, the neuro-ophthalmolgist will discuss the diagnosis (or possible diagnoses), the need for any additional testing and possible treatment.

        Dr. Walter M. Jay and Dr. Patricia Davis are members of the North American Neuro-Ophthalmology Society. The above information was obtained from their website with the permission of the society.
        Every day with DES is like a box of chocolates...You never know what you're going to get.

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        • #5
          Originally posted by ronnyp
          I was at the cleveland clinic today, trying to get some relief for the constant upper eye pain i am having. The dr. found nothing that could be causing my severe pain, and sent me on my way. Recommended that i see a neuro opthamologist back here in pittsburgh. I have no idea what a neuro opthamologist is or what they do. so far i have been to 9 eye doctors, 5 say i have dry eye and 4 say i dont. i cant figure out what is goin on, and who to believe right now. can someone tell me what a neuro opthamologist is gonna do?
          He will probably either (1) wonder why you were referred to him, or (2) suggest a diagnosis related to neuralgia.

          Neuro-ophthalmologists are either (1) ophthalmologists who take an additional residency in neurology, or (2) neurologists who take an additional residency in ophthalmology. In any event, they are mostly interested in the (1) optic nerve, (2) all of the other cranial nerves serving the eye (CN IV, V and VI), and the diseases such as MS, trauma, mass lesions, infarctions affecting any of the above.

          Their workups are extensive and often involve scans such as MRI and CT.
          Last edited by DrG; 20-Jan-2006, 09:28.

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          • #6
            neuro opthalmologists

            I was finally sent to one when no one could figure out why I was having terrible facial pain on my right side. After ruling out any tumors, etc. he diagnosed it as Trigeminal Neuralgia. He told me that the nerves of the cornea are directly linked to that nerve and my dry eye problem was setting it off. Besides telling me to keep the dry eye under control, he prescribed Trileptal for it and for nearly two years now, it has been pretty good. Some things still set it off, like wind in my face and forgetting to use drops enough, but it is nothing like it was.

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            • #7
              thanks for the replies everybody, i go to a neur-opth next thursday here in pittsburgh, it was bad enogh that my eyes were killing me, now the pain has moved down to my cheek bones on each side of my face also. Is it possible that dental problems can cause eye pain? I have always had real weak teeth, and seem to get a bunch of cavaties, and sore gums. just a thought, i am trying to think of anything right now. Also, can a neuro opthamologist check to see if my sinuses are clogged? thanks, Ron

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              • #8
                I have seen where people have had problems with the trigeminal nerve that started with dental surgery. I think that nerve is all connected to face, jaw, and eye.
                Not an expert on this, but do some research on that and see what you come up with.

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                • #9
                  My dry eye on my left side started after my paraotid surgery. There was a benign tumor on my trigeminal nerve and I guess it was tricky to remove. I didn't realize that there was a difference between my eyes post op until my boss told me that my left side looked 'younger' now .......less smile wrinkles around the left eye. Shortly afterwards I started waking up with a painful left eye.

                  I definitely believe that anything that affects those nerves can alter your eyelid's ability to close or stay closed properly.

                  Hope things turn out well with your visit to the neuro opthamologist.
                  Tigs

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                  • #10
                    I think that bilateral trigeminal neuralgia, i.e. on both sides, would not be common.

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                    • #11
                      Hi Ronny.......I understand your frustration. I scanned through some of your posts. One question I have for you is - do you have anyone with whom you can share your problem(s)? Can someone go to your doctor's appointments with you? I do not want any personal info, but if you have no one to understand this, it makes it much harder. Please don't put any personal info on the bb. That's not what I want. I don't need to know your circumstances, but it would help if you had a friend, cousin, mother, sister, brother to accompany you for moral support.

                      Good luck......Lucy
                      Don't trust any refractive surgeon with YOUR eyes.

                      The Dry Eye Queen

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                      • #12
                        my mom has gone with me a few times, and will be taking me to the neuro on thursday, if i have to have an mri i have to be sedated cause i have severe chlaustrophobia.. thanks for your concern lucy. unless you go thru this ity is real hard for anyone to understand, that is for sure

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                        • #13
                          Trigeminal Neuralgia

                          Hello Dr. G,

                          You are correct - bilateral Trigeminal Neuralgia is very uncommon according to my neuro/opthalmologist. I can't even begin to imagine it on both sides of my face. One side is enough to deal with.

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                          • #14
                            my mom has gone with me a few times, and will be taking me to the neuro on thursday, if i have to have an mri i have to be sedated cause i have severe chlaustrophobia.. thanks for your concern lucy. unless you go thru this ity is real hard for anyone to understand, that is for sure
                            Ronny, for what it's worth, I've had two MRI's for my eye problems. I want to say the MRI's are not bad and do not hurt. I understand if people are claustrophic - it can cause them extra stress. The medication will help with that. At least with the MRI, you know it's not painful. Mine never showed anything conclusive, but it needed to be done to rule out certain things.
                            I understand, as well as most of the folks on this bb.

                            PS. Mom's are the best for support. I know, I am one. I would be with my daughter through this type of thing too.
                            Don't trust any refractive surgeon with YOUR eyes.

                            The Dry Eye Queen

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                            • #15
                              mom's are good support, that is for sure. i am fine going to any other doctor by myself, but whenever i go to the eye doctor i really like my mom there for moral support. i get pretty upset whenever i hear yet another eye doctor tell me that he doesn't know how to help me. (also it's good to have someone drive me home, because all the probing and testing they do usually takes a toll on the eyes by the time my appointment is over!)

                              Good luck with the appointment in Pittsburgh next week! I hope you can find relief, and maybe someone to go along with you as well!
                              -Amy

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