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Thread: neuro opthamologist

  1. #1
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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. #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.

  3. #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

  4. #4
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    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.

  5. #5
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    Quote 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 at 09:28.

  6. #6
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    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.

  7. #7
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    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

  8. #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.

  9. #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

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

  11. #11
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    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

  12. #12
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    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

  13. #13
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    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.

  14. #14
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    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

  15. #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

  16. #16

    Mri

    I had one, and I am very claustrophobic. They gave me something beforehand that really helped. But what is really cool is that the pipe air into the machine, so it feels like wind on your face. Gives you the feeling of being outside if you just keep your eyes shut and pretend.
    But on the down side.....if you have dry eyes be aware of this beforehand and ask if yours will have air currents. You may want to wear extra protection on your eyes, even if you do have them shut.
    At least I think that was an MRI....or was it a CT scan??? Hmmmm.....

  17. #17
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    well i had my neuro/opth appt. today, basically started out by doing the ordinary eye exam, and then a field test, and then a test on the optical nerve. everything came back good, finally got a 100 percent guarentee of no dry eye, which is good i guess, couldnt tell me why i am in extreme pain, so i have to go in on sat. morning for an MRI/MRA of the brain, orbitol area, and neck. scared to death of this cause i have major chlaustrophobia, and was told i would be in the tunnel for 2 hours, they say they can put something in the IV that will calm me down and i wont know what is going on, which i hate, cause i am also a major control freak, and when i cant control my situation i panic, so i am pretty worried about this, the doctor seemed very interested in really checking out the sinus cavity, i have been taking sinu tab with no results, so i am not sure what is going on.

  18. #18
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    Ronny-

    I wish you all the best. Along with the eye issues, I've had four sinus surgeries, so I understand a bit of what you could be facing. Relief is worth it all.

    Obviously, we don't know each other, but I think I understand some of the anxiety that you're feeling re: the radiologic (CT/MRI) procedures. All I can offer is that you do whatever sort of relaxation activity/exercise/ritual works best for you ... from now through the time of the imaging.

    Whether it's meditation, walking, yoga, soft music, guided visual imagery, deep breathing, a massage (this is sounding good!) ... do something to help yourself relax prior to the imaging.

    Wish you all the best....

    Neil

  19. #19
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    thanks neil, relaxation usually involves a few jack and cokes, but dont think the doctors would care for that much.

  20. #20
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    Ronny,
    I will be interested in what happens with this new dr. the only dr. I havent seen is a neuro-opthamologist for my pain. ENT dr has done two MRIs and found nothing I am having pain after having an intracannicular plug put in and then irrigated out. The irrigation has been done twice the first time to remove it and the dr. was pretty rough the 2nd dr. was very gentle and they think the plug is out but I have terrible pain on the side of my nose and around my eye and through it. What is a MRA? I am also claustrophobic and with the relaxation drugs they give you, you should do great they also put a mirror in for me so I could see my husband somewhat that helped alot. It is amazing what a comfort it is to have someone go with you. I cant even go into an eye drs. office now without someone... Best of luck and hope you can get some answers... Do you take anything for the pain? I will be thinking of you...
    Peggy

  21. #21
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    we'll i survived the mri today, wasnt easy though, they had all intentions of putting me into a twilight sleep stage, but i have absolutely no reaction to any kind of sedative IV, the doctor couldnt understand it either, they gave me 4 times the amount of medication, that someone my weight should have, and said they couldnt understand why i wasnt almost in a coma, by that point. so , i sucked it up, and made it thru 2 hours in that tube. never been so happy to get out of there. when i came out my shirt and hair were soaking wet from the 2 hour panic attack. but i survived it.

  22. #22
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    I'm so sorry you had such a hard time with that. My mother had kinda the same thing happen...and she's very tough in every other way. Thank God it's over. I'll be interested in hearing about your results.

  23. #23
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    thanks diana, i am scheduled to go back and get results next thursday, i see you are from cincy, i run a delivery every week to mason, just off of rt. 71 past kings island.

  24. #24
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    Holy cow! I'm in West Chester...practically right up the street! Where exactly is Cabot, Pa?!

  25. #25
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    cabot is about 25 miles directly north of pittsburgh

  26. #26
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    Ever heard of McDonald PA? It's 20 miles south of Pittsburgh. My sis lives there.
    Don't trust any refractive surgeon with YOUR eyes.

    The Dry Eye Queen

  27. #27
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    yes, i know exactly where that is.

  28. #28
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    I was watching national weather station and you guys better get set for lots of snow. In Mich, we got dumped on last night and it looks to be headed towards your area.
    Don't trust any refractive surgeon with YOUR eyes.

    The Dry Eye Queen

  29. #29
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    My folks and a huge number of my family members are from Erie, PA. They're always ready for snow. It seems like it never stops there...particularly when the lake hasn't frozen yet. My guess is that is hasn't. I was supposed to head to Erie a few weeks ago to visit, but my son got the flu. Fortunately, we have a 4 WD and my husband likes snow.

  30. #30
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    got all my mri results today, everything is perfect, no sinus problems, no tumors, no problems with the veins. so i still dont have no answers, I had pictures of my eyes taken that show a 3d image, everything perfect. i had a kinda sonogram of the eye, once again perfect. this is the 12th doctor who still doesnt know what to do with me. my lower lids are slightly swelled and red, and they said my TBUT is a bit low, but shouldnt be causing this severe pain. I was perscribed 60 mg. of prednisone, and that was all. i have no idea where to turn next, cause this pain is terrible. made an appointment with my family doctor today, i have no idea why, but i dont know what to do. pain management clinic was mentioned, i dont understand what pain management is, i am thinking they just load you up on tons of meds, which might make you feel better, but there is something causing this pain, and i want a cure for it, not just cover it up with high dosage medication. HELP

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