Eye Care Blog

Central Nervous System

The greater the ophthalmologist’s knowledge of general disorders, the more help he will be in their diagnosis, or at least in making a wise referral. And this applies as much to nervous disorders as it does to diseases in the blood. The central nervous system is necessarily and intimately connected with the eye and vision, which are therefore affected by nerve and brain abnormalities. The most puzzling disorders, however, are those associated with psychosomatic and psychoneurotic conditions. While there may appear to be nothing wrong with the central nervous system, some symptoms characteristic of nervous disorders present themselves in patients who have a psychiatric history. To what extent can an abnormal personality affect the functions of otherwise normal tissues? If a doctor believes that this can happen to a significant degree, then any understanding of the signs and symptoms becomes very difficult. The ophthalmologist is also hampered by the technical limitations on measuring abnormality in the eye. He has to decide which technical means to use and, where there is a psychiatric overlay, they may very well render no positive results at all. Indeed, the tests themselves may induce introspective attitudes to the eye and vision not previously present in the patient. It can therefore become a question of when patients who continually present themselves with a symptom that seems to have no pathological basis deserve an expensive and sometimes hazardous investigation. To make a decision of this nature the experienced ophthalmologist must sometimes use non-clinical criteria in his judgment.

Tumors

Growths around the eyes, lids, tear glands and drainage apparatus, even in the eye, are very rare. Mostly they are non-malignant, and require only cosmetic treatment. In other words they can be masked by cosmetics, or just cut out. In general, once diagnosis is established, small lumps and bumps are watched, measured and photographed. Today the eye- surgeon is not likely to remove a whole eye simply on grounds of suspicion. Small cysts and pigmentary moles on the lids are watched or removed surgically. Cysts in the lid tissue itself, which press against the eye and disturb the vision, are generally removed by making an incision on the inside of the lid. The most common type is called a Meibomian cyst, or chalazion. This is a non-malignant growth or degeneration of a gland inside the lid. There are almost sixty such glands, and the removal of one of them is possibly the commonest form of eye surgery.

However, although the eye itself is little affected by malignant tumors, serious disorders in the brain, or in and about the optic nerve, will produce visual symptoms. Indeed, tumors on the brain, strokes and various forms of brain injury, can often be located by plotting an abnormality in the visual fields. In the past this was often the only way a brain surgeon had of knowing where to operate, but with modern X-ray brain-scan methods, diagnosis of brain disease by ophthalmology has become only a complementary measure.

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