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Neuro Ophthalmology

Neuro-ophthalmology is a specialist area in visual problems related to the nervous system, including loss of sight or visual field due to injury to the visual pathways which transmit visual signals from the eyes to the brain. Such brain or nerve injuries may be caused by trauma, inflammation, strokes, tumours, drug or chemical toxicity, radiation or infections. The vision, the visual fields, colour vision, pupils, and eye movements can be affected.

Neuro-ophthalmologists frequently treat patients who have neurological problems affecting the control of eye movements, which may present difficulty with eyesight in certain directions, double vision due to misalignment, or wobbling eyes nystagmus. Misalignment is a form of strabismus, and once the diagnosis and cause established, eye motility problems may be treated with prism lenses or in some cases with surgical procedures.

Conditions, symptoms, diagnosis and treatment of neuro ophthalmology


  • Optic nerve disease with colour vision loss and scotomas (patches in vision)
  • Vision and Visual field loss affecting part of the visual field.
  • Cranial nerve palsies with reduced or absent eye movement.
  • Cranial nerve palsies affecting the eyelids and pupils.
  • Double vision from ocular motility disorder.
  • Papilledema (swollen optic disc).
  • Idiopathic intracranial hypertension (IIH) with headaches.
  • Nystagmus (wobbly or oscillating eye movements).
  • Blepharospasm or hemifacial spasm.
  • Pituitary gland disorders affecting the visual pathways.


  • Sudden decrease or loss of vision
  • Sudden transient loss of vision (called transient ischemic attack or eye stroke)
  • Squint or strabismus
  • Visual Field Defects
  • Intractable headaches
  • Pupillary abnormalities (sluggish reaction, the difference in size of the pupils, whether small or large)
  • Difficulties in identifying colours
  • Inability to tolerate bright light
  • Visual hallucinations
  • Wobbling or oscillating vision
  • Double vision or diplopia


Neuro-ophthalmologic conditions can be diagnosed using tools and techniques such as colour vision testing, pupil testing, a visual field analysis test, optical coherence tomography (OCT) for looking at the optic nerve head and retina, scanning laser ophthalmoscopy (SLO) to look at the retina and choroid, and sometimes electrophysiology testing. The specialised retinal and optic nerve imaging tests are done in the E-DOC at Clinica London, the Eye Diagnostic and Orthoptic Centre.

The Neuro-Ophthalmologist works closely with Neurology Consultant colleagues as neuro-imaginfg with a brain scan MRI is often indicated.

The Neuro-Ophthalmolgist works closely with an Orthoptist. The Orthoptist helps detect and measure ocular motility problems and strabismus, measured accommodation, measured binocular vision and does specialised visual fields and fits prisms on glasses for double vision.


Patients who should be seen by a neuro-ophthalmologist include:

  • Patients who have any loss of visual acuity, visual field or colour vision due to a problem with the brain or optic nerves.
  • Patients who have or are suspected to have high intracranial pressure (pressure in the head), as this increased pressure can cause optic nerve swelling and loss of vision.
  • Patients who have problems moving their eyes or double vision due to misalignment – these issues may result from injury to the brain centres, nerves or muscles that control eye movements, or from a nerve transmission problem known as myasthenia gravis.
  • Patients with tumours of the pituitary gland or other tumours that compress visual pathways – even when patients are not aware of any visual problems, referral to a neuro-ophthalmologist is particularly important before and after tumour removal operations, to ensure no loss of visual field.
  • Patients with unequal pupils – a sudden change in pupil size may reflect a serious underlying condition and should be examined immediately.
  • Patients with involuntary shaking of the eyes (nystagmus).

Dr Naz Raoof – Neuro-Ophthalmologist

Dr Naz Raoof is the specialised Consultant Neuro-Ophthalmologist at Clinica London. Her subspeciality interests include neuro-ophthalmology (both paediatric and adult), strabismus and paediatric ophthalmology. She is a Consultant in the NHS and does her Private Practice at Clinica London.

At Clinica she works with the four specialist Orthoptists and the Ophthalmic Technician to establish the extent of the neurological problem and plan treatment. She is an excellent listener and explains clearly her findings, making the Neuro-Ophthalmology patient feel at ease.

Dr Raoof is highly experienced. She attended medical school at the University of Oxford and completed her Ophthalmology surgical training in Sheffield, South Yorkshire (UK). She undertook two further subspecialty Fellowships at Moorfields Eye Hospital (UK) and in Auckland (New Zealand). She is currently a member of the Paediatric Subcommittee of the Royal College of Ophthalmologists (UK).

She was instrumental in meeting with the Director for Consumer Affairs at the European Commission to discuss the threats to children’s vision posed by hand-held lasers purchased via online traders, and to look at ways of preventing further injuries through EU legislation.

Ms Raoof specialises in strabismus (misalignment of eyes and double vision) and neuro-ophthalmology (diseases of the optic nerve and brain conditions affecting vision). Patients can be booked in to see her via her secretary Jenny Burrows, jenny.burrows@clinicalondon.co.uk. It is recommended that potential Neuro-Ophthalmology patients have a referral letter from their physician or surgeon. Learn more about Dr Raoof here.


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