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Neuro-ophthalmology encompasses diseases of the central and peripheral nervous system that affect vision.  Comprising the largest neuro-ophthalmology practice in the region, our three neuro-ophthalmologists combine their training in both neurology and ophthalmology to provide world-class medical and surgical care for neuro-ophthalmic disease.

Clinical services are supplemented by ophthalmologic diagnostic laboratories and optometry centers.


Typically, patients are those with conditions such as stroke, brain tumor, multiple sclerosis, and conditions affecting the optic chiasm and/or optic nerve (the nerve that connects the eye to the brain). Damage to the nerve can result from ischemia, trauma, drug toxicity, diabetes, autoimmune disease and infections.

The Washington University Neuro-ophthalmology division commonly diagnoses and treats optic neuritis, pseudotumor cerebri, papilledema, myasthenia gravis, giant cell arteritis, optic neuropathy, strabismus, and visually significant stroke. We also work hand-in-hard with the Washington University neuroradiologists, neurosurgeons, neurologists, and ENT to provide the best care to patients with neuro-ophthalmic diseases.

Conditions and disorders include:

  • Diplopia
  • Visual migraine
  • Strabismus
  • Hemianopia
  • Optic atrophy
  • Optic neuritis
  • Papilledema
  • Papillitis
  • Pituitary adenoma
  • Ischemic optic neuropathy
  • Pseudotumor cerebri


Ocular misalignment, also known as strabismus, may be present from birth or acquired later in life. When strabismus is newly developed, patients often suffer from debilitating double vision. Our specialists can distinguish serious causes from benign causes of strabismus and plan appropriate treatments, ranging from prism glasses to eye muscle surgery.

Optic Neuritis

Optic neuritis is an inflammatory condition of the optic nerve that connects the eye to the brain. While there are many causes of optic neuritis, one form known as demyelinating optic neuritis is associated with multiple sclerosis. Our neuro-ophthalmologists are experts at distinguishing optic neuritis from other similar conditions, allowing them to provide patients an accurate treatment plan and prognosis.


Increased cerebral spinal fluid pressure surrounding the brain can lead to swelling of the optic nerves, a condition known as papilledema. There are thousands of causes for the appearance of swollen optic nerves, ranging from benign optic nerves that are not actually swollen (“pseudopapilledema”) to life threatening brain tumors. Neuro-ophthalmologists see swollen optic nerves routinely and are accustomed to diagnosing and treating the numerous different causes.


Techniques used to diagnose neuro-ophthalmic disorders look at how each eye works independently, including sight and the ability to distinguish color, fine detail and depth perception. Peripheral vision (seeing out of the corner of the eye) also is an important factor in determining optic health.

One test, called perimetry, measures the visual field by projecting spots of light onto a flat, lighted surface. The patient is asked to fix their gaze on one spot but respond when they detect the presence of another spot approaching the visual field. This is a relatively complex procedure that gives a neuro-ophthalmologist information about the nature and location of disease within the optic nerve or brain.

Treatment depends on the underlying nature of the problem. Whenever possible, we employ conservative techniques such as the use of optical devices or prisms to eliminate double vision, but surgical treatment may be needed if a patient doesn’t respond to other treatments.

Our specialists have extensive experience in injecting botulinum toxin for control of blepharospasm and hemifacial spasm, conditions in which involuntary closure of one or both eyes results in effectively losing total vision when not treated.

During an initial neuro-ophthalmology evaluation, you should expect to spend three to six hours for thorough testing and medical advice.

For a referral to a Washington University neurologist or neurosurgeon at Barnes-Jewish Hospital, call 855.925.0631.

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Find a doctor or make an appointment: 866.867.3627
General Information: 314.747.3000
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St. Louis, MO 63110
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