As a result of a stroke, there are often limitations in vision. According to the professional association Orthoptik Deutschland e.V. According to the latest research, about 30 to 40 percent of patients with brain damage, e.g.B. after a cerebral infarction or cerebral hemorrhage, various visual disturbances occur.
Which visual disturbances can occur with a stroke?
A stroke can lead to the development of various visual disorders:
- Double vision
- Restrictions of the visual field
- Blindness in one eye
double vision
In medicine, seeing double images is also referred to as double vision Diplopia denotes. Affected persons see persons or objects standing next to each other or on top of each other in an overlapping manner. For example, you reach next to an object or see blurredly as if through a fogged-up pane of glass.
Double vision results from paralysis of the eye muscles and the associated cranial nerves. The most common cause in sudden onset is a stroke in the brainstem, the brain region where control of eye movements is coordinated. More rarely, inflammation of the corresponding nerves can be the cause.
However, double vision can also occur with fatigue, squinting of the eyes or high alcohol consumption and then has nothing to do with a stroke.
Visual field defects
If the visual field is restricted, the affected person overlooks people or objects on one side. There is a feeling as if a blinker is sitting on one side of the face. Sufferers may bump into each other because they can no longer see the door frame. They may suddenly have difficulty finding their way in familiar surroundings. Reading can be difficult or impossible, because suddenly lines are missing or only half of them can be seen.
Under a hemianopsia (= hemifacial blindness) is the complete hemifacial loss of the visual field of one or both eyes. However, quadrant anopsia can also occur, in which a quarter of the visual field is lost and can no longer be perceived.
These visual field defects are caused by damage to the visual pathway, which extends in the brain from the temporal lobe to the occipital lobe.
Blindness in one eye
Blindness occurs when no light can be perceived by the eyeIt can occur in one or both eyes.
In the case of a so-called Amaurosis fugax (literally: fleeting blindness) a patient suddenly goes blind in one eye without accompanying pain. This temporary blindness can be the harbinger of a stroke and can occur together with other neurological deficits.
It results from a temporary disturbance of blood flow to the retina. Often accompanied by heart disease, high blood pressure or obesity. Often a high-grade narrowing of the equilateral anterior carotid artery is the cause of such a visual disturbance.
NoteEven if the visual disturbance can disappear completely, this is an emergency that must be immediately clarified by a doctor.
If a severe narrowing of the carotid arteries remains undiscovered, the affected person has a very high risk of suffering a cerebral infarction in the days or weeks following such a visual disturbance. In addition, there can be renewed, permanent circulatory disturbances of the retina, which can lead to permanent blindness.
How can visual disturbances occur due to a stroke?
For error-free vision, healthy eyes are needed to perceive the information of what is seen. This information is transmitted via the so-called visual radiation from the optic nerve via the brain tissue to the occipital lobe.
There, what is seen is processed and assigned. The eye provides the image of a chair, for example, and the brain then sorts out the information that it is a piece of furniture that can be sat on.
Which doctor can help?
In the case of visual disturbances that occur suddenly and last for a longer period of time, professional help should always be sought. Various professionals could help with conditions that affect the eye, u.a.:
- Ophthalmologist: he can detect and treat disorders and diseases of the eye.
- Neurologist: if the ophthalmologist does not detect any pathological changes in the eye that explain the visual disturbance, a referral is often made to a neurologist. This must clarify whether it is a visual disturbance, which is caused by a damage of the brain.
- OrthoptistsThey are responsible for the examination and treatment of disorders of monocular and binocular vision and specialize in strabismus in children and neurological eye diseases.
- Optometrist: they can determine vision and are responsible for a vision aid fitting.
How vision disorders are treated?
The treatment of visual disturbances depends very much on the type of visual disturbance present.
Double vision
In case of double vision, corrections can be made by special prism glasses or by sticking prism foils, which are fitted by an ophthalmologist or orthoptist.
Is this not enough, Covering the eye with an eye patch or a matte film on the lens can be tried. Furthermore, special eye movement training can help or "fusion training", in which a stability of the two-eyed cooperation is practiced. These therapies are often offered by orthoptists.
Visual field defect
There are different rehabilitation and training procedures for visual field defects. 2
During restitution training light, color and shape stimuli are set as part of a computer program. The area between the intact and failed visual field is stimulated in order to achieve the greatest possible restoration of the visual field.
In compensation training rapid and continuous eye movements (called saccades) are practiced by the patient to learn to compensate for his visual field defect.
Through exploration training the search field of the patient should be enlarged. Example: The patient is given a sheet on which various numbers are written. He is asked to look for certain numbers on this sheet of paper. Here it is important that the patient first searches for these numbers with his head held straight with his eyes only. Through these search movements with the eyes, the patient learns to keep an overview in certain situations. In everyday life, head movements will be used later.
Tips for dealing with vision problems 1
- See a doctor as soon as possible, when the visual disturbances appear suddenly.
- Double vision: covering one eye with an eye patch facilitates z.B. reading or activities at close range
- Visual field defect: when reading, you can use rulers and electronic markers (computer, e-reader) in order not to lose position along a line of text. Make sure you are tidy so you can always keep track of things. Reduce the number of objects that you could injure yourself on as you walk around the home.
- Talk to your relatives and friends About their vision problems. This is the only way to find out together what support could be useful.
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Author
Dr. med. Christina Ruckert is a specialist in neurology and geriatrics and worked for more than 10 years as a senior physician at the Oberschwabenklinik in Ravensburg, Germany. Her professional activities also included the deputy medical management of the Central Emergency Department. Since July 2021, she has been in private practice in Rothenburg ob der Tauber together with her husband – also a specialist in neurology. A main focus of her outpatient work is the aftercare of patients after stroke. [more]