Dr Clare Fraser Parkinsons disease and the eye

Dr Clare Fraser Parkinson’s disease and the eye

You see with your brain not with your eyes

So why is it blurry?

Start at the front

Dirty windshield

Dry Eye � 2/3 patients report dry, gritty and watery eyes �Low blink rate blink only 1 -2 times / minute (normal 16 -18) tear film evaporates cornea dries reflex tearing

Parkinson’s stare

Dry eye �Seborrheic blepharitis altered oily secretions from eyelids red and irritated lids

Close up

Dry eye

Treatment �Lid hygiene warm compress clean lid margin �Lubricating eye drops �Ointment at night �Punctal plugs

More troubles with the eyelids �Blepharospasm involuntary closure of both eyes squeezing interferes with ability to see �Apraxia of lid opening inability to lift the lids

Blepharospasm

Apraxia of opening

Treatment �Treat any dry eyes �Botulinum toxin injections simple injections to skin around eye well tolerated lasts 2 -3 months

Pre- and post- treatment

What I’m not going to talk about

Retina

Decreased contrast sensitivity �Loss of retinal dopamine neurons

Altered colour vision �blue-yellow spectrum

Treatment

Muscles of eye movement

Double vision

Convergence

Convergence insufficiency �Double vision when reading can’t cross the eyes to read up close very common complaint �Usually no double vision in distance

Reading

Push-ups? ?

Pencil push-ups

Lose the bifocals and multi-focals

Prisms

Reading also troubled by … �movements needed to follow a line are slowed can’t track across a line of text �difficulty starting to read like gait freezing = due to loss of motor dopamine neurons �Shaking page due to tremor

Red ruler

Upgaze/downgaze limitation

Lose the bifocals and multi-focals

Other visual motor problems

Difficulty following fast movement

Difficulty judging speed

Visual hallucinations

Visual hallucinations �¼ patients with early Parkinson’s more common when older associated with memory problems �Patients often know they aren’t real

Flashes

Shapes

People or objects

Bizarre

Treatment �Speak to your neurologist �certain Parkinson’s medications can: make it worse make it better

Visual hallucinations �Can be a sign of delirium infection don’t realise the images aren’t real

Driving

Other driving difficulties �Spatial perception and organisation distance between objects getting through a narrow space �Visual memory

Other cognitive issues �Impaired ability to read facial expressions

Drug side effects �Anti-cholinergics blurred vision and dry eyes �Levadopa can cause or help blepharospasm �Any medication visual hallucinations �Angle closure glaucoma – contraindication sinemet and madopar

In conclusion …. �Parkinson’s doesn’t cause vision loss �It can significantly affect visual quality of life �BUT there are options available