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Visual disturbances in Parkinson’s disease
  1. Anat Kesler1,
  2. Amos D Korczyn2
  1. 1Head of Neuro-ophthalmology, Neuro-ophthalmology Unit, Department of Ophthalmology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
  2. 2Sieratzki Chair of Neurology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
  1. Correspondence to:
 Dr Anat Kesler, Neuro-ophthalmology Unit, Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel;
 kesler{at}netvision.net.il

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Movement disorders consist of a diverse and heterogeneous group of neurological impairments, frequently accompanied by abnormalities in ocular motility and visual perception. Parkinson’s disease is one of the more common and is caused by degeneration of dopaminergic neurons in the substantia nigra of the midbrain with loss of dopamine terminals in the basal ganglia. It is regarded primarily as a disorder of the motor system with bradykinesia, rigidity, and tremor as its main features. However, autonomic, cognitive, and sensory symptoms frequently occur as well.

Visual disturbance is not considered to be one of the cardinal clinical symptoms of Parkinson’s disease even though blurred vision, photophobia, asthenopia (weakness or fatigue of the eyes, usually accompanied by headache and dimming of vision), or trouble reading are common, often significantly interfering with the patient’s quality of life.1,2 Visual problems have particular significance because of the Parkinson patient’s impaired mobility and the implications for driving safety. In most cases, however, gross eye examination appears normal. Nonetheless, several papers have been published describing ophthalmological abnormalities, including problems with visual function, ocular movements, and visual hallucinations, as well as complications of drug therapy or neurosurgical interventions. We will review these in this article.

OCULAR DISCOMFORT AND PAIN

The most common ocular complaints are the result of ocular surface irritation, including blepharitis and xerophthalmia (dry eyes). Blepharitis is often responsible for ocular pain;3 dry eyes can cause itching, burning, irritation, and blurred vision that may improve with blinking. Unfortunately, spontaneous blinking is impaired, leading to discomfort, particularly after periods of reading, watching TV, or computer use. Blepharitis can cause excessive tearing, but most studies show decreased lacrimal flow in Parkinson patients, reflecting autonomic dysfunction.2,4

The decreased blink rate, a classical manifestation of Parkinson’s disease,5 is likely to worsen any discomfort from dry eyes, …

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