Blurry vision, light sensitivity, brain fog, increased ocular pressure and cervical Instability
In this article we will provide summary and explanatory notes for the video below: Blurry vision, light sensitivity, brain fog, increased ocular pressure and cervical Instability.
People who visit our center have a myriad of symptoms. Symptoms a patient may report on any given visit are migraine headaches, right sided facial numbness and pain, heart palpitations, memory loss, confusion, bilateral fullness in my eyes, vertigo, tinnitus, impaired gait, hoarseness, severe fatigue, muscle weakness, sinus congestion, dysesthesias of the hands and forearms, TMJ, blurred vision, shoulder pain, right sided chest pain, swelling and pain on right side of the neck and nausea.
Blurry vision, eye pain, eye pressure, light sensitivity and other vision problems, along with symptoms above among the more troubling and disabling symptoms that are often due to cervical spine instability.
Cervical instability causes compression or pinching on the nerves, veins, and arteries that pass through the neck. Cervical nerves innervate the muscles and skin of the arms and hands but also the autonomic nerves that control blood pressure, heart rate, digestion, immune system function, breathing, and energy levels. Furthermore, cervical instability affects the neurons involved in the central relay systems in the brain that are involved with vision, proprioception (balance and 3-D perception), hormone levels, and even concentration, memory, emotions and happiness. In this article summary we will concentrate on the problems of vision.
(0:05 of the video)
Blurry and double vision. A visual of a world in motion.
Besides pain, probably the most distressing symptom that we see here at the Hauser Neck Center is gaze instability. We have two eyes and for vision to work properly, they have to see and process the same image so we can see in three dimensions. So imagine if the image and perception was different in the right eye than the left eye and you have been diagnosed with gaze instability. You vision is then either blurry or you see two images or you feel that you are moving through space while you are standing still. Patients will often tell us, “when I get in a car, I am terrible.” They get the feeling of sea-sickness in a car.
In our article Nystagmus – Oscillopsia caused by cervical spine instability and neck pain, we discuss the problem of a “world in motion,” and other vision problems and how one explanation as to why treatments and therapies have not helped you is because you have unidentified cervical neck/spine instability.
(1:00 of the video)
Many patients are in a progressive, degenerative vision situation. While this feeling of seasickness at first may have been limited to the motion of a moving car, it has now negatively progressed to the point that they feel “sea-sick” all the time and/or they can’t see clearly. Recently we saw a patient with terrible visual snow or like watching a TV with static.
Someone with gaze instability, they have blurry vision, double vision, spots, unclear visual images, and they go see several ophthalmologists even neural ophthalmologists and they’ll say that the eye is fine, the retina is fine, the lens is fine, there’s no loose bodies floating in the eye fluid, yet their vision is blurry.
Blurred vision, blind spots, water eyes, and difficultly focusing.
In many of our articles we discuss the problems patients have with blurred vision, blind spots, water eyes, and difficultly focusing. We are also able to demonstrate that many of these symptoms are problems caused by cervical neck instability. In the article Chronic Neck Pain and Blurred or Double Vision Problems? We write: “The pupil and iris of the eye function as a unit to produce a sharp focus by eliminating or controlling light stimuli. The pupil is responsible for controlling the diameter and size of the pupil, which is the part of the eye that allows light to reach the retina. The iris sphincter muscle (pupillary constrictor) which receives its impulses from the parasympathetic fibers of the third cranial nerve (oculomotor) constricts the pupil; whereas the iris dilator muscle (pupillary dilator) are innervated by sympathetic fibers running from the superior cervical sympathetic ganglion.”
The Superior cervical sympathetic ganglion (the nerve center that provides innervation to the head and neck) and pupillary dilation. Postganglionic axons (in simplest terms nerve fibers) of the Superior cervical ganglion innervate the eye, lacrimal (tear) gland, and pupillary dilator muscle which dilates the pupil.
When a stimulus (possibly a cervical disc herniation, impingement, or compression) causes superior cervical sympathetic ganglion activity to go hyperactive or disturbed this constant pupillary dilation can cause photophobia (sensitivity to light) and ultimately increased intraocular pressure since the Superior cervical sympathetic ganglion sits right in front of the C2 – C3 joint. When C2 – C3 instability is present, it is a likely structural cause of vision problems.
In this image and as explained in the video, the problems of vision can be caused by a disruption of the nerves and superior cervical ganglia. Cervical spine instability is the result of damaged cervical ligaments. These neck ligaments which hold the cervical spine in place can become weakened or damaged by wear and tear motion, poor posture, EDS hypermobility, or accident injury. In this state, damaged cervical spine ligaments can cause vision problems.
In the image below the neck-eye reflexes are described.
These reflexes keep the head balanced while a person is watching moving objects or the body or head is in motion.
- The reflex vestibulo-ocular (VOR) causes eye gaze stabilization during head motion
- The reflex cervico-ocular (COR) helps the eyes to move in relation to neck rotation, (because of cervical ligament and facet joint proprioceptors – neurons that sense motion.)
- The reflex vestibulocollic (VCR) helps to stabilize head in space when the body moves.
- The reflex cervicalcollic (CCR) muscles tightened to stabilize head (because of cervical ligament and facet joint proprioceptors – neurons that sense motion.)
Potentially all these reflexes are impaired with ligament cervical instability causing symptoms of vertigo, dizziness, Nystagmus, Oscillopsia, visual disturbance and poor balance.
In discussing vision or dizziness related to the cervical spine, several reflexes should be addressed that give balance to the body so we don’t fall over or get symptoms such as dizziness or vertigo when upright or changing positions. Balance is provided by automatic reflexes for stabilization of the visual field (vestibuloocular reflex, VOR) as well as for erect standing (vestibulospinal reflex, VSR) and head position (vestibulocollic reflex, VCR) so that we can have correct posture.
All of these reflexes are called ocular stabilization reflexes that serve to stabilize the visual image on the retina during head movements. These help us have the proper posture so we can balance and see what we are doing without falling over. When the vestibular system is not working properly, even small head movements can be accompanied by gaze instability, and postural imbalance results. The vestibular system is crucial in controlling gaze, balance and posture, and an imbalance can manifest as a dramatic, sudden onset of vertigo. The vestibuloocular reflex (VOR) functions to stabilize gaze and ensure clear vision during everyday activities. Vestibular signals from the inner ear go to the vestibular nuclei in the medulla (brainstem), which connect to the cranial nerves that control eye movements. During head movement, the eye movement is equal and opposite to that of head movement. The vestibulospinal (VSR) reflex stabilizes the head and upright posture in relation to gravity.
The vestibulocollic reflex (VCR) serves to stabilize the head position in space. Muscles of the neck respond to input from the vestibular system to provide reflexive head movement. For example, when the head is rotated in relationship to the neck, the vestibulocollic reflex (VCR) stabilizes the head position thereby stabilizing gaze direction in space. When the head moves, the vestibuloocular reflex (VOR) tends to stabilize the image of an object in space on the retina by producing eye movement compensatory to head movement.
Other reflexes also play a role including the cervicocollic and cervicooccular reflexes. The cervicocollic reflex (CCR) allows the neck to stabilize the head in space. It is dependent upon the input of the upper two or three cervical nerves, so the cervicocollic reflex (CCR) is evoked by activity of neck receptors and occurs when the head rotates in relation to the body. The cervicooccular reflex (COR) refers to those reflexive eye movements driven by neck proprioceptors and elicited by rotation of the neck. The proprioception of muscles and the facet joints of the cervical spine form the receptor part of this reflex. The purpose of the COR is to help us keep the visual image on the retina during self- motion of the neck.
(2:15 of the video)
They have had many tests on the eye ball and problems with the eye ball itself has been ruled out.
For many people, the eye itself is not the problem. They have had many tests on the eye ball and problems with the eye ball itself has been ruled out. The problem is the electric activity that connects what the eye sees with what the brain comprehends. The cable or connectivity between the eye and the brain has been disrupted. For example, during the hurricane the power went out. A person’s TV did not work. That does not mean the TV was broken, it meant that the connection to the electric power was broken.
(3:05 of the video)
The optic nerve
The nerve that takes it the image from the retina to the brain is called the optic nerve. You don’t see the image until the electrical current from eye to brain via the optical nerve gets interpreted by the brain and then then you actually see the image. For clear, steady image, the impulses from the right optic nerve and the left optic nerve has to be the same.
In this image below the caption reads:
Seeing multiple images at a time after the stimulus has been removed is palinopsia it seemed quite commonly with upper cervical instability induced intracranial hypertension caused by the increased fluid or pressure around the nerve making nerve impulses coming from the right eye reach the brain at a different time than those coming from the left eye.
(3:25 of the video)
Blockage of the jugular vein
Recently we saw a patient whose MRI demonstrated that she was having a blockage of the jugular vein on her left side. Testing demonstrated further that the fluid created by this blockage around her left eye optical nerve was greater than her right. The fluid and pressure on the left side would generally cause the image on the left side to be perceived slower. This would cause double vision and blurry vision. It was not the eye causing the problem, it was fluid around the optical nerve.
(4:15 of the video)
Increased superior cervical sympathetic ganglion activity causes dilation of the pupils
The graph below demonstrates ligamentous (ligament) cervical instability and its potential to cause long-term consequences to the eye. Increased superior cervical sympathetic ganglion activity causes dilation of the pupils which can potentially elevate intraocular pressure and cause the eyes diseases and symptoms.
This graph explains that there are other factors involved beyond the eye nerve. The superior cervical sympathetic ganglion causes your eye to dilate. A lot of our patients they have light sensitivity we do a pupilometer. A pupilometer shows that many of our patients have pupil dilations which causes them symptoms of light sensitivity. Further, constant dilated of the pupils increases intraocular pressure.
The superior cervical sympathetic ganglion and the C2 vertebrae
(5:00 of the video) The superior cervical sympathetic ganglion, sits near the C2 vertebrae. If there is upper cervical instability, the abnormal motion of the C2 can irritate the superior cervical sympathetic ganglion.
Many patients have gone first to an optometrist and part of the normal testing process is pupil dilation with eyes drops. When they leave the optometrist following the tests, people need to wear sunglasses or hats that reduce the amount of sunlight they see. When the medication wears off, the pupils should return to normal. For some people because of superior cervical sympathetic ganglion irritation, caused by neck instability and unnatural movement of the C2, their pupils are always dilated, their normal is the need to wear sun glasses and photophobia
Cerebral spinal fluid blockage and intracranial pressure build up
(6:00 of the video) There could be fluid build up around the eyes so we’re going to talk mainly on jugular vein compression causing the fluid to build but other causes such as cerebral spinal fluid blockage.
In this image, on the left, the spinal cord is surrounded by a complete ring of cerebral spinal fluid. On the right side, the two arrows show where the ring of spinal fluid has dried up. Any one who has taken cervical spine MRIs and you have an image of these scans, you can see if you have his type of blockage yourself. Sometimes this situation can be simply corrected by fixing the cervical neck curve.
(6:50 of the video) The most common cause of fluid going around the eye nerve is going to be jugular vein compression. How does jugular vein compression cause this fluid build up in the eyes?
(7:00 of the video) In the front of the neck are the jugular veins, one on each side. If these veins are compressed think, like a kink in a hose, the fluid builds up in the brain. Due to the pressure build up, the fluids then seep out and overflows into the optic area and surrounds the optic nerve. This is how visual snow, distorted vision, after images, after images are looking at an object, looking away, but they image of the object remains.
(8:40 of the video) Discussion of compression and stretching the jugular vein.
In this image: An MRI of the brain and brain stem shows bilateral posterior eyes squish (the white arrows at the back of the eye balls). The patient’s increased intracranial pressure from venous obstruction caused by her cervical neck changes and instability. This increased pressure causes the back of her eye balls to be squished and flattened.
(10:00 of the video) A discussion of a backed up brain fluid, increased pressure and how this pressure can cause high eye pressure. A common symptom of eye problems and cervical spine instability would be would be brain fog, cognitive dysfunction. More obvious problems would be neck pain, muscle tightness, headaches, dizziness, cracking and popping of the neck.
(12:20 of the video)
A case history is discussed. Described in the image below: This person’s optical nerve sheath diameter is almost twice the normal size signifying fluid backing up around the optic nerve. This person had many of the signs and symptoms of intracranial hypertension (high brain pressure) including visual disturbances, head pressure, eye pain, brain fog, inability to focus and photophobia.
(14:30 of the video) Neck exercises, traction and other means to correct cervical instability problems.
In our article Dynamic Structural Medicine Ross Hauser MD Review of Treatments for Cervical Spine Instability, Ross Hauser MD, reviews the following:
- Cervical curve correction uses traction and patient-specific weights in a standing or weight-bearing position to help restore natural cervical spine curve. Under x-ray guidance, specific chest and/or head weights are used to determine the best method of cervical curve correction. Other therapeutic components of the curve correction program include specific chiropractic adjustments, a Denneroll (chiropractic neck wedge), specific exercises, and of course, proper ergonomics while working. Cervical curve correction therapies optimize curvature and positioning, thereby helping to stabilize the spine. Because there is a significant correlation between increasing forward head posture and increasing neck pain and disability, treatment is imperative.
Results of treatment vary. Not all patients achieve similar results.
A lot of research shows that one of the most important parts of performing cervical traction is maintaining the cervical lordosis during performing traction. This is something to consider, Performing traction may not always be the best therapy for patients and if they do have a lot of instability you would want to be careful with doing a lot of traction because you don’t want to expose too much motion to an area that’s already moving too much.
Demonstration of Prolotherapy treatment
Prolotherapy is referred to as a regenerative injection technique that is used to stimulate repair of injured soft tissues, including ligaments.
This video jumps to 1:05 where the actual treatment begins.
This patient is having C1-C2 areas treated. Ross Hauser, MD, is giving the injections.
(15:00 of the video) Changing sleeping positions to avoid rotating your head.
Various diagnostic testing
We do a lot of testing including digital motion x-ray which is an x-ray movie where you’re moving your head in certain positions and we’ll see if your neck vertebrae are moving more than they should. We also look at the neck curve to see if your neck curve is serpentine in shape or moving towards a reversed or backward curve.
Caring Medical has been ordering DMX scans on individuals for many years to document the extent of the joint instability/injury, set an objective baseline, and develop an effective treatment plan. We find it beneficial as an advanced diagnostic tool for certain conditions that can have severe consequences if not properly diagnosed. These cases can include Upper cervical instability including C1-C2 instability. The video below is a demonstration of the DMX.
We do various eye tests we check the pupil diameter pupilometer we do tonometry which is eye pressure then we do optic nerve diameter and we can do them over time to see how the patient responds.
For treatment options please continue with our article: Treatments for Neck Pain and Cervical Instability: A review of upper cervical instability and symptom treatment with Ross Hauser, MD
Questions about our treatments?
If you have questions about your pain and how we may be able to help you, please contact us and get help and information from our Caring Medical staff.