Visual dysfunction

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A wide range of ocular signs and symptoms can occur in ME/CFS. These include eye pain, photophobia (light sensitivity), visual processing problems, floaters and spots, tearing, dry eyes, increased pupil size, pupillary unrest, pupillary fatigue, unequal pupils, poor focus, double vision, scotomata, blurred vision, tunnel vision, night blindness, depth-of-field loss, nystagmus, and early cataracts.[1]

Eye and visual symptoms[edit | edit source]

In 2016, British GP and ME/CFS specialist Amalok Bansal noted:

"Abnormalities of the pupils to light are seen in patients with cerebral ischaemic events, certain brain neoplasms, local disturbance in neural transmission and demyelination. Checking the pupil reflexes is often undertaken to detect alterations in the brainstem pathways mediating the perception of light, accommodation to distance and near vision and changes based on ambient illumination. In patients with CFS/ME I have observed two unusual responses that are evident on prolonged illumination of the pupils. The more frequent finding seen in three quarters of patients is a rhythmic contraction and dilatation of the pupils. The second pattern is a paradoxical dilation of the pupils after an initial contraction. The latter is seen in patients with autoimmune autonomic neuropathy that is caused by IgG antibodies to the ganglionic acetylcholine receptor [44]. However, these autoantibodies are absent in the patients with CFS with this type of pupil abnormality.
Interestingly these CFS/ME patients are more frequently faint on standing, have poor tolerance of prolonged standing and other features of POTS. In my experience other symptoms of a more generalised autonomic neuropathy are absent. The cause of these changes in the pupil reflexes is unclear but a persistent state of adrenergic over activity may be involved. This may oppose the constricting action of direct pupil illumination and produce the fluctuating response in many and a more significant but delayed dilatation in others. Interestingly, a delay in pupil constriction to direct light was reported in depressed patients by Fountoulakis et al. [45] and attributed to reduced noradrenergic tone."[2]

Klaus Wirth and Carmen Scheibenbogen (2021) reported that Bansal's pupil dilation observations weres consistent with their hypothesis that ME/CFS was primarily a neurovascular disease, with antibodies playing a key role.[3]

A 2021 article examining autonomic nervous system involvement in ME/CFS noted that unrecovered patients had larger pupils than those who recovered:

"The pupil diameter was more constricted in the ME/CFS-recovered patients than in the ME/CFS-unrecovered patients in the total population and the subpopulations stratified by sex, age, and hospitalization period."[4]

Prevalence[edit | edit source]

In 2001, a large Belgian study found that 74.4% of patients meeting the Fukuda criteria and 77.2% of patients meeting the Holmes criteria for CFS reported problems with visual accuity.[5]

In 2013, Hutchinson and colleagues used the CFS DePaul Symptom Questionnaire (DSQ) to assess patients, it includes four vision-related items, and CFS patients reported the following rates of vision and eye symptoms:

Symptom recognition[edit | edit source]

Blurred vision is a potential symptom of Long COVID in the World Health Organization's definition.[7]

Notable studies[edit | edit source]

See also[edit | edit source]

Learn more[edit | edit source]

In the United States, ME/CFS patient Brian Vastag was able to prove with qEEG and cognitive tests he had "significant problems with visual perception and analysis, scanning speed, attention, visual motor coordination, motor and mental speed, memory, and verbal fluency" winning his long term disability (LTD) claim.[20]

References[edit | edit source]

  1. ↑ Erica Verrillo, “Chapter 3: Symptoms - Vision and Eye Problems” in Chronic Fatigue Syndrome: A Treatment Guide, 2nd Edition. Amazon, 2012. (eBook)
  2. ↑ 2.0 2.1 Bansal, Amolak S. (July 19, 2016). "Investigating unexplained fatigue in general practice with a particular focus on CFS/ME" (PDF). BMC Family Practice. 17 (1): 81. doi:10.1186/s12875-016-0493-0. ISSN 1471-2296. PMC 4950776. PMID 27436349.
  3. ↑ Wirth, Klaus J.; Scheibenbogen, Carmen; Paul, Friedemann (November 22, 2021). "An attempt to explain the neurological symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". Journal of Translational Medicine. 19 (1): 471. doi:10.1186/s12967-021-03143-3. ISSN 1479-5876. PMC 8607226. PMID 34809664.
  4. ↑ Matsui, Takayoshi; Hara, Kazuhiro; Iwata, Makoto; Hojo, Shuntaro; Shitara, Nobuyuki; Endo, Yuzo; Fukuoka, Hideoki; Matsui, Masaki; Kawaguchi, Hiroshi (May 5, 2021). "Possible involvement of the autonomic nervous system in cervical muscles of patients with myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS)". BMC Musculoskeletal Disorders. 22: 419. doi:10.1186/s12891-021-04293-7. ISSN 1471-2474. PMC 8101228. PMID 33952227.
  5. ↑ De Becker, Pascale; McGregor, Neil; De Meirleir, Kenny (December 2001). "A definition‐based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome". Journal of Internal Medicine. 250 (3): 234–240. doi:10.1046/j.1365-2796.2001.00890.x.
  6. ↑ 6.0 6.1 Hutchinson, Claire V.; Badham, Stephen P. (June 2013). "Patterns of Abnormal Visual Attention in Myalgic Encephalomyelitis". Optometry and Vision Science. 90 (6): 607–614. doi:10.1097/opx.0b013e318294c232. ISSN 1040-5488.
  7. ↑ Soriano, Joan B.; Allan, Maya; Alsokhn, Carine; Alwan, Nisreen A.; Askie, Lisa; Davis, Hannah E.; Diaz, Janet V.; Dua, Tarun; de Groote, Wouter; Jakob, Robert; Lado, Marta; Marshall, John; Murthy, Srin; Preller, Jacobus; Relan, Pryanka; Schiess, Nicoline; Seahwag, Archana (October 6, 2021), A clinical case definition of post COVID-19 condition by a Delphi consensus, World Health Organization (WHO) clinical case definition working group on post COVID-19 condition, World Health Organization
  8. ↑ Potaznick, Walter F.A. A.O.; Kozol, Neil (October 1992). "Ocular Manifestations of Chronic Fatigue and Immune Dysfunction Syndrome". Optometry & Vision Science. 69 (10): 811–814. ISSN 1040-5488.
  9. ↑ Potaznick, Walter; Kozol, Neil (1994). "Survey of the Ocular Manifestations of Chronic Fatigue Immune Dysfunction Syndrome". Clinical Infectious Diseases. 18: 87-S87. ISSN 1058-4838. Retrieved September 4, 2016.
  10. ↑ Caffery, B.E.; Josephson, J.E.; Samek, M.J (March 1994). "The ocular signs and symptoms of chronic fatigue syndrome". Journal of the American Optometric Association. 65 (3): 187–191. PMID 8201170.
  11. ↑ Mastropasqua, L.; Ciancaglini, M.; Carpineto, P.; Iezzi, A. (January 1, 2000). "Ocular manifestations in chronic fatigue syndrome". Annals of Ophthalmology. 32 (3): 219–224. ISSN 1530-4086.
  12. ↑ Frolov, V.M.; Petrunia, A.M. (April 2003). "Pathology of the organ of vision in chronic fatigue syndrome". Vestnik Oftalmologii. 119 (2): 45–47. ISSN 0042-465X. PMID 13678013.
  13. ↑ Badham, Stephen P.; Hutchinson, Claire V. (August 6, 2013). "Characterising eye movement dysfunction in myalgic encephalomyelitis/chronic fatigue syndrome". Graefe's Archive for Clinical and Experimental Ophthalmology. 251 (12): 2769–2776. doi:10.1007/s00417-013-2431-3. ISSN 0721-832X.
  14. ↑ Hutchinson, Claire V.; Maltby, John; Badham, Stephen P.; Jason, Leonard A. (January 2014). "Vision-related symptoms as a clinical feature of chronic fatigue syndrome/myalgic encephalomyelitis? Evidence from the DePaul Symptom Questionnaire". The British Journal of Ophthalmology. 98 (1): 144–145. doi:10.1136/bjophthalmol-2013-304439. ISSN 1468-2079. PMID 24187048.
  15. ↑ Wilson, Rachel L.; Paterson, Kevin B.; Hutchinson, Claire V. (December 2015). "Increased Vulnerability to Pattern-Related Visual Stress in Myalgic Encephalomyelitis". Perception. 44 (12): 1422–1426. doi:10.1177/0301006615614467. ISSN 0301-0066. PMID 26562880.
  16. ↑ Godts, Daisy; Moorkens, Greta; Mathysen, Danny G P (January 2016). "Binocular Vision in Chronic Fatigue Syndrome". American Orthoptic Journal. 66 (1): 92–97. doi:10.3368/aoj.66.1.92. ISSN 0065-955X. PMID 27799582.
  17. ↑ Ahmed, Nadia S.; Gottlob, Irene; Proudlock, Frank A.; Hutchinson, Claire V. (January 17, 2018). "Restricted Spatial Windows of Visibility in Myalgic Encephalomyelitis (ME)". Vision. 2 (1). doi:10.3390/vision2010002.
  18. ↑ Ahmed (2018). "Ophthalmic Correlates of Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS)" (PDF).
  19. ↑ Wilson, R, Paterson, KB, McGowan, VA, Hutchinson, C (July 2018). "Visual aspects of reading performance in Myalgic Encephalomyelitis (ME)". Frontiers in Psychology. doi:10.3389/fpsyg.2018.01468.
  20. ↑ 20.0 20.1 Tillman, Adriane (June 4, 2018). "Victory for ME Disability Claim - U.S. Court Upholds Plaintiff's Lawsuit After Being Denied Disability". #MEAction. Retrieved February 2, 2019.
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