Visual dysfunction

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.

Eye and visual symptoms

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."

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.

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."

Prevalence

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.

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:

• eye pain 86%,
• sensitivity to bright lights 92%,
• being unable to focus vision and/or attention 88%, and
• loss of depth perception: 61%

Symptom recognition

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

Notable studies

• 1992, Ocular Manifestations of Chronic Fatigue and Immune Dysfunction Syndrome
• 1994, Survey of the Ocular Manifestations of Chronic Fatigue Immune Dysfunction Syndrome
• 1994, The ocular signs and symptoms of chronic fatigue syndrome
• 2000, Ocular manifestations in chronic fatigue syndrome
• 2003, Pathology of the organ of vision in chronic fatigue syndrome
• 2013, Characterising eye movement dysfunction in myalgic encephalomyelitis/chronic fatigue syndrome
• 2013, Patterns of abnormal visual attention in myalgic encephalomyelitis
• 2014, Vision-related symptoms as a clinical feature of chronic fatigue syndrome/myalgic encephalomyelitis? Evidence from the DePaul Symptom Questionnaire (Abstract)
• 2015, Increased Vulnerability to Pattern-Related Visual Stress in Myalgic Encephalomyelitis
• 2016, Binocular Vision in Chronic Fatigue Syndrome
• 2016, Investigating unexplained fatigue in general practice with a particular focus on CFS/ME [ (Abstract)]
• 2018, Restricted Spatial Windows of Visibility in Myalgic Encephalomyelitis (ME)
• 2018, Ophthalmic Correlates of Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) - Thesis - full text
• 2018, Visual aspects of reading performance in Myalgic Encephalomyelitis (ME) (Abstract)

See also

• Claire Hutchinson
• Dry eye syndrome
• Eye pain
• Photophobia

Learn more

• Visual stress could be a symptom of Chronic Fatigue Syndrome, research suggests - ProHealth

• Jun 4, 2018, Victory For ME Disability Claim – U.S. Court Upholds Plaintiff's Lawsuit After Being Denied Disability

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.

See myalgic encephalomyelitis.

See chronic fatigue syndrome.

1. of or relating to the brain or the intellect 2. of, relating to, affecting, or being the cerebrum.}

cerebral 1. of or relating to the brain or the intellect 2. of, relating to, affecting, or being the cerebrum.

neoplasm tumor

Region of the midbrain in adults, includes midbrain, pons, and medulla oblongata and develops.

brainstem Region of the midbrain in adults, includes midbrain, pons, and medulla oblongata and develops.

See ME/CFS.

autoantibody An antibody that works against the body's own antigens, a hallmark of autoimmune diseases. Autoantibodies are the opposite of an antibodies.

antibodies Antibody/immunoglobulin refers to any of a large number of specific proteins produced by B cells that act against an antigen in an immune response.

antibodies Antibody/immunoglobulin refers to any of a large number of specific proteins produced by B cells that act against an antigen in an immune response.

chronic fatigue (CF) - Persistent and abnormal fatigue is a symptom, not an illness. It may be caused by depression, multiple sclerosis, fibromyalgia, chronic fatigue syndrome or many other illnesses. The term "chronic fatigue" should never be confused with the disease chronic fatigue syndrome.

Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) - Chronic Fatigue and Immune Dysfunction Syndrome is another term for Chronic Fatigue Syndrome, but one which emphasizes the immunological aspects of the disease. Popular in the 1990s, this term has apparently fallen into disuse.

stress Stress can by either physical or psychological, or both. Stress is either 1) a state of emotional or psychological strain or 2) the physical stress (pressure or tension) that a physical object such the human body is placed under, e.g., a stress test is a medical test that monitors the cardiovascular system during strenuous exercise.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

World Health Organization (WHO) - "A specialized agency of the United Nations that is concerned with public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations." The International Statistical Classification of Diseases and Related Health Problems (ICD) is maintained by WHO.

See World Health Organization.