• Reference Number: HEY1159/2020
• Departments: Ophthalmology Department, Orthoptic
• Last Updated: 19 December 2023

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team. 

What is Parkinson’s disease and Progressive Supranuclear Palsy?

Parkinson’s disease and Progressive Supranuclear Palsy (PSP) are similar conditions in which there is a premature deterioration of nerve cells in the midbrain. Onset of both diseases is in late middle age with men more likely to be affected by both conditions. PSP occurs less frequently than Parkinson’s disease.

What are the causes of Parkinson’s disease and Progressive Supranuclear Palsy?

Both conditions are caused by damage to a specific area of the brain called the Substantia Nigra. As a result both conditions have similar symptoms.

Parkinson’s disease is caused by a loss of cells in a specific region of the brainstem (called the substantia nigra) deep within the brain. This leads to a reduction in a chemical called dopamine which is responsible for sending messages to the body to help control movements.

PSP occurs when cells in an area of the brain called the brainstem are damaged as a result of a build-up of a protein called Tau. Tau occurs naturally in the brain and is usually broken down before it reaches high levels. In people with PSP it is not broken down properly which prevents information passing between nerve cells.

How do Parkinson’s disease and Progressive Supranuclear Palsy affect your eyes, and why do you need to attend appointments?

Individuals with the condition may have a number of visual complaints: 

Difficulty moving the eyes

you may struggle to move your eyes quickly; this might be more noticeable when looking at fast moving objects, such as cars. Sometimes, instead of a smooth movement, your eyes may move in a slow and jerky way. These problems can make certain activities, such as driving or reading more difficult.

Blurred vision

Blurred vision can be caused by difficulty moving your eyes. It can also be a side-effect of the medications for your condition. Your vision can vary considerably dependent on the medication you are taking and how tired you feel. 

Diplopia (double vision)

Double vision is when you perceive two images instead of one. This can often occur when carrying out near tasks. Your Orthoptist may offer some exercises or alternately prisms (optical aids) to help join double vision. 

Problems with glasses

Some people with Parkinson’s disease find that their posture becomes stooped. As a result it can become difficult to be able to look through your glasses. Your Optician should be able to help you adjust your frames and lenses to suit your posture.

Dry eyes

People with Parkinson’s Disease or PSP blink less often than normal. Blinking helps protect the front part of the eye which is very sensitive. A reduced blink will make your eyes feel dry or sore. You Ophthalmologist (eye doctor) might suggest you try artificial tears to lubricate your eyes and reduce irritation.

Eyelid apraxia (Involuntary closing of the eyelids)

Eyelid apraxia occurs when the muscles that open the eyelids have trouble opening. This often happens during speech and can be as a result of side-effects of medication Levodopa (a common Parkinson’s drug). In mild cases of eyelid apraxia, simply rubbing the eyelids might help. Alternatively injections of botulinum toxin (Botox) can be used to help relax the muscles of your eyelids. 

Problems with low light (nyctalopia) and bright light (photophobia):

You might find that it is difficult to see in low light levels. You may also be unable to make out the shape of things clearly, such as a light-coloured object on a light background. This can also affect your ability to read small print. The use of daylight bulbs may provide better lighting. If bright light is a problem, wraparound sunglasses or tinted lenses can help.

Spatial awareness problems

You might have difficulty judging the space around you. You may find it difficult to judge the distance between objects, which can make it harder to move between pieces of furniture or through narrow doorways. Sometimes, reaching out to touch the sides of doorways or other objects can help.

Colour vision problems

Individuals with Parkinson’s or Progressive Supranuclear Palsy may have difficulty telling the difference between certain colours. This problem may be worse for shades of blue or blue/green. 

Glaucoma and Parkinson’s drugs

Glaucoma is a disease that can damage the optic nerve. If you have glaucoma, it is important you tell your specialist or Parkinson’s nurse as the medications used for the two conditions can affect each other. 

Driving and eye problems

You must tell the DVLA and your car insurance company if you have any problem that affects your eyesight. Driving without doing so may invalidate your insurance. 

Can there be any complications or risks?

Risks from Parkinson’s disease and PSP may arise from your symptoms. If you are affected by any of the above symptoms, you may need to make adjustments to cope better. Symptoms may vary between patients so it may help to tell the Eye Care Team if you are having problems so they are able to suggest personalised solutions.

Having double vision can be very disorientating and can increase the risk of trips and falls so make use of handrails where possible. Some people may find benefit in a walking stick.

It is important to keep your eyes well lubricated to keep them healthy. If you are suffering from dry eyes, please ensure you follow your Ophthalmologist’s instructions with regards to eye drops.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Orthoptic Department on telephone (01482) 816605