Best Neuro-Ophthalmologist in Gurgaon | Dr Shibal Bhartiya
Some vision problems are not eye problems. They are brain problems, nerve problems, or vascular problems, that show up in the eye first.
This is the territory of neuro-ophthalmology. Dr Shibal Bhartiya is a neuro-ophthalmologist in Gurgaon with clinical training at AIIMS New Delhi and the Department of Clinical Neurosciences, University of Geneva, Switzerland. She sees patients with optic nerve disease, unexplained visual loss, stroke-related vision changes, raised intracranial pressure, thyroid eye disease, double vision, and conditions where no diagnosis has yet been reached.
She works in close liaison with neurologists, neurosurgeons, interventional radiologists, and interventional neurologists; bringing a coordinated, multidisciplinary approach to complex neuro-ophthalmic conditions.
What Is Neuro-Ophthalmology?
Neuro-ophthalmology sits at the intersection of the eye and the nervous system.
The optic nerve carries visual information from the retina to the brain. The eye movements are controlled by cranial nerves. Visual fields are processed in the occipital cortex. Any disease affecting these pathways, whether a demyelinating illness, a vascular event, a tumour, raised pressure, or a metabolic process, can present with visual symptoms.
A neuro-ophthalmologist is trained to recognise these patterns, investigate them accurately, and coordinate care across specialties. Dr Bhartiya is a trained neuro-ophthalmologist in Gurgaon, who is also the Program Director of the Marengo Asia International Institute of Neurosciences & Spine.
Many patients arrive after seeing multiple doctors without a clear answer. That is exactly the situation a neuro-ophthalmologist is trained for.
Conditions We See
Optic Neuropathy
Optic neuropathy is damage to the optic nerve. It has many causes, and identifying the correct one determines the treatment.
Ischaemic optic neuropathy caused by reduced blood supply to the optic nerve. Anterior ischaemic optic neuropathy (AION) is the most common acute optic neuropathy in patients over 50. It typically presents as sudden, painless vision loss. Giant cell arteritis must be excluded urgently in older patients. It is a medical emergency.
Toxic optic neuropathy caused by medications, nutritional deficiencies (particularly B12 and folate), or exposure to toxic substances. Ethambutol toxicity in patients on tuberculosis treatment is an important and underdiagnosed cause in India. Early recognition and withdrawal of the offending agent can prevent permanent damage.
Compressive optic neuropathy caused by a tumour, thyroid eye disease, or other mass pressing on the optic nerve or chiasm. Imaging is essential. Pituitary adenomas, meningiomas, and orbital tumours are among the important causes.
Optic Neuritis
Optic neuritis is inflammation of the optic nerve. It typically presents as pain behind the eye, worsened by eye movement, followed by blurring or loss of vision, usually in one eye.
It is the most common presenting feature of multiple sclerosis. A first episode of optic neuritis requires urgent MRI to assess the risk of MS and guide decisions about early disease-modifying therapy.
Not all optic neuritis is MS-related. Neuromyelitis optica spectrum disorder (NMOSD), MOG-antibody associated disease, and other inflammatory conditions can present similarly and require different management.
Papilloedema and Raised Intracranial Pressure
Papilloedema is swelling of the optic disc caused by raised intracranial pressure (ICP). It is a serious finding that requires urgent investigation.
Causes include idiopathic intracranial hypertension (IIH, also called pseudotumour cerebri), intracranial tumours, cerebral venous sinus thrombosis, meningitis, and hydrocephalus.
Idiopathic intracranial hypertension is increasingly common, particularly in young women with obesity. It causes headache, pulsatile tinnitus, and transient visual obscurations. Without treatment, it can cause permanent visual field loss.
Management requires coordination between ophthalmology, neurology, and in some cases neurosurgery or interventional radiology (for venous sinus stenting).
Stroke and Occipital Infarcts
Stroke affecting the visual pathways produces characteristic patterns of visual field loss, hemianopia, quadrantanopia, or cortical blindness, depending on which part of the visual pathway is affected.
Posterior circulation strokes affecting the occipital cortex are a common cause of unexplained visual loss in older patients. The eye examination is normal, but visual field testing reveals the defect.
Accurate localisation of the lesion, whether in the optic tract, lateral geniculate nucleus, optic radiations, or occipital cortex, has direct implications for diagnosis, treatment, and driving fitness.
Dr Bhartiya works in close liaison with stroke neurologists and interventional neurologists for acute and post-stroke visual rehabilitation.
Thyroid Eye Disease (Graves Orbitopathy)
Thyroid eye disease causes inflammation and swelling of the muscles and fat around the eye. It can produce prominent eyes (proptosis), double vision, eyelid retraction, and in severe cases, compressive optic neuropathy threatening vision.
Management requires coordination between ophthalmology and endocrinology. In active, sight-threatening disease, treatment may include intravenous steroids, orbital radiotherapy, or surgical decompression.
Dr Bhartiya assesses thyroid eye disease with particular attention to optic nerve status, the critical question in any patient with proptosis.
Double Vision (Diplopia) and Cranial Nerve Palsies
Double vision is a symptom that demands careful evaluation. It can arise from a problem with the eye muscles, the neuromuscular junction, the cranial nerves (III, IV, or VI), the brainstem, or the orbit.
A third nerve palsy with a dilated pupil may be a neurosurgical emergency, it may indicate an expanding posterior communicating artery aneurysm. This must be excluded urgently.
Other causes include microvascular cranial nerve palsies (common in diabetes and hypertension), myasthenia gravis, Graves orbitopathy, and demyelinating disease.
Accurate diagnosis requires careful clinical examination, appropriate imaging, and in some cases neuromuscular testing.
Multiple Sclerosis and Demyelinating Disease
MS frequently affects the visual system. Optic neuritis, internuclear ophthalmoplegia, and nystagmus are all common manifestations.
For patients already diagnosed with MS, ophthalmological monitoring provides objective data on disease activity and treatment response, OCT of the retinal nerve fibre layer and ganglion cell layer are sensitive markers of subclinical optic nerve damage.
For patients with a first demyelinating episode, the ophthalmological assessment is part of the diagnostic workup that determines the risk of MS and guides early treatment decisions.
Unexplained Visual Loss
Many patients arrive with visual loss that has not been explained despite multiple consultations and investigations.
A structured neuro-ophthalmological evaluation, careful history, precise visual field mapping, OCT, VEP, and review of all imaging, frequently identifies the cause that has been missed. Common scenarios include functional visual loss, subtle optic neuropathy, chiasmal compression, and occipital pathology.
If you have been told your eyes are normal but your vision is not, a specialist evaluation is warranted.
Investigations We Use
The investigation of neuro-ophthalmic conditions requires a broader toolkit than standard ophthalmology.
Visual fields precise mapping of the visual field, essential for localising lesions along the visual pathway and monitoring progression. The Melbourne Rapid Field enables bedside evaluation also.
OCT of the optic nerve and RNFL structural imaging of the optic nerve head and retinal nerve fibre layer. Detects subtle atrophy. Particularly valuable in optic neuritis, MS monitoring, and glaucoma vs optic neuropathy differentiation.
Visual Evoked Potentials (VEP) measures the electrical response of the visual cortex to a visual stimulus. Delayed VEP latency is a sensitive marker of optic nerve demyelination, even when vision appears normal. Essential in MS diagnosis and monitoring.
Electroretinography (ERG) measures the electrical response of the retina. Used to distinguish retinal from optic nerve causes of visual loss, and to diagnose inherited retinal conditions.
MRI brain and orbits essential in optic neuritis, papilloedema, and any suspected compressive or demyelinating cause. Dr Bhartiya liaises directly with neuroradiology for reporting and interpretation.
MRA (MR Angiography) imaging of the cerebral and ophthalmic vasculature. Used in suspected vascular causes of optic neuropathy, cranial nerve palsies, and to exclude intracranial aneurysm.
MRV (MR Venography) imaging of the cerebral venous sinuses. Essential in suspected cerebral venous sinus thrombosis and idiopathic intracranial hypertension.
Carotid Doppler ultrasound assessment of carotid artery stenosis in patients with transient visual loss (amaurosis fugax), ischaemic optic neuropathy, or retinal vascular occlusion.
EMG (Electromyography) in suspected neuromuscular causes of double vision, particularly myasthenia gravis.
Vertigo laboratory assessment for patients with dizziness, nystagmus, or vestibular symptoms alongside visual complaints.
Interventional radiology and interventional neurology liaison for patients requiring venous sinus stenting (IIH), carotid intervention, or acute stroke treatment. Dr Bhartiya coordinates directly with interventional teams at Marengo Asia Hospitals.
Who Should See a Neuro-Ophthalmologist in Gurgaon
You should consider a neuro-ophthalmology consultation if:
- You have sudden or progressive visual loss and your eye examination has been reported as normal
- You have been told you have a swollen optic nerve or papilloedema
- You have double vision that has not been explained
- You have been diagnosed with MS and have visual symptoms
- You have optic neuritis, especially a first episode
- You have thyroid disease and your eyes are prominent, red, or you have double vision
- You have headaches with visual disturbance, particularly pulsatile tinnitus or transient blackouts of vision
- You have had a stroke and have visual field problems
- You are on ethambutol or other medications that can affect the optic nerve
- You have unexplained visual loss, no diagnosis after multiple consultations
- A neurologist, physician, or general ophthalmologist has referred you for a specialist opinion
What Happens at Your First Consultation
The first consultation is deliberately unhurried.
We begin with a detailed history; the precise nature of your visual symptoms, their onset, their pattern, and any associated neurological or systemic symptoms. The history alone often localises the problem before any test is done.
Examination includes visual acuity, colour vision, pupil reactions (including the swinging flashlight test for a relative afferent pupillary defect, RAPD), eye movement assessment, visual field testing at the slit lamp, and a dilated fundus examination with particular attention to the optic disc.
Further investigations are ordered based on what the examination reveals. You will receive a clear explanation of the findings, what they mean, and what the next steps involve.
Where specialist liaison is needed, neurology, endocrinology, neurosurgery, interventional radiology, referrals are made directly and expeditiously.
Frequently Asked Questions
What is the difference between a neuro-ophthalmologist and a general ophthalmologist?
A general ophthalmologist manages the full range of eye conditions; refractive errors, cataracts, glaucoma, retinal disease. A neuro-ophthalmologist has additional training in conditions where the visual system intersects with the nervous system and brain. This includes optic nerve disease, visual pathway lesions, raised intracranial pressure, eye movement disorders, and vision loss caused by neurological or vascular conditions.
My eyes have been examined and found normal. Why do I need a neuro-ophthalmology opinion?
A normal eye examination means the structures of the eye itself: the cornea, lens, retina, and intraocular pressure, are intact. It does not examine the optic nerve pathway, the visual cortex, or the connections between the eye and brain. Many important causes of visual loss: optic neuropathy, chiasmal compression, occipital infarcts, raised intracranial pressure. These produce a normal routine eye examination. A neuro-ophthalmological assessment specifically evaluates these structures.
I have been diagnosed with MS. Do I need to see a neuro-ophthalmologist?
Not routinely. But if you have visual symptoms, a history of optic neuritis, or if your neurologist wants an objective assessment of optic nerve status, a neuro-ophthalmological review is valuable. OCT of the retinal nerve fibre layer and ganglion cell layer provides quantitative, reproducible data on optic nerve health that complements MRI in monitoring MS activity.
What is a RAPD and why does it matter?
A relative afferent pupillary defect (RAPD) is detected with the swinging flashlight test. When a light is swung from one eye to the other, the pupil of the affected eye paradoxically dilates rather than constricts. An RAPD indicates a significant asymmetry in optic nerve function between the two eyes. It is one of the most important signs in neuro-ophthalmology, it confirms that a visual problem is due to optic nerve or retinal disease, not a problem behind the optic nerve.
What is idiopathic intracranial hypertension (IIH)?
IIH is a condition of raised intracranial pressure without an identifiable cause such as a tumour or infection. It predominantly affects young women with obesity. Symptoms include persistent headache, pulsatile tinnitus (a whooshing sound in the ears), and transient visual obscurations (brief blackouts of vision lasting seconds). The optic discs are swollen (papilloedema). Without treatment, IIH can cause permanent visual field loss. Treatment includes weight management, acetazolamide, and in refractory cases, surgical or interventional procedures.
What is amaurosis fugax?
Amaurosis fugax is a transient, monocular loss of vision, often described as a curtain descending over one eye, lasting seconds to minutes, then clearing completely. It is caused by temporary interruption of blood flow to the eye, usually from emboli arising from carotid artery disease or cardiac sources. It is a warning sign of impending stroke and requires urgent investigation including carotid Doppler, cardiac assessment, and neurology review.
Can optic neuritis be treated?
Yes. High-dose intravenous methylprednisolone speeds visual recovery from optic neuritis, although the final visual outcome at one year is similar whether treated or not. The more important question is what the optic neuritis means for the risk of MS. This is determined by MRI findings and guides decisions about early disease-modifying therapy. Prompt assessment and imaging are essential after a first episode.
Book a Neuro-Ophthalmology Consultation
Marengo Asia Hospitals, Golf Course Extension Road, Sector 56, Gurugram
Phone: +91 88826 38735 | +91 98187 00269
For patients outside Gurgaon, teleconsultation is available for initial review of reports, imaging, and visual field data before an in-person visit.
For referring neurologists, physicians, and general ophthalmologists: direct liaison is welcome. Please contact me on +91 98187 00269; or the coordinator at +91 88826 38735.
Read the research articles
This article has been written by Dr Shibal Bhartiya, a glaucoma specialist and neuro-ophthalmologist in Gurgaon known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. She is also a research collaborator with Mayo Clinic, Jacksonville, Florida, USA. This article has been updated in March, 2026.
She has published peer-reviewed research examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes.
These peer-reviewed article discussing glaucoma treatment are benchmarks for glaucoma surgeons globally, and can be accessed on PubMed and Google Scholar
If you would like a structured neuro-ophthalmology risk assessment or second opinion:
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