HYPOTHESIS AND THEORY article
Front. Neurol.
Sec. Neuro-Ophthalmology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1576315
Objective test findings in patients with chronic eye symptoms seeking care at an outpatient neck center: Ligamentous cervical instability etiology?
Provisionally accepted
- 1Caring Medical, Fort Myers, California, United States
- 2Independent Researcher for Caring Medical, St. Charles, United States
- 3Division of Behavioral and Organizational Sciences, Claremont Graduate University, Claremont, United States
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Purpose To examine the incidence and potential associations between eye symptoms and objective test findings in patients reporting to an outpatient neck center without known preexisting conditions. Methods Consecutive patients between January 1 and June 30, 2022, reporting at least 1 of 6 eye symptoms (light sensitivity, blurry vision, eye pain/pressure, vision changes, seeing flashes of light, eye tearing) without known etiology underwent these tests: pupillometry, tonometry, ultrasound of carotid sheath and optic nerve sheath, and digital motion x-ray (videofluoroscopy) and upright cone beam computed tomography scan of cervical spine. Results The analysis included 203/234 consecutive patients. Elevated optic nerve sheath diameter (total >12.2 mm) was documented in 98% (199/203). Supine cervical ultrasound revealed 99.5% (202/203) with internal jugular vein narrowing at C1: total internal jugular vein cross-sectional area <180 mm2. Mean internal jugular vein cross-sectional area at C1 was significantly higher with cervical orthotic Denneroll® (+35.76 mm, p <0.05). Some 95.6% evidenced vagus nerve degeneration (total cross-sectional area <4.2 mm2) and 86.2% had C1-C2 instability (total >4.0 mm). Pearson correlation coefficient analysis showed a positive relationship between pupil diameter and intraocular pressure (r = 0.29, p <0.01), while 20.7% had ocular hypertension. Discussion Elevated optic nerve sheath diameter, elevated intraocular pressure, ocular dysautonomia, and succeeding eye symptoms may be pathophysiological effects of internal jugular vein compression and vagus nerve degeneration with underlying ligamentous cervical instability etiology.
Keywords: Intraocular Pressure, Intracranial Pressure, optic nerve sheath diameter, ligamentous cervical instability, internal jugular vein, Cerebrospinal Fluid, depth of curve
Received: 13 Feb 2025; Accepted: 19 Aug 2025.
Copyright: © 2025 Hauser, Griffiths, Watterson, Matias and Rawlings. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Benjamin Ryan Rawlings, Caring Medical, Fort Myers, California, United States
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