Ross Hauser, MD, Morgan Griffiths, Ashley Watterson, Danielle R Steilen-Matias, PA, Benjamin Rawlings. Objective test findings in patients with chronic eye symptoms seeking care at an outpatient neck center: ligamentous cervical instability etiology?Front. Neurol., 21 September 2025. https://doi.org/10.3389/fneur.2025.1576315
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.
Introduction
An estimated 2.2 billion people suffered visual impairments worldwide in 2020 (1). Ligamentous cervical instability (LCI) and many eye conditions share the common characteristic of being progressive disorders necessitating vigilant monitoring and management to mitigate an ongoing impact on an individual’s health. There has been a reported 91.46% global increase in visual impairments from 1990 to 2019, with discernible unfavorable patterns in developed regions (2). With the ever-increasing usage of electronic devices comes myriad strains not only to the eye but to the cervical spine. “Computer vision syndrome” is associated with many ocular and musculoskeletal symptoms, including blurry vision, eye strain/fatigue, and head and neck symptoms (3). Recent evidence suggests that some eye symptoms may not be due to intraocular pathology stemming from the blue light emitted from the screen, as blue light-blocking spectacles do not significantly reduce symptoms in many people (4). Alternatively, symptoms may be due to destructive changes in the cervical spine from excessive poor posture, facedown/forward head posture (FD/FHP) that occurs with excessive screen time usage, also known as “tech neck” and “text neck” (5–7).