OCULAR MANIFESTATIONS OF NEUROLOGICAL DISEASES: A SYSTEMATIC REVIEW

Introduction: Neurological diseases often present with ocular manifestations that provide important diagnostic and prognostic information. These signs may precede or accompany systemic symptoms, allowing earlier detection and better monitoring of disease progression. Understanding these associations is crucial for both neurologists and ophthalmologists. Objective: The primary objective of this review is to evaluate the spectrum of ocular manifestations across major neurological diseases. Secondary objectives include analyzing diagnostic contributions of ocular findings, assessing their role in monitoring disease activity, and evaluating implications for patient outcomes. Methods: A systematic search was performed in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Inclusion criteria comprised studies published in the last five years, expanded to ten years if fewer than ten eligible studies were found. Only human studies were prioritized, although animal and in vitro research was considered in supplementary analysis. Data extraction and synthesis followed PRISMA 2020 guidelines, and risk of bias was assessed with RoB 2, ROBINS-I, and QUADAS-2. Certainty of evidence was graded using GRADE. Results and Discussion: Of 2,134 records identified, 29 studies met eligibility criteria. Findings demonstrated that ocular signs such as optic neuritis, nystagmus, retinopathy, and ocular motility disorders were strongly associated with conditions including multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, and myasthenia gravis. Multimodal imaging studies confirmed the diagnostic and monitoring value of these ocular features. Conclusion: Ocular manifestations play a pivotal role in the diagnosis and monitoring of neurological diseases. Their integration into multidisciplinary care enhances early detection and improves clinical outcomes. Standardized protocols and longitudinal studies are needed to establish ocular biomarkers as reliable clinical tools. Descriptors: Neurology, Ophthalmology, Ocular Manifestations, Neurodegenerative Diseases