Neuro-ophthalmology

Optic nerve diseases

Optic nerve : consists of axons that arise from the ganglion
cells, optic chiasm is its ending
Sheaths of optic nervethe fibrous wrapping that
ensheathe the optic nerve are continuous with the
meningesduraarachnoid and pia mater
Optic nerve diseases

Optic nerve diseases
Etiology

1.inflammationoptic neuritis

2.Diseases of blood vesselischemic
optic neuropathy

3.Tumoroptic gliomameningioma
of optic nerve
Optic neuritis

Definition: Optic neuritis is
inflammationdisintegration
and demyelinaton of the optic
nerve.

Classify according to site
Optic papillitisoften seen in
children
Retrobulbar neuritisoften seen in
youth

Optic neuritis

Etiology
Myelinoclasismultiple
sclerosis,optic neuromyelitis.
Childhood Infectionsmeasles
parotitis.
Infection of meningesorbit or nasal
sinus.
Infection of eyeballretinitisuveitis
Idiopathic

Optic neuritis

Clinical manifestations
Visionacute visual loss with the
peak about 1 week after onset.
orbital pain, the pain is exacerbated
by eye movement.
Occasionally Uhthoff's sign (visual
deficit with exercise or increase in
body temperature).
Micropsia, macropsia, metamorphopsia.
Pupil: relative afferent pupillary defect
(RAPD).

Optic neuritis
Clinical manifestations
Fundus: Swollen disc with or without
peripapillary flame-shaped hemorrhages.
Fundus is normal in retrobulbar optic neuritis
Visual field:
central scotoma,
concentric loss.
Colour vision
abnormal

Optic neuritis
Differential diagnosis
1.Ischemic optic neuropathy
2.Lebers optic neuropathy
3.Toxic or metabolic optic
neuropathy
Treatment
1.Corticosteroid
2.VitamineBVasodilator
Definition :Optic atrophy is a nonspecific
response to optic nerve (retina to lateral geniculate
body) damage from any cause.
Etiology
Intracranial hypertension or inflammation
Retinopathy
Optic neuropathy
Compressive lesion
Trauma
Metabolic
Hereditary
Nutrient
Optic atrophy
Normal fudus Optic atrophy
Optic atrophy
Classification due to lesion site of fundus and
optic nerve
Primary optic atrophyor descending
optic atrophy
Secondary optic atrophyor ascending
optic atrophy
Clinical manifestation
Visual loss significantlyvisual field
concentric constriction
Optic atrophy
Optic atrophy
Primary optic
atrophy
Secondary optic
atrophy
Etiology Damage of visual
path behind
cribriform plate
Lesions of optic disc
retina and choroid,
et al.
Optic papilla paleclear
border
Gray-whitedirty
darkborder not
clearphysiological
depression disappear
Vessel of
retina
normal Narrow artery
vessel with sheath
Diagnosis
According to fundus ,visual
acuity,visual field,VEP,CT,MRI
et al.
Treatment
Treat primary disease
Assistant treatmentneurotrophic
medicine and vasodilator

Optic atrophy
Etiology
1.intracranialtumorhemorrhage
edemaabscess
2.Intraorbitaltumorinflammation
Graves disease
3.intraocularocular hypotension
uveitis
4.Systemic diseasediabetes mellitus
leukemiamalignant hypertension
pulmonary heart disease.
Papilledema



Papilledema
Pathogenesis

Intracranial hypertension

The theory of axoplasma
flow
Clinical manifestaton
SymptomsEpisodes of
transient, often bilateral, visual
loss associated with psychiatric
symptoms
Visual fieldEnlarged
physiological blind spot, lately
concentric loss
Papilledema
Papilledema
Fundusfour stages
1. Early stage: hyperemic disc with blurring
of the disc margin, peripapillary retinal
hemorrhages
2. Advanced stage: Bilaterally swollen,
hyperemic discs with flame-like retinal
hemorrhagescotton-wool spots
macular hemorrhage and exudation.
3. Chronic stageprominence of disc, cup
disappearand hard exudation
4. Atrophic stagepale papillagliosis and
narrowing of the retinal vessels
Papilledema
Differential diagnosis
Optic neuronitis
psuedopapilledema
Lebers optic neuropathy
Ischemic optic neuropathy
Treatment
Treat according to causes
treat according to symptomsoptic
nerve sheath decompression

Papilledema
Anterior ischemic optic neuropathy
Definition: Anterior ischemic optic
neuropathy is characterized by
pallid disk swelling associated
with acute loss of vision. The
disorder is due to occlusion or
decreased perfusion of the short
posterior ciliary arteries.

Anterior ischemic optic neuropathy
Etiology
1.Local vascular lesion of papilla
2.Hypotension of eye or total body
3.Blood viscosity
4.High
5.Ocular hypertension
Anterior ischemic optic neuropathy
Clinical manifestation:
symptomssuddenpainlessnonprogressive visual
loss.
signs
visionmoderate loss
pupilafferent pupillary defect
Fundus: pale disc swelling often involving only a
segment of the disc, flame-shaped hemorrhages,
optic atrophy after the edema resolves
Visual field: altitudinal or central visual field
defect
Clinical types
Areritic Anterior ischemic optic neuropathy: due
to giant cell arteritis
nonAreritic Anterior ischemic optic neuropathy
5060 years
Anterior ischemic optic neuropathy
Differential diagnosis
Optic neuritis
Treatment
Treat systemic disease
General application of corticosteroid
vasodilator
Decrease IOP
Optic nerve sheath decompression
Optic glioma

Meningioma of optic nerve

Papillary angioma

Papillary melanoma
Tumor of optic nerve
Papillary melanoma Papillary angioma
Tumor of optic nerve
Tumor of optic nerve
Optic glioma
Optic nerve hypoplasia
Optic pit
Optic disc drusen
Coloboma of optic nerve
Morning-glory syndrome

Abnormal development of optic disc
Optic pit
Abnormal development of optic disc
Morning-glory syndrome
Visual pathway
Include:
retina
optic nerve
optic chiasma
optic tract
lateral geniculate
body
optic radiation
occipital cortex.
Optic chiasma and visual pathway diseases
Character: Hemianopia
homonymous hemianopsia
heteronymous hemianopsia
Optic chiasma and visual pathway diseases
Hemianopia blindness in one-half
of the field of vision of one or both
eyes, is the characteristic of visual
pathway lesions.
Anatomical position of optic chiasma
the optic chiasma is variably situated near
the top of the diaphragm of the sella turcica, the
lamina terminalis forms the anterior wall of the
third ventricle, the internal carotid A. lie just
laterally, adjacent to the cavernous sinuses.
Etiology
most diseases that affect the chiasma are
neoplastic, most common is pituitary tumors,
next are tuberculum sella meningioma
craniopharyngiomaanterior communicating
aneurysmtumor of third ventricle.
Optic chiasma lesions
Clinical manifestation
Blurred visionbilateral, simultaneously
or by turns
Defect of visual fieldbitemporal
hemianopsiaearly, these defects are
typically incomplete and are often
asymmetric.
Abnormal ocular movementtumor
offend cavernous sinus or superior orbital
fissure
optic atrophy
Symptoms of the primary disease
Treatment
treat primary disease.
Optic chiasma lesions


Contralateral of lesionbilateral
homonymous hemianopia.
Wernickes hemianopia tonic
pupil: when hemianopia side retina
exposed to slit lightpupil doesnt
constrict.
Lately, secondary optic atrophy
may occur.

Optic tract lesions
Optic tract

Optic tract lesions
Lateral geniculate body lesions

Contralateral of lesion
bilateral homonymous
hemianopia.

Lately, secondary optic
atrophy may occur.

Optic radiation lesions
Congruous bilateral homonymous
hemianopia
Macular sparing
Temporal crescent-shaped visual field
loss
No optic atrophy and Wernickes
hemianopia tonic pupil
Accompany with symptoms of
cerebrum lesion

Occipital lobe lesions

Character: congruous bilateral homonymous
hemianopia with sparing of the macula. No
optic atrophy and Wernickes hemianopia
tonic pupil. No phycotic symptoms.
Cortical blindnessBilateral occipital lobe
infarctions
Bilateral complete or severe loss of vision
Normal pupillary responses
Normal fundus and VEP



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