NEURO-OPHTHALMOLOGY

Dr. Gilbert WS Simanjuntak

Bagian IP Mata FK-UKI
SMF IP Mata RS PGI Cikini

 The eyes intimately related to the brain

frequently give important diagnostic clues to CNS
disorders
N2 is part of CNS
Frequent visual disturbances because of destruction
of or pressure upon some portion of the optic
pathways
N3,4,5,6 and 7

 Examination:
Perimetry static or kinetic
Relative afferent pupillary defect
CT Scan/MRI

Analysis of visual fields in localizing

lesions in the visual pathways

Rule of thumb
Lesions anterior to the chiasm (retina or N2) cause
unilateral field defects
Lesions posterior to the chiasm (anywhere in the
visual pathway) cause contralateral homonymous
defects
Congruent (identical in size, shape, and location)
Incongruent

Chiasmal lesions usually cause bitemporal defects

 Relative scotoma: spreading disease

Absolute scotoma: steep borders, vascular
disease/lesions
The more congruous the homonymous field
defects (ie, the more similar the two hemifields),
the farther posterior the lesion is in the visual
pathway
The more posterior the lesion, the more likely
there is to be macular sparing; maintenance of
good visual acuity in both hemifields

Optic nerve disease

Optic neuritis (papillitis and retrobulbar neuritis)
Severe VA decreased, pain, rapd, central scotoma,
hyperemia of the optic disk and distention of large
veins

Ischemic optic neuropathy

Age persons (60-70s), VA decreased from mild to
light perception, pale disk in resolved acute process,
altitudinal or central scotoma (occasionally)

 Papilledema (Choked disk)

Associated with increased intracranial pressure
(cerebral tumors, abscesses, subdural hematoma,
acquired hydrocephalus, A-V malformations,
malignant hypertension)
Hyperemia of the disk, choroidal folds, hemorrhages,
cotton-wool spots, VA relative normal

Optic nerve atrophy

Vascular, degenerative, secondary to papilledema,
secondary to optic neuritis, pressure against the optic
nerve, toxic, metabolic, traumatic, and glaucomatous

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