NEURONEURO--OPHTHALMOLOGYOPHTHALMOLOGY

Dr. Gilbert WS SimanjuntakBagian 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 Analysis of visual fields in localizing lesions in the visual pathwayslesions in the visual pathways

Rule of thumbRule 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 diseaseOptic 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

THANK YOUTHANK YOU

NEURO-OPHTHALMOLOGYAnalysis of visual fields in localizing lesions in the visual pathwaysRule of thumbOptic nerve diseaseTHANK YOU