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Neuro- opHthalmology. Dr M ahmood F auzi ASSIST PROF OPHTHALMOLOGY AL MAAREFA COLLEGE. Objectives. Define the term ‘Neuro-Ophthalmology’ Describe the characteristics of normal fundus, optic disc, Identify Selected optic nerve diseases. - PowerPoint PPT Presentation
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NEURO-OPHTHALMOLOGY
Dr Mahmood FauziASSIST PROF OPHTHALMOLOGY
AL MAAREFA COLLEGE
OBJECTIVES Define the term ‘Neuro-Ophthalmology’ Describe the characteristics of normal
fundus, optic disc, Identify Selected optic nerve diseases
Neuro-ophthalmology is the sub-specialty of both
neurology and ophthalmology concerning
visual problems that are related to the
nervous system Some commonly seen diseases that a neuro-ophthalmologist
may see include optic neuritis, optic neuropathy, papilledema, Optic atrophy
Visual light pathway
Visual acuity
Confrontation visual fields
Pupil size and reaction Efferent vs Afferent (Marcus Gunn) problem
Ocular motility Strabismus, limitation and nystagmus
Fundus exam Optic nerve swelling and spontaneous venous pulsations
NEURO-OPHTHALMIC EXAM
VISUAL FIELD
confrontation
Kinetic perimetry Static perimetry
SELECT NEURO-OPTH. CONDITIONS
OPTIC NERVE DISEASEOptic neuropathy optic nerve abnormalities or damage,
including causes such as blocked blood flow or toxic exposure.
Non-Arteritic Ischemic Optic Neuropathy (NAION) Vascular disorder Pale, swollen disc +/– splinter hemorrhage Loss of VA , VF ( often altitudinal )
Arteritic Ischemic Optic Neuropathy (AION) Symptoms of giant cell arteritis ESR, CRP, Platelets +/– TABx Rx : systemic steroids
OPTIC NEURITIS
Anterior/bulbar/intra-ocular Optic Neuritis/Papillitis Inflammatory-- malaria, syphilis, orbital inflammation Auto immune – SLE, PAN, wegeners granulomatosis, Toxic— methanol ethombutol chloramphenicol
Posterior/Retrobulbar/orbital OpticNeuritis Demyelinating disease of CNS ie-- ENCEPHALITIS
Multiple Sclerosis
Sign and Symptoms: sudden loss of vision , central and para central scotoma
In retrobulbar optic neuritis pt sees nothing due to scotoma and physician sees nothing (fundus appears normal)
Afferent puppilary defect (RAPD)
Decreased visual acuity
red green color blindness
Pain on movement of eyes
Enlargement of blind spot or scotoma
And delayed latency in VEP
Unilateral edema, hemorrhage
MULTIPLE SCLEROSIS: OPTIC NEURITIS 50% of patients with MS will
develop Optic Neuritis 20-30% of time will be
presenting sign for MS
CONGENITAL ANOMALOUS DISC ELEVATION
Absence of edema, hemorrhage Presence of SVP Consider:
Optic disc drusen Hyperopia
THE SWOLLEN OPTIC DISC
Swelling of optic nerve head other than raised intra cranial pressure
•Papillitis
•Malignant hypertension
•Ischaemic optic neuropathy
•Diabetic optic neuropathy
•CRVO
•Intraocular inflammation
PAPILLOEDEMA Disc swelling secondary to raised
ICP Absence of SVP Usually bilateral Unilateral papilledema suggest orbital
pathology, such as an optic nerve glioma.
Headache Worse in the morning Valsalva manouver
Nausea and projectile vomiting Horizontal diplopia (VI palsy) Causes
Space occupying lesion Intracranial hypertension
Idiopathic Drugs Endocrine
Diffuse cerebral edema Severe hypertension Obstruction of CSF absorption as in
meningitis
Haemorrhages
CWS
Blurred optic disc margin
Small optic cup
Disc pallor
Vessel attenuation
Inflammation of the optic nerve head•hyperemia of the optic disk and large veins(early signs)
•edema (nearly more than 3D) (common)•blurring of the disk margins (common)•filling of the physiologic cup (common)
PAPILLITIS
Optic Atrophy Pallor of optic disc due to damage of retinal ganglion cells. Optic atrophy occurs four to six weeks after cell damage due to reduced blood circulation or inflammation
Types Primary: pallor occurs without prior optic disc swelling, and is due to retro bulbar damage of optic nerve up to lateral geniculate body. Color of Disc is chalky white with well defined margins.
Secondary: optic disc swelling is seen prior to pallor, margins may appear less defined, and color appears dirty white to grey.
consecutive: consequence of diffuse retinal disease and findings are as in secondary optic atrophy.
Glaucoma Previous optic neuritis Previous ischemic optic neuropathy Long-standing papilledema Optic nerve compression by a mass lesion Retinitis pigmentosa