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NEURO-OPHTHALMOLOGY Dr Mahmood Fauzi ASSIST PROF OPHTHALMOLOGY AL MAAREFA COLLEGE

Neuro- opHthalmology

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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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Page 1: Neuro- opHthalmology

NEURO-OPHTHALMOLOGY

Dr Mahmood FauziASSIST PROF OPHTHALMOLOGY

AL MAAREFA COLLEGE

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OBJECTIVES Define the term ‘Neuro-Ophthalmology’ Describe the characteristics of normal

fundus, optic disc, Identify Selected optic nerve diseases

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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

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Visual light pathway

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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

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VISUAL FIELD

confrontation

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Kinetic perimetry Static perimetry

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SELECT NEURO-OPTH. CONDITIONS

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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

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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

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MULTIPLE SCLEROSIS: OPTIC NEURITIS 50% of patients with MS will

develop Optic Neuritis 20-30% of time will be

presenting sign for MS

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CONGENITAL ANOMALOUS DISC ELEVATION

Absence of edema, hemorrhage Presence of SVP Consider:

Optic disc drusen Hyperopia

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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

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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

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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

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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

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