Transcript Optic neuritis

Neuro-ophthalmology
Department of ophthalmology,CMU4h
Ophthalmologic hospital,CMU
Optic nerve diseases
Optic nerve : consists of axons that arise from the ganglion
cells, optic chiasm is its ending
Sheaths of optic nerve：the fibrous wrapping that
ensheathe the optic nerve are continuous with the
meninges——dura、arachnoid and pia mater；
Optic nerve diseases
Optic nerve diseases
Etiology：
• 1.inflammation：optic neuritis
• 2.Diseases of blood vessel：ischemic
optic neuropathy
• 3.Tumor：optic glioma、meningioma
of optic nerve
Optic neuritis
• Definition: Optic neuritis is
inflammation、disintegration
and demyelinaton of the optic
nerve.
• Classify according to site：
Optic papillitis：often seen in
children
Retrobulbar neuritis：often seen in
youth
Optic neuritis
Etiology：
• Myelinoclasis：multiple
sclerosis,optic neuromyelitis.
• Childhood Infections：measles、
parotitis.
• Infection of meninges、orbit or nasal
sinus.
• Infection of eyeball：retinitis、uveitis
• Idiopathic：
Optic neuritis
Clinical manifestations：
• Vision：acute visual loss with the
nadir about 1 week after onset.
• flare，orbital pain, the pain is
exacerbated by eye movement.
• Occasionally Uhthoff's sign
(visual deficit with exercise or
increase in body temperature).
• 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.
• VEP: abnormal.
Optic neuritis
Differential diagnosis：
• 1.Ischemic optic neuropathy
• 2.Leber’s optic neuropathy
• 3.Toxic or metabolic optic
neuropathy
Treatment：
• 1.Corticosteroid：
• 2.VitamineB，Vasodilator：
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:
symptoms：sudden、painless、nonprogressive visual
loss.
signs：
 vision：moderate loss
 pupil：afferent 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
50～60 years
Anterior ischemic optic neuropathy
Differential diagnosis：
 Optic neuritis：
 Kennedy syndrom：
Treatment：
Treat systemic disease
General application of corticosteroid
vasodilator
Decrease IOP
Optic nerve sheath decompression
Optic atrophy
• 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 atrophy：or descending
optic atrophy
• Secondary optic atrophy：or ascending
optic atrophy
Clinical manifestation：
Visual loss significantly，visual field
concentric constriction
Optic atrophy
Primary optic
atrophy
Secondary optic
atrophy
Etiology
Damage of visual Lesions of optic disc
path behind
、retina and choroid,
cribriform plate et al.
Optic papilla
pale，clear
border、screen
mes can be seen
in cup
Gray-white、dirty
dark，border not
clear、physiological
depression disappear
Vessel of
retina
normal
Narrow artery，
vessel with sheath
Optic atrophy
Diagnosis：
• According to fudus ,visual
acuity,visual field,VEP,CT,MRI
et al.
Treatment：
• Treat primary disease
• Assistant treatment：neurotrophic
medicine and vasodilator
Papilledema
Etiology：
1.intracranial：tumor、hemorrhage、
edema、abscess
2.Intraorbital：tumor、inflammation
、Grave’s disease
3.intraocular：ocular hypotension、
uveitis
4.Systemic disease：diabetes mellitus、
leukemia、malignant hypertension
、pulmonary heart disease.
Papilledema
Pathogenesis：
•
Intracranial hypertension
• The theory of axoplasma
flow
Papilledema
Clinical manifestaton：
• Symptoms：Episodes of
transient, often bilateral, visual
loss associated with psychiatric
symptoms
• Visual field：Enlarged
physiological blind spot, lately
concentric loss
Papilledema
Papilledema
Fundus：four 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
hemorrhages、cotton-wool spots、
macular hemorrhage and exudation.
3. Chronic stage：prominence of disc, cup
disappear，and hard exudation
4. Atrophic stage：pale papilla，gliosis and
narrowing of the retinal vessels
Papilledema
Differential diagnosis：
• Optic neuronitis
• puedopapilledema
• Leber’s optic neuropathy
• Ischemic optic neuropathy
Treatment：
• Treat according to causes：
• treat according to symptoms：optic
nerve sheath decompression
Tumor of optic nerve
Optic glioma
Meningioma of optic nerve
Papillary angioma
Papillary melanoma
Tumor of optic nerve
Papillary melanoma
Papillary angioma
Tumor of optic nerve
Optic glioma
Abnormal development of optic disc
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Optic nerve hypoplasia
Optic pit
Optic disc drusen
Coloboma of optic nerve
Morning-glory syndrome
Optic pit
Abnormal development of optic disc
Morning-glory syndrome
Optic chiasma and visual pathway diseases
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
Hemianopia ：blindness in one-half
of the field of vision of one or both
eyes, is the characteristic of visual
pathway lesions.
Optic chiasma 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、
craniopharyngioma、anterior communicating
aneurysm、tumor of third ventricle.
Optic chiasma lesions
Clinical manifestation：
 Blurred vision：bilateral, simultaneously
or by turns
 Defect of visual field：bitemporal
hemianopsia，early, these defects are
typically incomplete and are often
asymmetric.
 Abnormal ocular movement：tumor
offend cavernous sinus or superior orbital
fissure
 optic atrophy
 Symptoms of the primary disease
Treatment：
treat primary disease.
Optic tract lesions
• Contralateral of lesion、bilateral
homonymous hemianopia.
• Wernicke’s hemianopia tonic
pupil: when hemianopia side retina
exposed to slit light，pupil doesn’t
constrict.
• Lately, secondary optic atrophy
may occur.
Optic tract lesions
Optic tract
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 Wernicke’s
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 Wernicke’s hemianopia
tonic pupil. No phycotic symptoms.
Cortical blindness：Bilateral occipital lobe
infarctions
• Bilateral complete or severe loss of vision
• Normal pupillary responses
• Normal fundus and VEP
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