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
meningesdura 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.Lebers 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 Secondary optic
atrophy atrophy
Etiology Damage of visual Lesions of optic
path behind disc retina and
cribriform plate choroid, et al.
Optic papilla pale clear Gray-white dirty
border screen dark border not
mes can be seen clear physiological
in cup depression disappear
Vessel of normal Narrow
retina 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 Graves 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
Papilledema
Differential diagnosis
Optic neuronitis
puedopapilledema
Lebers 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
Optic nerve hypoplasia
Optic pit
Optic disc drusen
Coloboma of optic nerve
Morning-glory syndrome
Abnormal development of optic disc
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.
Wernickes hemianopia tonic
pupil: when hemianopia side retina
exposed to slit light pupil doesnt
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 Wernickes
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 Wernickes 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
Thank you!