Neuro-ophthalmology Department of ophthalmology,CMU4h Ophthalmologic hospital,CMU.
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Transcript of Neuro-ophthalmology Department of ophthalmology,CMU4h Ophthalmologic hospital,CMU.
Neuro-ophthalmology
Department of ophthalmology,CMU4hOphthalmologic 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
childrenRetrobulbar 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 neuritisClinical 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
neuropathyTreatment :• 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 body3.Blood viscosity ↑4.High 5.Ocular hypertension
Anterior ischemic optic neuropathyClinical manifestation:symptoms : sudden 、 painless 、 nonprogressive
visual loss.signs :
vision : moderate losspupil : afferent pupillary defectFundus: 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 diseaseGeneral application of corticosteroidvasodilatorDecrease IOPOptic nerve sheath decompression
• 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
Optic atrophyPrimary optic atrophy
Secondary optic atrophy
Etiology Damage of visual path behind cribriform plate
Lesions of optic disc、 retina and choroid, 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
Diagnosis :• According to fudus ,visual
acuity,visual field,VEP,CT,MRI et al.
Treatment :• Treat primary disease• Assistant treatment: neurotrophic
medicine and vasodilator
Optic atrophy
Etiology :1.intracranial :
tumor 、 hemorrhage 、 edema 、 abscess2.Intraorbital :
tumor 、 inflammation 、 Grave’s disease3.intraocular : ocular hypotension 、 uveitis4.Systemic disease : diabetes
mellitus 、 leukemia 、 malignant hypertension 、 pulmonary heart disease.
Papilledema
Papilledema
Pathogenesis :
• Intracranial hypertension
• The theory of axoplasma flow
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 stages1. 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 neuropathyTreatment : • Treat according to causes :• treat according to symptoms : optic
nerve sheath decompression
Papilledema
Optic glioma
Meningioma of optic nervePapillary angioma
Papillary melanoma
Tumor of optic nerve
Papillary melanoma Papillary angioma
Tumor of optic nerve
Optic nerve hypoplasia Optic pit Optic disc drusen Coloboma of optic nerve Morning-glory syndrome
Abnormal development of optic disc
Abnormal development of optic disc
Optic pit
Abnormal development of optic disc
Morning-glory syndrome
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
Optic chiasma and visual pathway diseases
Hemianopia : blindness in one-half
of the field of vision of one or both
eyes, is the characteristic of visual
pathway 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 diseaseTreatment : treat primary disease.
Optic chiasma 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
Optic tract lesions
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
Thank you!