Optic nerve 2

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Optic nerve 2

  1. 1. Evaluation of optic nerve disease
  2. 4. Clinical features of optic nerve dysfunction <ul><li>Reduced visual acuity </li></ul><ul><li>Afferant pupillary defect </li></ul><ul><li>Dyschromatopsia </li></ul><ul><li>Diminished light brightness sensitivity </li></ul><ul><li>Diminished contrast sensitivity </li></ul><ul><li>Vsual field defects </li></ul>
  3. 5. Optic disc changes 1 –Normal disc 2-Disk swelling 3-optico-ciliary shunts 4-optic atrophy
  4. 6. Optic atrophy primary optic atrophy <ul><li>A; causes </li></ul><ul><li>Following retrobulbar neuritis </li></ul><ul><li>Compressive lesions such as tumors and aneurysms </li></ul><ul><li>hereditary optic neuropathies </li></ul><ul><li>Toxic and nutritional optic neuropathies </li></ul>
  5. 7. Disc appearance <ul><li>White flat disk with clearly delineated mar gins </li></ul><ul><li>Reduction in number of blood </li></ul><ul><li>Crossing the disk </li></ul><ul><li>Attenuation of prepapillary vessels </li></ul>
  6. 8. Secondary optic atrophy Causes papilloedema papillitis AION Disc appearance white slightly raised poorly delineated margin
  7. 9. Special investigation Automated perimetry MRI Visual evoked potential Fluorescein angiography
  8. 10. Classification of optic neuritis <ul><li>1-Ophthalmoscopic classification </li></ul><ul><li>a; retrobulbar neuritis </li></ul><ul><li>b; pappillitis </li></ul><ul><li>c; neuroretinitis </li></ul><ul><li>2-Aetiological classification </li></ul><ul><li>a; demyelinating </li></ul><ul><li>b; parainfectious </li></ul><ul><li>c; infectius </li></ul>
  9. 11. Optic neuriotis and demyelination <ul><li>VISUAL PATHWAY LESIONS </li></ul><ul><li>BRAIN STEM LESION </li></ul>
  10. 12. Demyelination diseases <ul><li>Isolated optic neuritis </li></ul><ul><li>Multiple sclerosis </li></ul><ul><li>devic disease </li></ul><ul><li>Schilder disease </li></ul>
  11. 13. Systemic feature of MS <ul><li>Spinal cord lesion </li></ul><ul><li>Brain stem lesion </li></ul><ul><li>Hemisphere lesion </li></ul><ul><li>Transient phenomena </li></ul>
  12. 14. Special investigation <ul><li>Lumbar puncture </li></ul><ul><li>VEP </li></ul><ul><li>MRI </li></ul>
  13. 15. Optic neuritis <ul><li>70% of women and 30% of men develop MS </li></ul><ul><li>Evidance of optic neuritis in 70% of MS </li></ul><ul><li>In 70% of isolated optic neuritis abnorml MRI </li></ul><ul><li>Risk of MS winter onset HLA DR2 & uthuff </li></ul>
  14. 16. presentation <ul><li>Sudden onest of visul loss </li></ul><ul><li>discomfort in or around the eye </li></ul><ul><li>Frontal headache tenderness of globe </li></ul>
  15. 17. signs <ul><li>Normal disc in two-thirds (retrobulbar) </li></ul><ul><li>Diminished visual acuity (very mild –very sever) </li></ul><ul><li>Impairment of visual acuity & contrast sensitivity </li></ul><ul><li>Visual field defect (central scotoma) </li></ul>
  16. 18. Clinical course <ul><li>Impairment of visual acuity becomes maximum after 1-2 weeks (6/18-6/60) </li></ul><ul><li>Recovery takes 4-6 weeks usually </li></ul>
  17. 19. Prognosis <ul><li>Excellent in 75% (V/A 6/9) </li></ul>
  18. 20. treatment <ul><li>In mild visual loss treatment is probably unnecessary </li></ul><ul><li>When visual acuity in the first week of symptom is worse than 6/12 treatment may speed up recovery </li></ul><ul><li>Intravenous methylprednisolon sodium succinat </li></ul><ul><li>Treatment dose not appear to have any long term benefit on final visual acuity </li></ul>
  19. 22. Other causes of optic neuritis <ul><li>Parainfectious ON (Viral) </li></ul><ul><li>Infectios ON (sinus related,syphlis,lyme,… </li></ul>
  20. 24. signs <ul><li>Pale disc </li></ul><ul><li>Diffuse or sectoral edema </li></ul><ul><li>Localized disc hyperfluorescence </li></ul><ul><li>V/A in 1/3 of patient is normal in remainder have moderate to sever impairment </li></ul><ul><li>Visual field defect is typically altitudinal </li></ul><ul><li>Color vision is diminished </li></ul>
  21. 25. managment <ul><li>Serologic study </li></ul><ul><li>Fasting lipid profile </li></ul><ul><li>Blood glucose, fibrinogen & packed cell volume </li></ul>
  22. 26. Treatment <ul><li>Treatment of any underlying diseases </li></ul><ul><li>Stop smoking </li></ul><ul><li>Low-dose aspirin </li></ul>
  23. 27. Arteritic anterior ischemic optic neuropathy: clinical features of giant cell arteritis <ul><li>Scalp tenderness </li></ul><ul><li>Jaw claudification </li></ul><ul><li>Polymyalgia rheumatica </li></ul><ul><li>Neck pain, weight loss, anorexia fever, night sweets, malaise depression </li></ul><ul><li>Superficial temporal arteritis </li></ul><ul><li>Arteitis of other arteries </li></ul><ul><li>Occult arterritis </li></ul>
  24. 28. Arteritic anterior iscxhemic optic neuropathy <ul><li>Uniocular sudden and profound loss of vision </li></ul><ul><li>Periocular pain </li></ul><ul><li>Transient visual obscuration </li></ul><ul><li>Flashing lights </li></ul>
  25. 29. Signs <ul><li>pale and swollen optic disc </li></ul><ul><li>Splinter hemorrhages </li></ul><ul><li>Finaly optic atrophy </li></ul>
  26. 30. Special investigation <ul><li>ESR </li></ul><ul><li>C-reactive protein </li></ul><ul><li>Temporal artery biopsy </li></ul>
  27. 31. treatment <ul><li>Intravenous methylprednisolon 1g/day for 3 day together with oral prednisolon 80 mg </li></ul><ul><li>After 3 days 60 mg for 3 day than 40 mg/days </li></ul><ul><li>Than daily dose reduced 5 mg weekly </li></ul><ul><li>Maintanance is 10 mg </li></ul>
  28. 33. Papillodema causes <ul><li>Space-ocupaying lesion </li></ul><ul><li>Blockage of the ventricular system </li></ul><ul><li>Obstruction of CSF absorption </li></ul><ul><li>Benign intracranial hypertention, diffuse cerebral edema, sever hypertention </li></ul><ul><li>Hypersecretion of CSF </li></ul>
  29. 34. Early papillodema <ul><li>Visual symptom are absent ,V/A normal </li></ul><ul><li>Hyperaemia and mild elevation in optic disc </li></ul><ul><li>Indistinct disc margin </li></ul><ul><li>Absent spontaneous venous pulsation </li></ul><ul><li>Nasal margin is blured in first </li></ul>
  30. 35. Estabilished papillodema <ul><li>Transient visual osscuration </li></ul><ul><li>V/A is normal or reduced </li></ul><ul><li>Sever hyperemic optic disc </li></ul><ul><li>Smal vessele obscured </li></ul><ul><li>Venous engorgment flam shap hemorrhage </li></ul><ul><li>Cotton-wool spots </li></ul><ul><li>Hyperfluorescence </li></ul><ul><li>Retinal fold </li></ul><ul><li>Hard exudates </li></ul><ul><li>Enlarge blind spot </li></ul>
  31. 36. Long standing papillodema <ul><ul><li>V/A variable </li></ul></ul><ul><ul><li>V/F constriction </li></ul></ul><ul><ul><li>Cotton-wool and hemorrhage absent </li></ul></ul><ul><ul><li>Optociliary shunts </li></ul></ul>
  32. 37. Atrophic papillodema <ul><li>V/A sever diminish </li></ul><ul><li>White optic disc </li></ul>
  33. 38. Differential diagnosis <ul><li>Malignant hypertention </li></ul><ul><li>Bilateral papilitis </li></ul><ul><li>Bilateral compressive thyroid orbitopathy </li></ul><ul><li>Bilateral simultaneousanteriorischemic optic neuropathy </li></ul><ul><li>Bilateral compromisedvenous drainage </li></ul>
  34. 39. Congenital optic nerve anomalies

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