This document discusses the evaluation and classification of various optic nerve diseases. It covers clinical features of optic nerve dysfunction, optic disc changes, types of optic atrophy, signs of secondary optic atrophy, special investigations, classification of optic neuritis, associations between optic neuritis and demyelination diseases, clinical features and treatment of optic neuritis, and other causes of optic neuritis including infectious, parainfectious, and arteritic anterior ischemic optic neuropathy.

1. Evaluation of optic nerve disease

4. Clinical features of optic nerve dysfunction Reduced visual acuity Afferant pupillary defect Dyschromatopsia Diminished light brightness sensitivity Diminished contrast sensitivity Vsual field defects

5. Optic disc changes 1 –Normal disc 2-Disk swelling 3-optico-ciliary shunts 4-optic atrophy

6. Optic atrophy primary optic atrophy A; causes Following retrobulbar neuritis Compressive lesions such as tumors and aneurysms hereditary optic neuropathies Toxic and nutritional optic neuropathies

7. Disc appearance White flat disk with clearly delineated mar gins Reduction in number of blood Crossing the disk Attenuation of prepapillary vessels

8. Secondary optic atrophy Causes papilloedema papillitis AION Disc appearance white slightly raised poorly delineated margin

9. Special investigation Automated perimetry MRI Visual evoked potential Fluorescein angiography

10. Classification of optic neuritis 1-Ophthalmoscopic classification a; retrobulbar neuritis b; pappillitis c; neuroretinitis 2-Aetiological classification a; demyelinating b; parainfectious c; infectius

11. Optic neuriotis and demyelination VISUAL PATHWAY LESIONS BRAIN STEM LESION

12. Demyelination diseases Isolated optic neuritis Multiple sclerosis devic disease Schilder disease

13. Systemic feature of MS Spinal cord lesion Brain stem lesion Hemisphere lesion Transient phenomena

14. Special investigation Lumbar puncture VEP MRI

15. Optic neuritis 70% of women and 30% of men develop MS Evidance of optic neuritis in 70% of MS In 70% of isolated optic neuritis abnorml MRI Risk of MS winter onset HLA DR2 & uthuff

16. presentation Sudden onest of visul loss discomfort in or around the eye Frontal headache tenderness of globe

17. signs Normal disc in two-thirds (retrobulbar) Diminished visual acuity (very mild –very sever) Impairment of visual acuity & contrast sensitivity Visual field defect (central scotoma)

18. Clinical course Impairment of visual acuity becomes maximum after 1-2 weeks (6/18-6/60) Recovery takes 4-6 weeks usually

19. Prognosis Excellent in 75% (V/A 6/9)

20. treatment In mild visual loss treatment is probably unnecessary When visual acuity in the first week of symptom is worse than 6/12 treatment may speed up recovery Intravenous methylprednisolon sodium succinat Treatment dose not appear to have any long term benefit on final visual acuity

22. Other causes of optic neuritis Parainfectious ON (Viral) Infectios ON (sinus related,syphlis,lyme,…

24. signs Pale disc Diffuse or sectoral edema Localized disc hyperfluorescence V/A in 1/3 of patient is normal in remainder have moderate to sever impairment Visual field defect is typically altitudinal Color vision is diminished

25. managment Serologic study Fasting lipid profile Blood glucose, fibrinogen & packed cell volume

26. Treatment Treatment of any underlying diseases Stop smoking Low-dose aspirin

27. Arteritic anterior ischemic optic neuropathy: clinical features of giant cell arteritis Scalp tenderness Jaw claudification Polymyalgia rheumatica Neck pain, weight loss, anorexia fever, night sweets, malaise depression Superficial temporal arteritis Arteitis of other arteries Occult arterritis

28. Arteritic anterior iscxhemic optic neuropathy Uniocular sudden and profound loss of vision Periocular pain Transient visual obscuration Flashing lights

29. Signs pale and swollen optic disc Splinter hemorrhages Finaly optic atrophy

30. Special investigation ESR C-reactive protein Temporal artery biopsy

31. treatment Intravenous methylprednisolon 1g/day for 3 day together with oral prednisolon 80 mg After 3 days 60 mg for 3 day than 40 mg/days Than daily dose reduced 5 mg weekly Maintanance is 10 mg

33. Papillodema causes Space-ocupaying lesion Blockage of the ventricular system Obstruction of CSF absorption Benign intracranial hypertention, diffuse cerebral edema, sever hypertention Hypersecretion of CSF

34. Early papillodema Visual symptom are absent ,V/A normal Hyperaemia and mild elevation in optic disc Indistinct disc margin Absent spontaneous venous pulsation Nasal margin is blured in first

35. Estabilished papillodema Transient visual osscuration V/A is normal or reduced Sever hyperemic optic disc Smal vessele obscured Venous engorgment flam shap hemorrhage Cotton-wool spots Hyperfluorescence Retinal fold Hard exudates Enlarge blind spot

36. Long standing papillodema V/A variable V/F constriction Cotton-wool and hemorrhage absent Optociliary shunts

37. Atrophic papillodema V/A sever diminish White optic disc

38. Differential diagnosis Malignant hypertention Bilateral papilitis Bilateral compressive thyroid orbitopathy Bilateral simultaneousanteriorischemic optic neuropathy Bilateral compromisedvenous drainage

39. Congenital optic nerve anomalies