Transcript
8/17/2019 57Optic Neuropathies.ppt
1/13
OPTIC NEUROPATHIES
1. Clinical features
2. Special investigations
. !e"er #ere$itar% optic neuropat#%
&. Optic neuritis
'. Anterior isc#ae(ic optic neuropat#% )AION*
• Retro"ul"ar neuritis• Papillitis
• Neuroretinitis
8/17/2019 57Optic Neuropathies.ppt
2/13
Signs of optic nerve $%sfunction
• Re$uce$ visual acuit%
• +i(inis#e$ lig#t"rig#tness sensitivit%
• +%sc#ro(atopsia
• Afferent pupillar%con$uction $efect
8/17/2019 57Optic Neuropathies.ppt
3/13
Applie$ anato(% of afferent con$uction $efect
Anato(ical pat#,a% Signs
• E-ual pupil sie
• !ig#t reaction
/ ipsilateral $irect is a"sent or $i(inis#
/ consensual is nor(al
• Near refle0 is nor(al in "ot# e%es
• Total $efect )no P!* a(aurotic pupil
• Relative $efect arcus 3unn pupil
3r $
8/17/2019 57Optic Neuropathies.ppt
4/13
4isual fiel$ $efects
Central scoto(a
Altitu$inal Nerve fi"re "un$le
Centrocaecal scoto(a
8/17/2019 57Optic Neuropathies.ppt
5/13
Optic $isc c#anges
• Retro"ul"ar neuritis• Earl% co(pression
Nor(al
• Papilloe$e(a• Papillitis an$ neuroretinitis
S,elling
• Optic nerve s#eat# (eningio(a• Occasionall% optic nerve glio(a
Optico/ciliar% s#unts
• Postneuritic• Co(pression
Atrop#%
•
AION
• Here$itar% optic atrop#ies
8/17/2019 57Optic Neuropathies.ppt
6/13
Special investigations
Or"ital fat/suppression tec#ni-ues inT1/,eig#te$ i(ages
Assess(ent of electrical activit% of visual corte0 create$ "% retinalsti(ulation
RI 4isuall% evo5e$ potential
8/17/2019 57Optic Neuropathies.ppt
7/13
Classification of optic neuritis
Retro"ul"ar neuritis )nor(al $isc*
• +e(%elination / (ost co((on
• Sinus/relate$ )et#(oi$itis*
• !%(e $isease
Papillitis )#%perae(ia an$oe$e(a*
• 4iral infections an$ i((uniation in c#il$ren )"ilateral*
• +e(%elination )unco((on*
• S%p#ilis
Neuroretinitis )papillitian$ (acular star*
• Cat/scratc# fever
• !%(e $isease
• S%p#ilis
8/17/2019 57Optic Neuropathies.ppt
8/13
Non/arteritic AION
• Pale $isc ,it# $iffuse or sectorial oe$e(a
•
Eventuall% "ilateral in &67 )give aspirin*
• Age / '/8 %ears• Altitu$inal fiel$ $efect
Presentation
Acute signs
• 9e,: s(all splinter/s#ape$ #ae(orr#ages
• Resolution of oe$e(a an$ #ae(orr#ag• Optic atrop#% an$ varia"le visual loss
!ate signs
8/17/2019 57Optic Neuropathies.ppt
9/13
9A in acute non/arteritic AION
3eneralie$ #%perfluorescenIncreasing localie$#%perfluorescence
!ocalie$ #%perfluorescence
8/17/2019 57Optic Neuropathies.ppt
10/13
Superficial te(poral arteritis
• Hea$ac#e
• Age / 8/;6 %ears• Scalp ten$erness
Presentation
• Superficial te(poral arteritis
•
8/17/2019 57Optic Neuropathies.ppt
11/13
Histolog% of giant cell arteritis
• Hig#/(agnification s#o,s giant cells• 3ranulo(atous cell infiltration
• +isruption of internal elastic la(ina
•
Proliferation of inti(a• Occlusion of lu(en
8/17/2019 57Optic Neuropathies.ppt
12/13
Arteritic AION• Affects a"out 27 of untreate$ patients ,it# giant cell arteritis
• Severe acute visual loss
• Treat(ent / steroi$s to protect fello, e%e
•
>ilateral in 87 if untreate$
• Pale $isc ,it# $iffuse oe$e(a• 9e,: s(all splinter/s#ape$ #ae(orr#ages
• Su"se-uent optic atrop#%
8/17/2019 57Optic Neuropathies.ppt
13/13
!e"er #ere$itar% optic neuropat#%
aternal (itoc#on$rial +NA (utations
Signs
• +isc #%perae(ia an$ $ilate$ capillaries)telangiectatic (icroangiopat#%*
• 4ascular tortuosit%• S,elling of peripapillar% nerve fi"re la%e
Presents
• T%picall% in (ales / t#ir$ $eca$e• Occasionall% in fe(ales / an% age• Initiall% unilateral visual loss•
9ello, e%e involve$ ,it#in 2 (ont#s• >ilateral optic atrop#%
• Su"se-uent "ilateral optic atrop#%