Transcript
Other causes of optic neuritis
• Parainfectious ON (Viral)• Infectios ON (sinus related,syphlis,lyme,…
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
managment
• Serologic study
• Fasting lipid profile
• Blood glucose, fibrinogen & packed cell volume
Treatment
• Treatment of any underlying diseases
• Stop smoking
• Low-dose aspirin
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
Arteritic anterior iscxhemic optic neuropathy
• Uniocular sudden and profound loss of vision
• Periocular pain
• Transient visual obscuration
• Flashing lights
Signs
• pale and swollen optic disc
• Splinter hemorrhages
• Finaly optic atrophy
Special investigation
• ESR• C-reactive protein • Temporal artery
biopsy
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
Papillodemacauses
• Space-ocupaying lesion
• Blockage of the ventricular system
• Obstruction of CSF absorption
• Benign intracranial hypertention, diffuse cerebral edema, sever hypertention
• Hypersecretion of CSF
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
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
Long standing papillodema
– V/A variable– V/F constriction– Cotton-wool and
hemorrhage absent– Optociliary shunts
Atrophic papillodema
• V/A sever diminish• White optic disc
Differential diagnosis
• Malignant hypertention
• Bilateral papilitis
• Bilateral compressive thyroid orbitopathy
• Bilateral simultaneousanteriorischemic optic neuropathy
• Bilateral compromisedvenous drainage
Congenital optic nerve anomalies
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