57Optic Neuropathies.ppt

8/17/2019 57Optic Neuropathies.ppt

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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


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


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 $


4/13

4isual fiel$ $efects

Central scoto(a

Altitu$inal Nerve fi"re "un$le

Centrocaecal scoto(a


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


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


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


8/13

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


9/13

9A in acute non/arteritic AION

3eneralie$ #%perfluorescenIncreasing localie$#%perfluorescence

!ocalie$ #%perfluorescence


10/13

Superficial te(poral arteritis

• Hea$ac#e

• Age / 8/;6 %ears• Scalp ten$erness

Presentation

• Superficial te(poral arteritis

•


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


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#%


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#%

57Optic Neuropathies.ppt

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