Optic nerve 1

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