Download - Chp15 Neuro Ophthalmology
![Page 1: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/1.jpg)
Neuro-ophthalmology
![Page 2: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/2.jpg)
Optic nerve diseasesOptic nerve : consists of axons that arise from the ganglion
cells, optic chiasm is its endingSheaths of optic nerve : the fibrous wrapping that
ensheathe the optic nerve are continuous with the meninges——dura 、 arachnoid and pia mater ;
![Page 3: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/3.jpg)
Optic nerve diseases
![Page 4: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/4.jpg)
Optic nerve diseasesEtiology :• 1.inflammation : optic neuritis
• 2.Diseases of blood vessel : ischemic optic neuropathy
• 3.Tumor : optic glioma 、 meningioma of optic nerve
![Page 5: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/5.jpg)
Optic neuritis
• Definition: Optic neuritis is inflammation 、 disintegration and demyelinaton of the optic nerve.
• Classify according to site :Optic papillitis : often seen in childrenRetrobulbar neuritis : often seen in
youth
![Page 6: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/6.jpg)
Optic neuritis
Etiology :• Myelinoclasis : multiple sclerosis,optic
neuromyelitis.• Childhood Infections :
measles 、 parotitis.• Infection of meninges 、 orbit or nasal
sinus.• Infection of eyeball : retinitis 、 uveitis• Idiopathic :
![Page 7: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/7.jpg)
Optic neuritis
Clinical manifestations :• Vision : acute visual loss with the
peak about 1 week after onset.• orbital pain, the pain is exacerbated
by eye movement.• Occasionally Uhthoff's sign (visual
deficit with exercise or increase in body temperature).
• Micropsia, macropsia, metamorphopsia.• Pupil: relative afferent pupillary defect
(RAPD).
![Page 8: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/8.jpg)
Optic neuritisClinical manifestations :• Fundus: Swollen disc with or without
peripapillary flame-shaped hemorrhages. Fundus is normal in retrobulbar optic neuritis
• Visual field: central scotoma, concentric loss. • Colour vision abnormal
![Page 9: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/9.jpg)
Optic neuritisDifferential diagnosis :• 1.Ischemic optic neuropathy• 2.Leber’s optic neuropathy• 3.Toxic or metabolic optic
neuropathyTreatment :• 1.Corticosteroid :• 2.VitamineB , Vasodilator :
![Page 10: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/10.jpg)
• Definition :Optic atrophy is a nonspecific response to optic nerve (retina to lateral geniculate body) damage from any cause.
• Etiology :– Intracranial hypertension or inflammation– Retinopathy– Optic neuropathy– Compressive lesion– Trauma – Metabolic – Hereditary– Nutrient
Optic atrophy
![Page 11: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/11.jpg)
Normal fudus Optic atrophy
Optic atrophy
![Page 12: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/12.jpg)
Classification due to lesion site of fundus and optic nerve :
• Primary optic atrophy : or descending optic atrophy
• Secondary optic atrophy : or ascending optic atrophy
Clinical manifestation :Visual loss significantly , visual
field concentric constriction
Optic atrophy
![Page 13: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/13.jpg)
Optic atrophyPrimary optic atrophy
Secondary optic atrophy
Etiology Damage of visual path behind cribriform plate
Lesions of optic disc、 retina and choroid, et al.
Optic papilla pale , clear border
Gray-white 、 dirty dark , border not clear 、 physiological depression disappear
Vessel of retina
normal Narrow artery , vessel with sheath
![Page 14: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/14.jpg)
Diagnosis :• According to fundus ,visual
acuity,visual field,VEP,CT,MRI et al.
Treatment :• Treat primary disease• Assistant treatment : neurotrophic
medicine and vasodilator
Optic atrophy
![Page 15: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/15.jpg)
Etiology :1.intracranial :
tumor 、 hemorrhage 、 edema 、 abscess2.Intraorbital :
tumor 、 inflammation 、 Grave’s disease3.intraocular : ocular hypotension 、 uveitis4.Systemic disease : diabetes
mellitus 、 leukemia 、 malignant hypertension 、 pulmonary heart disease.
Papilledema
![Page 16: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/16.jpg)
Papilledema
Pathogenesis :• Intracranial hypertension
• The theory of axoplasma flow
![Page 17: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/17.jpg)
Clinical manifestaton :• Symptoms : Episodes of
transient, often bilateral, visual loss associated with psychiatric symptoms
• Visual field : Enlarged physiological blind spot, lately concentric loss
Papilledema
![Page 18: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/18.jpg)
Papilledema
![Page 19: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/19.jpg)
Fundus : four stages1. Early stage: hyperemic disc with blurring
of the disc margin, peripapillary retinal hemorrhages
2. Advanced stage: Bilaterally swollen, hyperemic discs with flame-like retinal hemorrhages 、 cotton-wool spots 、 macular hemorrhage and exudation.
3. Chronic stage : prominence of disc, cup disappear , and hard exudation
4. Atrophic stage : pale papilla , gliosis and narrowing of the retinal vessels
Papilledema
![Page 20: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/20.jpg)
Differential diagnosis :• Optic neuronitis• psuedopapilledema• Leber’s optic neuropathy• Ischemic optic neuropathyTreatment : • Treat according to causes :• treat according to symptoms : optic
nerve sheath decompression
Papilledema
![Page 21: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/21.jpg)
Anterior ischemic optic neuropathy
Definition: Anterior ischemic optic neuropathy is characterized by pallid disk swelling associated with acute loss of vision. The disorder is due to occlusion or decreased perfusion of the short posterior ciliary arteries.
![Page 22: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/22.jpg)
Anterior ischemic optic neuropathy
Etiology :1.Local vascular lesion of papilla 2.Hypotension of eye or total body3.Blood viscosity ↑4.High 5.Ocular hypertension
![Page 23: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/23.jpg)
Anterior ischemic optic neuropathyClinical manifestation:symptoms : sudden 、 painless 、 nonprogressive visual
loss.signs :
vision : moderate losspupil : afferent pupillary defectFundus: pale disc swelling often involving only a
segment of the disc, flame-shaped hemorrhages, optic atrophy after the edema resolves
Visual field: altitudinal or central visual field defectClinical types :
Areritic Anterior ischemic optic neuropathy: due to giant cell arteritis :
nonAreritic Anterior ischemic optic neuropathy 50~ 60 years
![Page 24: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/24.jpg)
Anterior ischemic optic neuropathy
Differential diagnosis : Optic neuritisTreatment :Treat systemic diseaseGeneral application of corticosteroidvasodilatorDecrease IOPOptic nerve sheath decompression
![Page 25: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/25.jpg)
Optic glioma
Meningioma of optic nervePapillary angioma
Papillary melanoma
Tumor of optic nerve
![Page 26: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/26.jpg)
Papillary melanoma Papillary angioma
Tumor of optic nerve
![Page 28: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/28.jpg)
Optic nerve hypoplasia Optic pit Optic disc drusen Coloboma of optic nerve Morning-glory syndrome
Abnormal development of optic disc
![Page 29: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/29.jpg)
Abnormal development of optic disc
Optic pit
![Page 30: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/30.jpg)
Abnormal development of optic disc
Morning-glory syndrome
![Page 31: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/31.jpg)
Visual pathway :Include:retina 、optic nerve 、optic chiasma 、optic tract 、lateral geniculate body 、optic radiation occipital cortex.
Optic chiasma and visual pathway diseases
![Page 32: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/32.jpg)
Character: Hemianopia
homonymous hemianopsia heteronymous hemianopsia
Optic chiasma and visual pathway diseases
Hemianopia : blindness in one-half of the field of vision of one or both eyes, is the characteristic of visual pathway lesions.
![Page 33: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/33.jpg)
Anatomical position of optic chiasma : the optic chiasma is variably situated near the
top of the diaphragm of the sella turcica, the lamina terminalis forms the anterior wall of the third ventricle, the internal carotid A. lie just laterally, adjacent to the cavernous sinuses.
Etiology : most diseases that affect the chiasma are
neoplastic, most common is pituitary tumors, next are tuberculum sella meningioma 、 craniopharyngioma 、 anterior communicating aneurysm 、 tumor of third ventricle.
Optic chiasma lesions
![Page 34: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/34.jpg)
Clinical manifestation : Blurred vision : bilateral, simultaneously
or by turns Defect of visual field : bitemporal
hemianopsia , early, these defects are typically incomplete and are often asymmetric.
Abnormal ocular movement : tumor offend cavernous sinus or superior orbital fissure
optic atrophy Symptoms of the primary diseaseTreatment : treat primary disease.
Optic chiasma lesions
![Page 35: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/35.jpg)
• Contralateral of lesion 、 bilateral homonymous hemianopia.• Wernicke’s hemianopia tonic pupil: when hemianopia side retina exposed to slit light , pupil doesn’t constrict.• Lately, secondary optic atrophy may occur.
Optic tract lesions
![Page 36: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/36.jpg)
Optic tract
Optic tract lesions
![Page 37: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/37.jpg)
Lateral geniculate body lesions
Contralateral of lesion 、 bilateral homonymous hemianopia.
Lately, secondary optic atrophy may occur.
![Page 38: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/38.jpg)
Optic radiation lesions Congruous bilateral homonymous
hemianopia Macular sparing Temporal crescent-shaped visual field loss No optic atrophy and Wernicke’s
hemianopia tonic pupil Accompany with symptoms of cerebrum
lesion
![Page 39: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/39.jpg)
Occipital lobe lesionsCharacter: congruous bilateral homonymous
hemianopia with sparing of the macula. No optic atrophy and Wernicke’s hemianopia tonic pupil. No phycotic symptoms.
Cortical blindness : Bilateral occipital lobe infarctions
• Bilateral complete or severe loss of vision• Normal pupillary responses • Normal fundus and VEP
![Page 40: Chp15 Neuro Ophthalmology](https://reader033.vdocument.in/reader033/viewer/2022050714/577cc6cd1a28aba7119f258b/html5/thumbnails/40.jpg)
Thank you!