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Neuro- opHthalmology

Neuro- opHthalmology. Dr M ahmood F auzi ASSIST PROF OPHTHALMOLOGY AL MAAREFA COLLEGE. Objectives. Define the term ‘Neuro-Ophthalmology’ Describe the characteristics of normal fundus, optic disc, Identify Selected optic nerve diseases.

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Neuro- opHthalmology

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  1. Neuro-opHthalmology DrMahmood FauziASSIST PROF OPHTHALMOLOGY AL MAAREFA COLLEGE

  2. Objectives • Define the term ‘Neuro-Ophthalmology’ • Describe the characteristics of normal fundus, optic disc, • Identify Selected optic nerve diseases

  3. Neuro-ophthalmology is the sub-specialty of both neurology and ophthalmology concerning visual problems that are related to the nervous system • Some commonly seen diseases that a neuro-ophthalmologist may see include • optic neuritis, • optic neuropathy, • papilledema, • Optic atrophy

  4. Visual light pathway

  5. Neuro-Ophthalmic Exam • Visual acuity • Confrontation visual fields • Pupil size and reaction • Efferent vs Afferent (Marcus Gunn) problem • Ocular motility • Strabismus, limitation and nystagmus • Fundus exam • Optic nerve swelling and spontaneous venous pulsations

  6. Visual field confrontation

  7. Kinetic perimetry Static perimetry

  8. SELECT NEURO-OPTH. CONDITIONS

  9. Optic Nerve Disease Optic neuropathy optic nerve abnormalities or damage, including causes such as blocked blood flow or toxic exposure. • Non-ArteriticIschemic Optic Neuropathy (NAION) • Vascular disorder • Pale, swollen disc +/– splinter hemorrhage • Loss of VA , VF ( often altitudinal ) • Arteritic Ischemic Optic Neuropathy (AION) • Symptoms of giant cell arteritis • ESR, CRP, Platelets +/– TABx • Rx : systemic steroids

  10. Optic Neuritis • Anterior/bulbar/intra-ocular Optic Neuritis/Papillitis • Inflammatory-- malaria, syphilis, orbital inflammation • Auto immune – SLE, PAN, wegenersgranulomatosis, • Toxic— methanol ethombutol chloramphenicol • Posterior/Retrobulbar/orbital OpticNeuritis Demyelinating disease of CNS ie-- ENCEPHALITIS Multiple Sclerosis Sign and Symptoms: sudden loss of vision , central and para central scotoma In retrobulbar optic neuritis pt sees nothing due to scotoma and physician sees nothing (fundus appears normal) Afferent puppilary defect (RAPD) Decreased visual acuity red green color blindness Pain on movement of eyes Enlargement of blind spot or scotoma And delayed latency in VEP • Unilateral edema, hemorrhage

  11. Multiple Sclerosis: Optic Neuritis 50% of patients with MS will develop Optic Neuritis 20-30% of time will be presenting sign for MS

  12. Congenital Anomalous Disc Elevation • Absence of edema, hemorrhage • Presence of SVP • Consider: • Optic disc drusen • Hyperopia

  13. The swollen optic disc • Swelling of optic nerve head other than raised intra cranial pressure • Papillitis • Malignant hypertension • Ischaemic optic neuropathy • Diabetic optic neuropathy • CRVO • Intraocular inflammation

  14. Papilloedema Blurred optic disc margin • Disc swelling secondary to raised ICP Absence of SVP • Usually bilateral • Unilateral papilledema suggest orbital pathology, such as an optic nerve glioma. • Headache • Worse in the morning • Valsalvamanouver • Nausea and projectile vomiting • Horizontal diplopia (VI palsy) • Causes • Space occupying lesion • Intracranial hypertension • Idiopathic • Drugs • Endocrine • Diffuse cerebral edema • Severe hypertension • Obstruction of CSF absorption as in meningitis Haemorrhages Small optic cup CWS Disc pallor Vessel attenuation

  15. Papillitis • Inflammation of the optic nerve head • hyperemia of the optic disk and large veins(early signs) • edema (nearly more than 3D) (common) • blurring of the disk margins (common) • filling of the physiologic cup (common)

  16. Optic Atrophy Pallor of optic disc due to damage of retinal ganglion cells. Optic atrophy occurs four to six weeks after cell damage due to reduced blood circulation or inflammation Types Primary:pallor occurs without prior optic disc swelling, and is due to retro bulbar damage of optic nerve up to lateral geniculate body. Color of Disc is chalky white with well defined margins. Secondary: optic disc swelling is seen prior to pallor, margins may appear less defined, and color appears dirty white to grey. consecutive: consequence of diffuse retinal disease and findings are as in secondary optic atrophy. • Glaucoma • Previous optic neuritis • Previous ischemic optic neuropathy • Long-standing papilledema • Optic nerve compression by a mass lesion • Retinitis pigmentosa

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