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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 • Non-Arteritic Ischemic 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. Selected Optic Nerve Diseases • Papillitis/Anterior Optic Neuritis • Unilateral edema, hemorrhage • Consider • inflammatory

  11. Optic Nerve Disease • Optic neuritis • Idiopathic or associated with multiple sclerosis • Young adults • Decreased visual acuity and colour vision • RAPD • Pain with ocular movement • Bulbar (disc swelling) or retrobulbar (normal disc) • Traumatic optic neuropathy • Direct trauma to optic nerve • Indirect : shearing force to the vascular supply

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

  13. Selected Optic Nerve Disease • Ischemic Optic Neuropathy • Pallor, swelling, hemorrhage • Altitudinal Visual Field Loss

  14. Sickle Cell Anemia • SC and S Thal more likely to have eye involved • Arteriolar occlusion • intravasc sickling  hemolysis  hemostasis  thrombosis  capillary non-perfusion • Similar to diabetes – poor perfusion = retinal ischemia  neovascularization • Laser Tx – can prevent vision loss

  15. 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

  16. 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

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

  18. Papillitis • 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) Fundus

  19. Selected Optic Nerve Disease • 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. • Consider: • Glaucoma • Previousoptic neuritis • Previous ischemic optic neuropathy • Long-standing papilledema • Optic nerve compression by a mass lesion • Retinitis pigmentosa

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