OPTIC NEUROPATHIES 2

OPTIC NEUROPATHIES

Marwan Salah Salman MD.


Signs of optic nerve dysfunction

Reduced visual acuity

Afferent pupillary
conduction defect
Dyschromatopsia
Diminished light
brightness sensitivity



Applied anatomy of afferent conduction defect
Signs
Equal pupil size
Light reaction
- ipsilateral direct is absent or diminished
- consensual is normal
Near reflex is normal in both eyes
Total defect (no PL) = amaurotic pupil
Relative defect = Marcus Gunn pupil


Optic disc changes
Swelling in:
Papilloedema
Papillitis and neuroretinitis
AION

Atrophy

Postneuritic
Compression
Hereditary optic atrophies

Optico-ciliary shunts

Optic nerve sheath meningioma
Occasionally optic nerve glioma

Classification of optic neuritis

Retrobulbar neuritis
(normal disc)
Demyelination - most common
Sinus-related (ethmoiditis)
Lyme disease
Papillitis (hyperaemia and
oedema)
Viral infections and immunization
in children (bilateral)
Demyelination (uncommon)
Syphilis
Neuroretinitis (papillitis
and macular star)
Cat-scratch fever
Lyme disease
Syphilis


Non-arteritic AION
Presentation
Age - 45-65 years
Altitudinal field defect
Eventually bilateral in 30% (give aspirin)

Acute signs

Pale disc with diffuse or sectorial oedema
Few, small splinter-shaped haemorrhages

Late signs

Resolution of oedema and haemorrhages
Optic atrophy and variable visual loss

Superficial temporal arteritis

Presentation
Age - 65-80 years
Scalp tenderness
Headache
Jaw claudication
Polymyalgia rheumatica
Superficial temporal arteritis
Acute visual loss


Special investigations
ESR - often > 60, but normal in 20%
C-reactive protein - always raised
Temporal artery biopsy

Arteritic AION

Affects about 25% of untreated patients with giant cell arteritis
Severe acute visual loss
Treatment - steroids to protect fellow eye
Bilateral in 65% if untreated

Presentation

ON NON AION AION
Presentation
ON NON AION AION

20-40

40-65
70-80
female
male=female
Female
Acute and progressive
Dramatic sudden onset
Dramatic sudden onset
Painful
painless
Painful
Ms symptoms
D,M H,T
Amaurosis fugax


Signs
Mild loss VA

Sever loss

Sever loss
unilateral
Unilateral then other eye 30 %
Unilateral then other eye 65 %
RAPCD
RAPCD
RAPCD
Normal or papilitis pink
Disc swelling
Pale
Disc swelling
Chalky
Disprporttional to VA loss
Propotional to VA loss

Investigations

VF diffuse scotoma
Inferior altitudinal

Blood normal

ESR elevated
ESR elevated
CRP markedly raised
FFA mild leakage
Moderate leakage
Sever leakage
VEP latency increase
Amplitude decrease
Amplitude decrease
MRI

Temporal artery biopsy

Done by Omar Abid ALsamrrae

With best wishes