Neuro-ophthalmology

Neuro-ophthalmology

Broadman area 17

Lesions in Visual Pathway

SIGNS OF OPTIC NERVE DYSFUNCTION:
1- Decreased visual acuity. 2- Diminish light pupillary reflex. 3- Dyschromatopsia 4- Diminished light brightness sensitivity. 5- Visual field defect

SPECIAL INVESTIGATIONS:

perimetry Visual Evoked Potential (VEP) MRI Fluorescein angiography

OPTIC NEURITIS

1- Ophthalmoscopic classification: a- Retrobulbar neuritis b- Papillitis


2- Aetiological classification: a- Demyelinating:most common cause. b- Para-infectious: a viral or immunization. c- Infectious: d- Autoimmune: systemic autoimmune disease.
OPTIC NEURITIS

OPTIC ATROPHY

PRIMARY

OPTIC ATROPHY

1- Primary optic atrophy Causes: - Retrobulbar neuritis (not papillitis). - Compressive lesions. - Hereditary optic neuropathies. - Toxic and nutritional optic neuropathies.

OPTIC ATROPHY

SECONDARY


2- Secondary optic atrophy Causes: - Chronic papilloedema. - AION (Anterior Ischaemic Optic Neuropathy): - Papillitis.
OPTIC ATROPHY

PAPILLOEDEMA

BILATERAL

Differential diagnosis of papilloedema:

1- Malignant hypertension. 2- Bilateral papillitis. 3- Bilateral compressive thyroid ophthalmopathy. 4- Bilateral simultaneous AION. 5- Bilateral compromised venous drainage.

ABNORMAL PUPILLARY REACTION

Applied Anatomy

A total afferent defect (TAPD, amaurotic pupil) A relative afferent defect (RAPD, Marcus Gunn pupil)
AFFERENT PUPILLARY CONDUCTION DEFECTS

RAPD

NEAR REFLEX
'light-near dissociation'
Dark Light Near

SYMPATHETIC SUPPLY

Applied Anatomy

HORNER SYNDROM