1. Dr. G. Rajasekhar D.N.B, FRCS
NEUROPHTHALMOLOGY
Dr. G. Rajasekhar
D.N.B, FRCS

2. NEUROPHTHALMOLOGY
Papilloedema
Optic neuritis
Optic atrophy

3. Optic disc edema Causes of bilateral disc edema:
Papilloedema
Thyroid orbitopathy
Anaemia
Hypertensive retinopathy
Congenital (pseudo papilloedema)
Causes of unilateral disc edema:
Inflammation
Papillitis
Neuro retinitis
Ocular disease
Uveitis
Hypotony
Vein occlusion
acute angle closure glaucoma
Orbital disease
Tumours
Thyroid orbitopathy
Orbital cellulitis
Vascular causes
AION

4. PAPILLOEDEMA
Passive bilateral edema of optic disc secondary to raised intra cranial pressure
ETIOLOGY
ICSOL
Infections
Obstructed CSF flow
Pseudo tumor cerebri
Systemic:
Malignant HTN
Toxemia of pregnancy
Blood dyscrasias
Medications (steroids including OCP, vit A toxicity, out dated tetracyclins, nalidixic acid)

5. PAPILLOEDEMA Unilateral disc edema with rise of ICT
Foster-kennedy syndrome (frontal lobe tumours)
Pseudo Foster-kennedy syndrome (optic atrophy)
Congenital anomalies of meninges covering optic nerve

6. PAPILLOEDEMA Clinical features:
Headache (worse in the morning, increase with valasalva)
Projectile vomitting
No eye complaints till late
Transient blurring of vision
Peripehral filed loss (Night blindness)
Vision loss, color vision loss and filed loss in later stages

7. PAPILLOEDEMA
Pathogenesis:

8. PAPILLOEDEMA Pathogenesis: Intra cranial Pressure 120 mm of CSF
Intra ocular
Pressure
10-20 mm of Hg
Perfusion
Pressure
20-30 mm
of Hg

9. PAPILLOEDEMA
Pathogenesis:

10. PAPILLOEDEMA Pathogenesis: Intra cranial Pressure 120 mm of CSF
Intra ocular
Pressure
10-20 mm of Hg
Perfusion
Pressure
20-30 mm of Hg

11. PAPILLOEDEMA
STAGES:
EARLY
ESTABLISHED
CHRONIC
ATROPHIC

12. PAPILLOEDEMA
EARLY

13. PAPILLOEDEMA
ESTABLI-
-SHED

14. PAPILLOEDEMA
CHRONIC

15. PAPILLOEDEMA
ATROPHIC

16. PAPILLOEDEMA Treatment Radio imaging (CT) Treat specific cause
Anti biotics
Steroids
Drainage shunts

17. OPTIC NEURITIS Inflammation of optic nerve Types:
By ophthalmoscopic appearance
RETRO BULBAR (common in Multiple Sclerosis)
PAPILLITIS (common in children)
NEURO RETINITIS

18. OPTIC NEURITIS CAUSES: AETIOLOGICAL DEMYELINATING (commonest)
PARA INFECTIOUS (post viral or vaccination)
INFECTIOUS (sinus, syphilis, cat scratch, lyme disease, zoster)
NON INFECTIOUS (sarcoid, SLE, PAN)

19. OPTIC NEURITIS Clinical features
Unilateral rapid loss of vision (with in hours to days)
Loss of visual filed (central)
Some times associated with eye pain associated with eye movements especially adduction and elevation
h/o similar episodes in past
h/o suggestive of demyelinating / auto immune disease/ infection.

20. OPTIC NEURITIS Clinical features Visual acuity from 6/18 to PL+
Defective color vision
Loss of contrast sensitivity
Field defects
Sluggish pupil with RAPD
Posterior vitreous cells +/-
Optic disc changes +/-

21. OPTIC NEURITIS
Visual filed
defects

22. OPTIC NEURITIS
papillitis

23. OPTIC NEURITIS
Neuro-
-retinitis

24. OPTIC NEURITIS Treatment
Intra venous methyl prednisolone 1gm daily * 3 days
Followed by oral prednisolone 1mg/kg (tapered)
Treatment of the cause

25. PAPILLOEDEMA Vs OPTIC NEURITIS
Bilateral Transient blurring +/- Absent + signs of rised ICT Clear media Hyperemic disc Blurred margins Disc elevation 2-6 D Peri papillary edema + Venous engorgement +++ Exudates and haemorrhages +++ Macular star / fan Enlarged blind spot Pooling around the disc
Laterality
Vision
Pain
Fundus
Fields
FFA
Unilateral
Marked rapid loss of vision & CV
+/- with ocular movements
Posterior vitreous cells
Hyperemic disc
Blurred margins
Disc elevation upto 3 D
Peri papillary edema +
Venous engorgement +
Exudates + and haemorrhages -
Macular fan / star
Central / centrocecal scotoma
Minimal leaking of dye at disc

26. OPTIC ATROPHY PRIMARY OPTIC ATROPHY SECONDARY OPTIC ATROPHY
CONSECUTIVE OPTIC ATROPHY

27. OPTIC ATROPHY PRIMARY OPTIC ATROPHY CAUSES: RBN COMPRESSIVE LESIONS
HERIDITARY OPTIC NEUROPATHIES
TOXIC AND NUTRITIONAL OPTIC NEUROPATHIES

28. OPTIC ATROPHY
PRIMARY OPTIC ATROPHY

29. OPTIC ATROPHY SECONDARY OPTIC ATROPHY CAUSES: PAPILLOEDEMA AION
PAPILLITIS

30. OPTIC ATROPHY
SECONDARY OPTIC ATROPHY

31. OPTIC ATROPHY CONSECUTIVE OPTIC ATROPHY CAUSES: RETINITIS PIGMENTOSA
PHOTO COAGULATION

32. OPTIC ATROPHY
CONSECUTIVE
OPTIC ATROPHY