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Dr Mahmood Fauzi ASSIST PROF OPHTHALMOLOGY AL MAAREFA COLLEGE.

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Presentation on theme: "Dr Mahmood Fauzi ASSIST PROF OPHTHALMOLOGY AL MAAREFA COLLEGE."— Presentation transcript:

1 Dr Mahmood Fauzi ASSIST PROF OPHTHALMOLOGY AL MAAREFA COLLEGE

2  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

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5  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

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7 Kinetic perimetry Static perimetry

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9 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  Papillitis/Anterior Optic Neuritis  Unilateral edema, hemorrhage  Consider inflammatory

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

13 Ischemic Optic Neuropathy Pallor, swelling, hemorrhage Altitudinal Visual Field Loss

14 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 Swelling of optic nerve head other than raised intra cranial pressure Papillitis Malignant hypertension Ischaemic optic neuropathy Diabetic optic neuropathy CRVO Intraocular inflammation

16  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  Valsalva manouver  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 CWS Blurred optic disc margin Small optic cup Disc pallor Vessel attenuation

17  Absence of edema, hemorrhage  Presence of SVP  Consider: Optic disc drusen Hyperopia

18 Fundus 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)

19 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 Previous optic neuritis Previous ischemic optic neuropathy Long-standing papilledema Optic nerve compression by a mass lesion Retinitis pigmentosa

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