1. Dr Mahmood Fauzi ASSIST PROF OPHTHALMOLOGY AL MAAREFA COLLEGE
Neuro-opHthalmology
Dr Mahmood Fauzi ASSIST 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
Optic neuropathy optic nerve abnormalities or damage, including causes such as blocked blood flow or toxic exposure.
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. Optic Neuritis Anterior/bulbar/intra-ocular Optic Neuritis/Papillitis
Inflammatory-- malaria, syphilis, orbital inflammation
Auto immune – SLE, PAN, wegeners granulomatosis,
Toxic— methanol ethombutol chloramphenicol
Posterior/Retrobulbar/orbital OpticNeuritis
Demyelinating disease of CNS ie-- ENCEPHALITIS
Multiple Sclerosis
Sign and Symptoms: sudden loss of vision , central and para central scotoma
In retrobulbar optic neuritis pt sees nothing due to scotoma and physician sees nothing (fundus appears normal)
Afferent puppilary defect (RAPD)
Decreased visual acuity
red green color blindness
Pain on movement of eyes
Enlargement of blind spot or scotoma
And delayed latency in VEP
Unilateral edema, hemorrhage

11. Multiple Sclerosis: Optic Neuritis
50% of patients with MS will
develop Optic Neuritis
20-30% of time will be
presenting sign for MS

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

13. 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

14. Papilloedema Usually bilateral
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
Blurred optic disc margin
Haemorrhages
Small optic cup
CWS
Disc pallor
Vessel attenuation

15. Papillitis Inflammation of the optic nerve head
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)

16. 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.
Glaucoma
Previous optic neuritis
Previous ischemic optic neuropathy
Long-standing papilledema
Optic nerve compression by a mass lesion
Retinitis pigmentosa