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    Optic Disc Disorders

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    Amin Allam
    The optic nerve carries visual information from the eye to the brain. It has three sections - intraocular, intraorbital, and intracranial. Optic nerve disorders can be inflammatory, ischemic, congenital, traumatic, or compressive and cause signs like reduced vision, color vision changes, and visual field defects. Optic neuritis is an inflammatory condition that often affects young females and causes pain on eye movement with vision loss and color vision changes that typically improve over weeks with steroids. Ischemic optic neuropathy can be non-arteritic or arteritic, with the latter associated with temporal arteritis and requiring high-dose steroids to prevent vision loss in the fellow eye.

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    Optic Disc Disorders

    Uploaded by

    Amin Allam
    20 views48 pages
    The optic nerve carries visual information from the eye to the brain. It has three sections - intraocular, intraorbital, and intracranial. Optic nerve disorders can be inflammatory, ischemic, congenital, traumatic, or compressive and cause signs like reduced vision, color vision changes, and visual field defects. Optic neuritis is an inflammatory condition that often affects young females and causes pain on eye movement with vision loss and color vision changes that typically improve over weeks with steroids. Ischemic optic neuropathy can be non-arteritic or arteritic, with the latter associated with temporal arteritis and requiring high-dose steroids to prevent vision loss in the fellow eye.

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    Optic Disc Disorders[1]

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    The optic nerve carries visual information from the eye to the brain. It has three sections - intraocular, intraorbital, and intracranial. Optic nerve disorders can be inflammatory, ischemic, congenital, traumatic, or compressive and cause signs like reduced vision, color vision changes, and visual field defects. Optic neuritis is an inflammatory condition that often affects young females and causes pain on eye movement with vision loss and color vision changes that typically improve over weeks with steroids. Ischemic optic neuropathy can be non-arteritic or arteritic, with the latter associated with temporal arteritis and requiring high-dose steroids to prevent vision loss in the fellow eye.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    20 views48 pages

    Optic Disc Disorders

    Uploaded by

    Amin Allam
    The optic nerve carries visual information from the eye to the brain. It has three sections - intraocular, intraorbital, and intracranial. Optic nerve disorders can be inflammatory, ischemic, congenital, traumatic, or compressive and cause signs like reduced vision, color vision changes, and visual field defects. Optic neuritis is an inflammatory condition that often affects young females and causes pain on eye movement with vision loss and color vision changes that typically improve over weeks with steroids. Ischemic optic neuropathy can be non-arteritic or arteritic, with the latter associated with temporal arteritis and requiring high-dose steroids to prevent vision loss in the fellow eye.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 48

    Optic nerve disorders

    GHADA ELNADY
    Optic nerve anatomy
    The ON carries 1.2 million afferent nerve fibers.
    one third of the fibers subserve the central 5 degree of the visual
    field.(papillomacular bundl).
    80% are visual fibers and 20% are pupillary fibers for light reflex.
    The ON is surrounded by myline sheath and 3 meningeal layers :
    ◦ Inner pia mater,archanoid and dura mater.

    CSF
    Anatomical subdivisions
    1- intraocular: (optic nerve head) 1mm.
    2- intraorbital: 25-30 mm,extends from globe to the optic foramen.
    Its diameter 3-4 mm because of the addition of myelin sheath.
    At the orbital apex the ON is surrounded by the annulus of zinn.
    3- intracanalicular: 6mm.
    4- intracranial :10 mm,joins the chisma.
    Clinical Classification
    1- optic disc

    2- Retrobulbar optic nerve

    functions of optic nerve


    Light reflex
    RAPD
    Signs of ON dysfunction
    1- Reduced VA.
    2- RAPD.
    3- Dyschromatopsia.(red,green).
    4- Diminished contrast sensitivity.
    5- Visual field defects.
    Central scotoma,altitudinal defects acc to the underlying pathology.
    6- delayed counduction of the VEP.
    Classification of the optic neuropathy
    1- Inflammatory: optic neuritis (demyelinating,infectious).
    2- Ischaemic: arteratic and non arteratic optic neuropathy
    Diabetic papillopathy
    3- congenital hereditary optic neuropathy:leber ,morning glory and
    optic nerve hypoplasia.
    4- papilloedema: secondry to rasied intracranial pressure.
    5- Nutritional and toxic.
    6- Glaucomatous.
    7- Traumatic optic neuropathy.
    8- Compressive optic neuropathy. TED,Orbital myositis
    9-Infltrative optic neuropathy: eg sarcoidosis and tumors.

    Optic atrophy
    acute optic neuropathy
    1-optic neuritis:
    - papilitis
    - retrobulbar neuritis

    2- ischemic optuc nuropathy:


    - arteritic optic nuropathy
    - Non artertic optic nuropathy
    optic Neuritis
    Inflamation of the optic nerve fibers
    causes
    1- Non infectious causes:
    Demyelinating disorders (MS)
    Middle aged female

    2- Infectious causes:viremia ,vaccination,organism from nearby sinus or


    menengies .usu in children.
    Symptos, signs and Investigation
    1- acute sever drop of vision and decrease in contrast sensitivity.
    2- Dyschromatopsia esp for red and green
    The colour is washed out
    3- RAPD and pain
    4- Disc oedema and hyperemia esp in papilitis.
    Most cases ocure in children
    Bilaltral
    Good prognosis
    Field of vision
    Central and centrocaecal scotomas are most frrquent due to
    affection of papillomacular bundle first by MS.
    MRI

    Demylination plaques.
    VEP
    It is the action potential of the visual cortex evoked by visual
    stimulus.
    Course of ON
    Vision warsens over days to 3 weeks ,begins to improve over 6-12 ms
    More than 90% of pts recover VA to 6/9 .

    Coulor vision and contrast sensitivity may remain abnormal.

    10% develop chronic optic neuritis end with optic atrophy and visual
    loss.
    Treat or not? ONTT
    457 pts with acute optic neuritis randomized to 3 groups
    - 250 mg IV methylpred/6h x 3 days,then oral steroid over 11
    days and taper.
    - Oral prednisolone 1mg/kg per day fo 14 days.
    - Oral placebo for 14 days.
    Outcomes are assessed over 6ms (VA,colour,contrast sensitivity and
    visual field ).
    outcomes
    Visual functions recovered faster in IV steroid group.

    Oral prednisolone alone associated with increased risk of optic


    neuritis recurrence.
    IV methylprednisolone 1 gm daily for 3 days followed by oral
    predenisolone :1 mg /kg daily)for 11 days then tapered over 3 days.

    Disease modifying therapies for MS : Interferon and monoclonal ABS.


    Home messages from ONTT
    It is acceptable to give or withhold IV steroids.

    Steroides only accelerate recovery with no affection in long term


    visual outcome.

    There is no role for moderate dose oral steroids(1mg/kg/day)


    It can increase recurrence of ON.
    Ischemic optic neuropathy
    1-Non arteritic ischemic optic neuropathy

    2-Arteritic ischemic optic neuropathy


    Non arteritic ischemic optic neuropathy
    Caused by occlusion of the short post ciliary arteries resulting in
    partial or total infarction of the optic nerve.

    HTN,DM,HYPERLIPIDEMIA
    Sudden hypotensive events,sleep apnea
    Diagnosis

    Age :50 ys
    c/o sudden painless monocular visual loss usu discovered on
    awakening.
    Altitudinal visual field defect.
    Dyschromatopsia usu proportional to the visual impairment.
    Difuse or sectoral hypermic disc swelling followed by pallor 3-6 ws.
    IX
    Systemic work up
    BP
    FBS
    Lipid profile
    Referal to control the systemic predisposition
    Prognosis of NAION
    Improvment of vision is common
    50% can achieve 6/9
    25% will reach 6/60 0r worse

    Involvment of the fellow eye occurs in 15% after 5 years


    Arteritic ischemic optic nuropathy
    it is caused by GCA
    Inflamation (necrotizing arteritis) with predilection for large and
    medium sized arteries
    Superficial temporal artry,aortic branches and post ciliary artries
    50% of pt have polymyalagia rheumatic
    Diagnosis
    Age 70-80 rare under 50ys
    Female to male 4:1
    Sever headache and scalp tenderness
    Jaw claudication (pathognomonic): cramp like pain on chewing
    Thickned ,tender superfacial temporal artery
    Sever visual loss not preceded by amaurosis fugax
    Start with altitudinal visual field defect then progressing
    Pale (chalky white) disc oedema
    The course is very aggressive end with optic atropy

    The fellow eye will be involved in more than 30% of cases within
    days to 1 week.
    IX
    Increased ESR and CRP
    Temporal artery biopsy TAP

    Pseudo Foster Kenedy syndrome


    TREATMENT
    IV methylprednisolone 1 gm/day for 3 days then oral dose 1-2 mg/kg
    per day for 4ws or until ESR&CRP normalization
    Taper along 1 -2 ys
    Some pts may need maintenance therapy.
    Referal and systemic work up due to complications
    Myocardial infarction,aortic incompetence,renal failure and brain
    stroke.
    papillioedema
    papilloedema
    Disc swelling scondry to raised ICP (bilateral)
    All pts with papilloedema should do MRI to exclude tumors
    Causes: idiopathic ICH
    Obstruction of the ventricular system
    space ocuupying lesion
    Diagnosis
    Headache early in the morning increase with head bending
    Nausea,vomiting
    Vision is preserved till late of the disease
    Transient visual obscurations pp by bending,caugh,vulsalva
    manoeuver
    Horizontal diplopia due to 6th N palsy
    MRI
    VF :enlarged blind spot
    Treatment : of the cause

    Foster Kenedy syndrme


    Optic atrophy
    Types
    1- Primary optic atrophy
    Occurs without previous swilling of the optic disc
    Flat white disc with delinated margins
    Reduction of number of small blood vessles
    Causes: optic neuritis,hereditary optic neuropathies
    Compression by tumors and aneurysms
    Toxic and nutritional optic neuropathy and truma
    2- secondry optic atrophy
    Preceded by swilling of the optic n head
    White greyish disc with poorly delinated margins
    Sheathing of arterioles and venous tortuosity
    Causes: papillitis
    papillioedema
    AION
    3-Consecutive optic atrophy
    Caused by disease of the retia or its blood supply
    Obvious on fundus examination (RP,CRRO)
    The disc appers waxy
    4- Glaucomatous optic atrophy
    Visual field defects in optic neuropathies
    1- central scotom:
    - demyelination
    - toxic and nutritional
    - compression
    2- enlarged blind spot : papilloedema
    3- altitudinal ,respect horizontal meridian:
    ischemic ON,Glaucoma

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