Neuro-ophthalmology sjtu ophthalmology

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Neuro-ophthalmology

• sjtu ophthalmology
• ??

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Neuro-ophthalmology

• an important sensory end organ
• intimatedly related to the brain
• cranial nerves 50 II?III?IV?V?VI?VII
• cranial nerve fiber 38
• intracranial diseases 65
• vision loss blindness die
• diagnosis including etiology and location

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optic neuropathy
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structure of retina
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nerve fiber layer
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sensory visual pathway
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anatomy of the optic nerve

• from optic disc to optic chiasm
• length4550mm
• includingintraglobe 1 mm
• intraorbit 2530 mm
• optic canal 5 mm
• intracrania 10 mm

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histology of the optic nerve

• comprised by ganglion cell axons
• covered by meninges (3 layers)
• lack of Schwann's cells
• hard to rebuild

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to valuate optic nerve

• morphologyophthalmoscope ultrasonic
• X-ray CT MRI
• functionvision acuity visual field
• pupil test VEPERG
• dark adaption colour
  perception

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visual field testing

• steady fixation
• measure the comdined function of the retina
• peripheral vision
• lt30central visual field
• gt30peripheral visual field

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kinetic perimetry

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static perimetry

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electrophysiologic testing

• electrooculogram EOG
• electroretinogram ERG
• visual evoked potential VEP

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pupil
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light reflex
normal
abnormal
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optic neuropathy

• inflammatory
• optic neuritis
• vascular
• anterior ischemic optic neuropathy (AION)
• neoplastic infiltration
• glioma, leukaemia, lymphoma,
• meningeal carcinomatosis
• others
• optic atrophy?papilledema

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Optic neuritis

• duo to a variety of causes
• the most common is demyelination
• else immune-mediated
• direct infections
• granulomatous optic nueropathy
• contiguous inflammatory disease

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demyelinative optic neuritis

• clinical features
• chiefly in women(31) chiefly in white
• associated with multiple sclerosis
• subacute(27days)
• color vision and contrast sensitivity
  impaired
• pain(in eye 90)(by eye movement 50)
• abmormal in pupil testing
• change in VEP
• a central scotoma in most cases
• brain MRI (necesssary)
• including papillitis
• retrobulbar neuritis

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Papillitis

• in 35 cases
• 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)
• retinal exudates and edema (uncommon)
• hemorrhage (uncommon)
• vitreous cells (uncommon)

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Papillitis
Fundus

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Papillitis
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Papillitis
CT
Visual field
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Retrobulbar neuritis

• vision loss
• no obvious changes in the optic disk (at earlier
  stage)
• secondary optic atrophy

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demyelinative optic neuritis

• differential diagnosis
• compressive optic neuropathy
• anterior ischemic optic neuropathy
• autoimmune optic neuropathy
• toxic amblyopia
• Leber's hereditary optic neuropathy
• vitamin B12 deficiency
• papilledema

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demyelinative optic neuritis

• treatment
• steroid therapy
• can accelerate recovery of vision
• can not influence the ultimate visual outcome
• may increase the risk of recurrency
• intravenous steroid therapy
• useful for multiple sclerosis

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anterior ischemic optic neuropathy (AION)

• due to infarction of the retrolaminar optic
  nerve from occlusion or decreased perfusion of
  the short posterior ciliary arteries

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vessels of the optic nerve
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AION

• causes
• arteriosclerosis
• diabetes
• hypertension
• hyperlipidemia
• intracranial stroke
• vasculitis,migraine,inherited prothrombotic
  states(in younger patients)
• reduced cup,optic nerve head drusen,increased
  intraocular pressure

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AION

• clinical features
• in the sixth or seventh decade
• vision loss without pain
• generally abrupt,progressive
• altitudinal vision field defects()
• FFAdecreased perfusion
• segmented the
  nonarteritic form
• diffuse the
  arteritic form
• disk leakage the
  late phase

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AION
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AION
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AION

• treatment
• No treatment has been shown to provide long-term
  benefit.
• Low-dose aspirin may reduce the risk of
  involvement of the fellow eye.
• identify the arteritic AION (high-dose systemic
  steroids)

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Papilloedema

• noninflammatory congestion due to raised
  intracranial pressure
• causes
• intracranial mass
• abscesses
• subdural hematoma
• arteriovenous malformation
• subarachnoid hemorrhage
• meningitis or encephalitis
• acquired hydrocephalitis
• else

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Papilledema

• increased intracranial pressure
• axonal transpot is blocked
• edema

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Papilledema

• clinical features
• normal vision in most cases for early papilledema
• 12days to occur and 1 week to develop fully
• severe vision loss for late papilledema

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Papilledema
the early stage
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papilledema
the middle stage
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papilledema
the late stage
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papilledema

• FFA

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papilledema

• differential diagnosis
• burid drusen of the optic nerve
• small hyperopic disks
• AION
• myelinated nerve fibers

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papilledema

• treatment
• deal with the underlying cause

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Optic atrophy

• primary optic atrophy
• secondary optic atrophy

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Optic atrophy
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Optic atrophy

• treatment to the underlying cause

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optic nerve tumor

• glioma of optic nerve
• meningioma of optic nerve

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Glioma of optic nerve
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Glioma of optic nerve
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Meningioma of optic nerve
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Meningioma of optic nerve
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optic nerve tumor

• treatment operation

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the optic chiasm

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the optic chiasm diseases

• pituitary adenoma
• craniopharyngioma
• tuberculum sellae meningioma
• chiasmatic and optic nerve gliomas

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pituitary adenoma
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the retrochiasmatic visual pathways

• cortical blindness
• macular sparing
• macular splitting

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cases
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