Neuro Ophthalmology

Afferent: Optic nerve, retina, chiasm, visual pathyways, cortx.

Efferent: Cranial nerve III,IV,VI, ocular muscles, brain stem control centers.

AION (Arteritic/Giant cell arteritis)

Occlusive vasculitis of
ophthalmic artery and its
branches
Elderly
Symptoms
Bilateral
irreversible visual
loss if untreated
Temporal
tenderness
Jaw claudication
Scalp tenderness
Headache
Constitutional
symptoms, eg
weight loss,
anorexia
Signs
Variable visual
acuity but often
severe vision loss
Pale optic disc with
diffuse edema and
haemorrhages
later optic atrophy
Thickened non
pulsatile temporal
artery

NON ARTERITIC
Clinical features
- Age group affected usually is
45-65 yrs
- Altitudinal visual field defect
- Visual loss of variable degree
- Swollen optic disc with
edema /splinter
haemorrhages
- Normal ESR and CRP
- Hypertension
Treatment
- Treat underlying
vascular disorders
(Hypertension ,
Diabetes,Hyperlipide
mia )
- Aspirin to prevent
further vascular
events

Papillodema
Bilateral optic disc
swelling due to raised
intracranial pressure
Clinical features
- Visual acuity usually
normal
- May be associated with
transient visual loss
- Enlargement of the
blind spot
- Swollen discs
- Optic atrophy if chronic

Optic Neuritis
3 ANATOMICAL TYPES
-PAPILLITIS (optic disc)
-NEUROTINITIS
(optic disc+surrounding retina)
-RETROBULBAR NEURITIS
(optic nerve behind retina)
Symptom
- Sudden, progressive and profound
visual loss
- Visual obscuration in bright light
- Impairment of colour vision

Optic Atrophy
1. Loss of vision (sudden or
gradual onset)
2. Pupil is semidilated and
direct light reflex is very
sluggish or absent
3. Visual field loss
4. Ophthalmoscopic features in
general:
Pallor of the disc (due to loss
of vasculature)
Decrease the number of
small vessels
Causes:

Sign
- Visual acuity reduced markedly.
2. Colour vision severely impaired.
3. Pupil poor constriction to light
Fundus exam
-Optic disc is
hyperaemic with blurred margin.
ii. Disc become oedematous
iii. Retinal veins are tortuous
and distorted.
iv. Exudates are present
at the disc and retina

trauma
ischemia
toxic
inflammation
glaucoma
hereditory

 RAPD +
Investigations (urgent)
ESR raised > 60 mm/hr
(normal = half the age for
men and half the age plus
10 for women)
C reactive protein (CRP)
raised
Temporal artery biopsy histology confirms
diagnosis
Treatment
Aim is to prevent blindness
in the fellow eye
Initial treatment is with
high dose intravenous
methylprednisolone then
oral prednisolone 60 mg
daily.Taper oral steroids
gradually

Treatment
-Treat the underlying cause.
-No effective treatment
.-Corticosteroid therapy
may shorten the period
of visual loss

Cotton wool spot

Engorged retinal vein
Flame shaped hemorrage

1. Optic nerve lesion

- Ipsilateral total visual field defect
1. Chiasma Lesion
-Bitemporal hemianopia
1. Post-Chiasma Lesion
-Homonymous hemianopia

Pale disc
Thin retinal vessel