Dr. G. Rajasekhar D.N.B, FRCS NEUROPHTHALMOLOGY Dr. G. Rajasekhar D.N.B, FRCS

NEUROPHTHALMOLOGY Papilloedema Optic neuritis Optic atrophy

Optic disc edema Causes of bilateral disc edema: Papilloedema Thyroid orbitopathy Anaemia Hypertensive retinopathy Congenital (pseudo papilloedema) Causes of unilateral disc edema: Inflammation Papillitis Neuro retinitis Ocular disease Uveitis Hypotony Vein occlusion acute angle closure glaucoma Orbital disease Tumours Thyroid orbitopathy Orbital cellulitis Vascular causes AION

PAPILLOEDEMA Passive bilateral edema of optic disc secondary to raised intra cranial pressure ETIOLOGY ICSOL Infections Obstructed CSF flow Pseudo tumor cerebri Systemic: Malignant HTN Toxemia of pregnancy Blood dyscrasias Medications (steroids including OCP, vit A toxicity, out dated tetracyclins, nalidixic acid)

PAPILLOEDEMA Unilateral disc edema with rise of ICT Foster-kennedy syndrome (frontal lobe tumours) Pseudo Foster-kennedy syndrome (optic atrophy) Congenital anomalies of meninges covering optic nerve

PAPILLOEDEMA Clinical features: Headache (worse in the morning, increase with valasalva) Projectile vomitting No eye complaints till late Transient blurring of vision Peripehral filed loss (Night blindness) Vision loss, color vision loss and filed loss in later stages

PAPILLOEDEMA Pathogenesis:

PAPILLOEDEMA Pathogenesis: Intra cranial Pressure 120 mm of CSF Intra ocular Pressure 10-20 mm of Hg Perfusion Pressure 20-30 mm of Hg

PAPILLOEDEMA Pathogenesis:

PAPILLOEDEMA Pathogenesis: Intra cranial Pressure 120 mm of CSF Intra ocular Pressure 10-20 mm of Hg Perfusion Pressure 20-30 mm of Hg

PAPILLOEDEMA STAGES: EARLY ESTABLISHED CHRONIC ATROPHIC

PAPILLOEDEMA EARLY

PAPILLOEDEMA ESTABLI- -SHED

PAPILLOEDEMA CHRONIC

PAPILLOEDEMA ATROPHIC

PAPILLOEDEMA Treatment Radio imaging (CT) Treat specific cause Anti biotics Steroids Drainage shunts

OPTIC NEURITIS Inflammation of optic nerve Types: By ophthalmoscopic appearance RETRO BULBAR (common in Multiple Sclerosis) PAPILLITIS (common in children) NEURO RETINITIS

OPTIC NEURITIS CAUSES: AETIOLOGICAL DEMYELINATING (commonest) PARA INFECTIOUS (post viral or vaccination) INFECTIOUS (sinus, syphilis, cat scratch, lyme disease, zoster) NON INFECTIOUS (sarcoid, SLE, PAN)

OPTIC NEURITIS Clinical features Unilateral rapid loss of vision (with in hours to days) Loss of visual filed (central) Some times associated with eye pain associated with eye movements especially adduction and elevation h/o similar episodes in past h/o suggestive of demyelinating / auto immune disease/ infection.

OPTIC NEURITIS Clinical features Visual acuity from 6/18 to PL+ Defective color vision Loss of contrast sensitivity Field defects Sluggish pupil with RAPD Posterior vitreous cells +/- Optic disc changes +/-

OPTIC NEURITIS Visual filed defects

OPTIC NEURITIS papillitis

OPTIC NEURITIS Neuro- -retinitis

OPTIC NEURITIS Treatment Intra venous methyl prednisolone 1gm daily * 3 days Followed by oral prednisolone 1mg/kg (tapered) Treatment of the cause

PAPILLOEDEMA Vs OPTIC NEURITIS Bilateral Transient blurring +/- Absent + signs of rised ICT Clear media Hyperemic disc Blurred margins Disc elevation 2-6 D Peri papillary edema + Venous engorgement +++ Exudates and haemorrhages +++ Macular star / fan Enlarged blind spot Pooling around the disc Laterality Vision Pain Fundus Fields FFA Unilateral Marked rapid loss of vision & CV +/- with ocular movements Posterior vitreous cells Hyperemic disc Blurred margins Disc elevation upto 3 D Peri papillary edema + Venous engorgement + Exudates + and haemorrhages - Macular fan / star Central / centrocecal scotoma Minimal leaking of dye at disc

OPTIC ATROPHY PRIMARY OPTIC ATROPHY SECONDARY OPTIC ATROPHY CONSECUTIVE OPTIC ATROPHY

OPTIC ATROPHY PRIMARY OPTIC ATROPHY CAUSES: RBN COMPRESSIVE LESIONS HERIDITARY OPTIC NEUROPATHIES TOXIC AND NUTRITIONAL OPTIC NEUROPATHIES

OPTIC ATROPHY PRIMARY OPTIC ATROPHY

OPTIC ATROPHY SECONDARY OPTIC ATROPHY CAUSES: PAPILLOEDEMA AION PAPILLITIS

OPTIC ATROPHY SECONDARY OPTIC ATROPHY

OPTIC ATROPHY CONSECUTIVE OPTIC ATROPHY CAUSES: RETINITIS PIGMENTOSA PHOTO COAGULATION

OPTIC ATROPHY CONSECUTIVE OPTIC ATROPHY