Neuro-ophthalmology

Broadman area 17

Lesions in Visual Pathway

SIGNS OF OPTIC NERVE DYSFUNCTION: 1- Decreased visual acuity. 2- Diminish light pupillary reflex. 3- Dyschromatopsia 4- Diminished light brightness sensitivity. 5- Visual field defect

SPECIAL INVESTIGATIONS: perimetry Visual Evoked Potential (VEP) MRI Fluorescein angiography

OPTIC NEURITIS 1- Ophthalmoscopic classification: a- Retrobulbar neuritis b- Papillitis

OPTIC NEURITIS 2- Aetiological classification: a- Demyelinating:most common cause. b- Para-infectious: a viral or immunization. c- Infectious: d- Autoimmune: systemic autoimmune disease.

OPTIC ATROPHY PRIMARY

OPTIC ATROPHY 1- Primary optic atrophy Causes: - Retrobulbar neuritis (not papillitis). - Compressive lesions. - Hereditary optic neuropathies. - Toxic and nutritional optic neuropathies.

OPTIC ATROPHY SECONDARY

OPTIC ATROPHY 2- Secondary optic atrophy Causes: - Chronic papilloedema. - AION (Anterior Ischaemic Optic Neuropathy): - Papillitis.

PAPILLOEDEMA BILATERAL

Differential diagnosis of papilloedema: 1- Malignant hypertension. 2- Bilateral papillitis. 3- Bilateral compressive thyroid ophthalmopathy. 4- Bilateral simultaneous AION. 5- Bilateral compromised venous drainage.

ABNORMAL PUPILLARY REACTION Applied Anatomy

AFFERENT PUPILLARY CONDUCTION DEFECTS A total afferent defect (TAPD, amaurotic pupil) A relative afferent defect (RAPD, Marcus Gunn pupil)

RAPD

NEAR REFLEX 'light-near dissociation' Dark Light Near

SYMPATHETIC SUPPLY Applied Anatomy

HORNER SYNDROM