Department of ophthalmology,CMU4h Ophthalmologic hospital,CMU Neuro-ophthalmology Department of ophthalmology,CMU4h Ophthalmologic hospital,CMU

Optic nerve diseases Optic nerve : consists of axons that arise from the ganglion cells, optic chiasm is its ending Sheaths of optic nerve：the fibrous wrapping that ensheathe the optic nerve are continuous with the meninges——dura、arachnoid and pia mater；

Optic nerve diseases

Optic nerve diseases Etiology： 1.inflammation：optic neuritis 2.Diseases of blood vessel：ischemic optic neuropathy 3.Tumor：optic glioma、meningioma of optic nerve

Optic neuritis Definition: Optic neuritis is inflammation、disintegration and demyelinaton of the optic nerve. Classify according to site： Optic papillitis：often seen in children Retrobulbar neuritis：often seen in youth

Optic neuritis Etiology： Myelinoclasis：multiple sclerosis,optic neuromyelitis. Childhood Infections：measles、parotitis. Infection of meninges、orbit or nasal sinus. Infection of eyeball：retinitis、uveitis Idiopathic：

Optic neuritis Clinical manifestations： Vision：acute visual loss with the nadir about 1 week after onset. flare，orbital pain, the pain is exacerbated by eye movement. Occasionally Uhthoff's sign (visual deficit with exercise or increase in body temperature). Pupil: relative afferent pupillary defect (RAPD).

Optic neuritis Clinical manifestations： Fundus: Swollen disc with or without peripapillary flame-shaped hemorrhages. Fundus is normal in retrobulbar optic neuritis Visual field: central scotoma, concentric loss. VEP: abnormal.

Optic neuritis Differential diagnosis： 1.Ischemic optic neuropathy 2.Leber’s optic neuropathy 3.Toxic or metabolic optic neuropathy Treatment： 1.Corticosteroid： 2.VitamineB，Vasodilator：

Anterior ischemic optic neuropathy Definition: Anterior ischemic optic neuropathy is characterized by pallid disk swelling associated with acute loss of vision. The disorder is due to occlusion or decreased perfusion of the short posterior ciliary arteries.

Anterior ischemic optic neuropathy Etiology： 1.Local vascular lesion of papilla 2.Hypotension of eye or total body 3.Blood viscosity ↑ 4.High 5.Ocular hypertension

Anterior ischemic optic neuropathy Clinical manifestation: symptoms：sudden、painless、nonprogressive visual loss. signs： vision：moderate loss pupil：afferent pupillary defect Fundus: pale disc swelling often involving only a segment of the disc, flame-shaped hemorrhages, optic atrophy after the edema resolves Visual field: altitudinal or central visual field defect Clinical types： Areritic Anterior ischemic optic neuropathy: due to giant cell arteritis： nonAreritic Anterior ischemic optic neuropathy 50～60 years

Anterior ischemic optic neuropathy Differential diagnosis： Optic neuritis： Kennedy syndrom： Treatment： Treat systemic disease General application of corticosteroid vasodilator Decrease IOP Optic nerve sheath decompression 师傅说过

Optic atrophy Definition :Optic atrophy is a nonspecific response to optic nerve (retina to lateral geniculate body) damage from any cause. Etiology ： Intracranial hypertension or inflammation Retinopathy Optic neuropathy Compressive lesion Trauma Metabolic Hereditary Nutrient

Optic atrophy Normal fudus Optic atrophy

Optic atrophy Classification due to lesion site of fundus and optic nerve： Primary optic atrophy：or descending optic atrophy Secondary optic atrophy：or ascending optic atrophy Clinical manifestation： Visual loss significantly，visual field concentric constriction

Optic atrophy Primary optic atrophy Secondary optic atrophy Etiology Damage of visual path behind cribriform plate Lesions of optic disc、retina and choroid, et al. Optic papilla pale，clear border、screen mes can be seen in cup Gray-white、dirty dark，border not clear、physiological depression disappear Vessel of retina normal Narrow artery，vessel with sheath

Optic atrophy Diagnosis： According to fudus ,visual acuity,visual field,VEP,CT,MRI et al. Treatment： Treat primary disease Assistant treatment：neurotrophic medicine and vasodilator

Papilledema Etiology： 1.intracranial：tumor、hemorrhage、edema、abscess 2.Intraorbital：tumor、inflammation、Grave’s disease 3.intraocular：ocular hypotension、uveitis 4.Systemic disease：diabetes mellitus、leukemia、malignant hypertension、pulmonary heart disease.

Papilledema Pathogenesis： Intracranial hypertension The theory of axoplasma flow

Papilledema Clinical manifestaton： Symptoms：Episodes of transient, often bilateral, visual loss associated with psychiatric symptoms Visual field：Enlarged physiological blind spot, lately concentric loss

Papilledema

Papilledema Fundus：four stages Early stage: hyperemic disc with blurring of the disc margin, peripapillary retinal hemorrhages Advanced stage: Bilaterally swollen, hyperemic discs with flame-like retinal hemorrhages、cotton-wool spots、macular hemorrhage and exudation. Chronic stage：prominence of disc, cup disappear，and hard exudation Atrophic stage：pale papilla，gliosis and narrowing of the retinal vessels

Papilledema Differential diagnosis： Optic neuronitis puedopapilledema Leber’s optic neuropathy Ischemic optic neuropathy Treatment： Treat according to causes： treat according to symptoms：optic nerve sheath decompression

Tumor of optic nerve Optic glioma Meningioma of optic nerve Papillary angioma Papillary melanoma

Tumor of optic nerve Papillary melanoma Papillary angioma

Tumor of optic nerve Optic glioma

Abnormal development of optic disc Optic nerve hypoplasia Optic pit Optic disc drusen Coloboma of optic nerve Morning-glory syndrome

Abnormal development of optic disc Optic pit

Abnormal development of optic disc Morning-glory syndrome

Optic chiasma and visual pathway diseases Include: retina、 optic nerve、 optic chiasma、 optic tract、 lateral geniculate body、 optic radiation occipital cortex.

Optic chiasma and visual pathway diseases Character: Hemianopia homonymous hemianopsia heteronymous hemianopsia Hemianopia ：blindness in one-half of the field of vision of one or both eyes, is the characteristic of visual pathway lesions.

Optic chiasma lesions Anatomical position of optic chiasma： the optic chiasma is variably situated near the top of the diaphragm of the sella turcica, the lamina terminalis forms the anterior wall of the third ventricle, the internal carotid A. lie just laterally, adjacent to the cavernous sinuses. Etiology： most diseases that affect the chiasma are neoplastic, most common is pituitary tumors, next are tuberculum sella meningioma、craniopharyngioma、anterior communicating aneurysm、tumor of third ventricle.

Optic chiasma lesions Clinical manifestation： Blurred vision：bilateral, simultaneously or by turns Defect of visual field：bitemporal hemianopsia，early, these defects are typically incomplete and are often asymmetric. Abnormal ocular movement：tumor offend cavernous sinus or superior orbital fissure optic atrophy Symptoms of the primary disease Treatment： treat primary disease.

Optic tract lesions Contralateral of lesion、bilateral homonymous hemianopia. Wernicke’s hemianopia tonic pupil: when hemianopia side retina exposed to slit light，pupil doesn’t constrict. Lately, secondary optic atrophy may occur.

Optic tract lesions Optic tract

Lateral geniculate body lesions Contralateral of lesion、bilateral homonymous hemianopia. Lately, secondary optic atrophy may occur.

Optic radiation lesions Congruous bilateral homonymous hemianopia Macular sparing Temporal crescent-shaped visual field loss No optic atrophy and Wernicke’s hemianopia tonic pupil Accompany with symptoms of cerebrum lesion

Occipital lobe lesions Character: congruous bilateral homonymous hemianopia with sparing of the macula. No optic atrophy and Wernicke’s hemianopia tonic pupil. No phycotic symptoms. Cortical blindness：Bilateral occipital lobe infarctions Bilateral complete or severe loss of vision Normal pupillary responses Normal fundus and VEP

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