1. إِنَّكَ أَنتَ الْعَلِيمُ الْحَكِيمُ }
Neuro-ophthalmology
اعوذ بالله من الشيطان الرجيم
{قَالُواْ سُبْحَانَكَ لاَ عِلْمَ لَنَا إِلاَّ مَا عَلَّمْتَنَا
إِنَّكَ أَنتَ الْعَلِيمُ الْحَكِيمُ }
1/14/2019
MAHGOUB SALEEM

2. MAHGOUB SALEEM ASSOCIATE PROFESSOR Neuro-ophthalmology
MBBS (U of K) , DORCS (Eng.) , MRCOphth (UK),
FRCOphth (UK) , FICS , FACS (USA)
SENIOR CONSULTANT OPHTHALMOLOGIST
ASSOCIATE PROFESSOR
FACULTY OF MEDICINE AL NEELAIN UNIVERCITY
1/14/2019
MAHGOUB SALEEM

3. Neuro-ophthalmology
NEURO-OPHTHALMOLOGY
1/14/2019
MAHGOUB SALEEM

4. 4. Lateral Geniculate Bodies 5.Optic radiations 6. Visual cortix
Neuro-ophthalmology
The Visual Pathway:
1. Optic nerves
2. Optic chiasma
3. Optic tracts
4. Lateral Geniculate Bodies
5.Optic radiations
6. Visual cortix
1/14/2019
MAHGOUB SALEEM

5. The Visual Pathway: Neuro-ophthalmology Optic nerves =
complete blindness
1/14/2019
MAHGOUB SALEEM

6. The Visual Pathway: Optic chiasma = bitemporal / binasal hemianopia
Neuro-ophthalmology
The Visual Pathway:
Optic chiasma =
bitemporal /
binasal hemianopia
1/14/2019
MAHGOUB SALEEM

7. The Visual Pathway: 3. Optic tracts 4. Lateral Geniculate Bodies
Neuro-ophthalmology
The Visual Pathway:
3. Optic tracts
4. Lateral Geniculate
Bodies
5.Optic radiations
6. Visual cortix
homonymous hemianopia
1/14/2019
MAHGOUB SALEEM

8. The Visual Pathway: Neuro-ophthalmology Lesions of Visual Pathways:
1. Trauma
2. Vacular
3. Inflammatory
4. Neoplasms
5. Degenerative
1/14/2019
MAHGOUB SALEEM

9. The Visual Pathway: Neuro-ophthalmology Pupillary reflexes ` direct
` indirect (consensual)
` near reflex
`convergence reflex
`accommodation reflex
1/14/2019
MAHGOUB SALEEM

10. The Visual Pathway: Neuro-ophthalmology
Abnormalities of pupillary reactions:
1 . Amaurotic light reflex =
No DLR on affected side +
No inderect P.reflex on good eye
1/14/2019
MAHGOUB SALEEM

11. The Visual Pathway: Neuro-ophthalmology
Abnormalities of pupillary reactions:
2. Efferent pupillary defect:
No DPR+No IPR on affected
eye: parasympathetic drugs,atropine, IIInerve palsy,internal ophthalmoloplegia
1/14/2019
MAHGOUB SALEEM

12. The Visual Pathway: Neuro-ophthalmology
Abnormalities of pupillary reactions:
3. Marcus Gunn pupil:
4.Argyil Rebertson pupil (ARP)
5. Adie`s tonic pupil
1/14/2019
MAHGOUB SALEEM

13. Relative Afferent Papillary Defect Mid-brain pupil
Neuro-ophthalmology
Horner`s syndrome
Relative Afferent Papillary Defect
Mid-brain pupil
1/14/2019
MAHGOUB SALEEM

14. 2.Acute Retrobulber nuritis 3.Toxic amblyopia 4.Papilloedema
Neuro-ophthalmology
Optic nerve diseases:
1.Papillitis
2.Acute Retrobulber nuritis
3.Toxic amblyopia
4.Papilloedema
5.Optic Atrophy(1ry, 2ry)
1/14/2019
MAHGOUB SALEEM

15. Symptomatic disturbance of vision: Night blindness 2. Day blindness
Neuro-ophthalmology
Symptomatic disturbance of vision:
Night blindness
2. Day blindness
3. Colour blindness
4. Amaurosis
5. Amblyopia
6. Malingering blindness
7. Hysterical blindness
1/14/2019
MAHGOUB SALEEM

16. Neuro-ophthalmology Neuro-ophthalmology
is the subspecialty of both neurology and ophthalmology concerning concerning visual problems that are related to the nervous system
1/14/2019
MAHGOUB SALEEM

17. Clinical Examination Neuro-ophthalmology Visual Acuity Colour Vision
Visual Fields
Pupils
1/14/2019
MAHGOUB SALEEM

18. The swollen optic disc Neuro-ophthalmology Papilloedema Papillitis
Malignant hypertension
Ischaemic optic neuropathy
Diabetic optic neuropathy
CRVO
Intraocular inflammation
1/14/2019
MAHGOUB SALEEM

19. Optic neuritis Neuro-ophthalmology 25 y.o. female Reduced VA
Pain with eye movement
Colour desaturation
RAPD
Optic neuritis
1/14/2019
MAHGOUB SALEEM

20. Papilloedema Neuro-ophthalmology
• Disc swelling secondary to raised ICP
• Headache
– Worse in the morning
– Valsalva maneuver
• Nausea and projectile vomiting
• Horizontal diplopia (VI palsy)
• Causes
– Space occupying lesion
– Intracranial hypertension
• Idiopathic
• Drugs
• Endocrine
– Severe hypertension
1/14/2019
MAHGOUB SALEEM

21. The pale optic disc Neuro-ophthalmology Congenital Secondary to
• raised ICP
• vascular
• retinal disease
• optic neuritis
• optic nerve compression
• trauma
Glaucoma
1/14/2019
MAHGOUB SALEEM

22. Pupil Neuro-ophthalmology Reflexes ( direct , consentiual) APD
1/14/2019
MAHGOUB SALEEM

23. Pupil DM Neuro-ophthalmology Constricted (mioisis)
Sympathetic (pupillodilator) denervation
Drugs ( Pilocarpine Morphine ) DM
1/14/2019
MAHGOUB SALEEM

24. DM Pupil Neuro-ophthalmology Dilated (mydriasis) denervation
Parasympathetic ( pupilloconstrictor )
denervation
Lesion of the III Cranial Nerve
Drugs ( Atropine ,Cocaine ) DM
1/14/2019
MAHGOUB SALEEM

25. Neuro-ophthalmology
Sympathetic Pathway
READ
1/14/2019
MAHGOUB SALEEM

26. Horner’s (Oculosympathetic paresis):
Neuro-ophthalmology
Horner’s (Oculosympathetic paresis):
– Ptosis
– Miosis
– Ipsilateral anhidrosis
– Does not dilate with cocaine 4%
Causes
1/14/2019
MAHGOUB SALEEM

27. Afferent & efferent papillary defects APD
Neuro-ophthalmology
Afferent & efferent papillary defects
APD
Argyll-Robertson pupil
Miotonic pupil (Adie’s syndrome)
Holmes-Adie syndrome
1/14/2019
MAHGOUB SALEEM

28. Cranial Nerve Palsies III IV VI Ophthalmoplegia Neuro-ophthalmology
1/14/2019
MAHGOUB SALEEM

29. Third nerve palsy Neuro-ophthalmology – Double vision
– Eye turned down & out
– Ptosis
– Dilated pupil & headache
• Compressive lesion
causes
1/14/2019
MAHGOUB SALEEM

30. Neuro-ophthalmology
IV nerve palsy
1/14/2019
MAHGOUB SALEEM

31. Sixth nerve palsy Neuro-ophthalmology – Double vision – Eye turned in
1/14/2019
MAHGOUB SALEEM

32. Internuclear Ophthalmoplegia
Neuro-ophthalmology
Internuclear Ophthalmoplegia
Defective adduction of the ipsilateral eye
Nystagmus of the contralateral (abducting) eye
NORMAL CONVERGENCE
Causes
– Young patients
• Bilateral
• Demyelination
– Older patients
• Unilateral
• Vascular,
• tumours
1/14/2019
MAHGOUB SALEEM

33. • Normal reflexes & sensatio
Neuro-ophthalmology
Myasthenia Gravis
• Fatigability
• Double vision
• Lid twitch
• Ptosis
• Normal reflexes & sensatio
1/14/2019
MAHGOUB SALEEM

34. Neuro-ophthalmology Localising the lesion
• Monocular visual field defects indicate
lesions anterior to the optic chiasm
• Bitemporal defects are the hallmark of
chiasmal lesions
• Binocular homonymous hemianopia result
from lesions in the contralateral
postchiasmal region
• Binocular quadrantanopias reflect optic tract
lesions
1/14/2019
MAHGOUB SALEEM

35. Neuro-ophthalmology
Localising the lesion
1/14/2019
MAHGOUB SALEEM

36. Neuro-ophthalmology
THANK YOU
1/14/2019
MAHGOUB SALEEM