1. Important notes by the doctor

2. Neuro-ophthalmic diseases

3. Optic disc = blind spot ( yellowish orange )
Normal cup:disc ratio is 0.4
Optic nerve is surrounded by sheath of dura mater , pia mater , arachnoid ( the meninges )

4. Papilledema : optic disc swelling secondary to increase ICP .
Caused by anything that increase ICP
1- space occupying lesion : tumor 60% ,hydocephalus , hemorrhage .
2- inflammatory : meningitis
3- drugs : steroid
4- malignant HTN

5. Clinical pic :
Headache , vision is not always affected ( may be blurred .
Chronic papilledema cause optic disc atrophy because of decrease blood supply due to edema .

6. RAPD Seen in : 1- extensive retinal disease ( RAO ,RVO , maculopathy )
2- optic nerve disease (ON , AION )
Cataract doesn’t cause RAPD .
RAPD : a medical sign observed during swinging flash light test , where the patient’s pupils constrict less ( appearing to dilate ) when bright light is swung from normal eye to affevted eye .. Wiki

7. Optic neuritis Many causes associated with MS . F:M =2:1 , age 20-45
Is demylinating inflammation of optic nerve .
Types :
1- papillitis (10%) : if optic nerve head is affected , more in children, disc swelling .
2- retrobulbar (90%) : when nerve is affected posteriorly , more in young , disc swelling is not seen .

8. 1- sudden significant blurring in vision
2- change in color perception ( dyschromatopsia )
3- change in light saturation
4- RAPD : if optic nerve is affected until geniculate body , if posterior to that RAPD is not seen
5- central scotoma
6- pain on ocular movement : because medial and superior recti are attached to meninges sheath of optic nerve .

9. -Investigation : MRI -TT : IV steroid for 3 days Oral steroid for 11 days Then tapering

10. AION
Internal carotid artery – ophthalmic artery – short ciliary ( anterior ) – central retinal artery
1- non-arteric (90%) : due to ischemia in ant. Ciliary artery circulation .
Etiology : HTN , atherosclerosis , DM
Clinical pic :
1-altitudinal defect : combination of a relative inferior altitudinal defect and absolute inferior nasal defect ( most common )
2-Sudden painless loss of vision on wakening
3-Poor visual acuity
Management : investigation + internal consultation

11. TT : admission and IV steroid
2- arteric (10%) :
Ex. Giant cell arteritis ( skip lesion ) : ( Jaw claudication , temporal headache , loss of pulsation )
Investigation : biopsy of artery +ve in 90-95% but maybe false –ve due to skip lesion .
TT : admission and IV steroid

12. Idiopathic intracranial HTN ( IIH)
Aka : pseudotumor cerecbri , benign intracranial HTN
Is increase ICP with no lesion in brain ( papilledema )
Dx by exclusion
Risk factors : 1- overweight 2- fair , female (90%) , at child bearing age 3- OCP
Clinical pic :
Headache , diplopia , transient visual obstruction , dizziness, nausea and vomiting , photopsia , retrobulbar pain , pulse ( synchromous tinnitus )
TT : 1- weight reduction 2- remove any precipitating factor if possible 3- acetazolamide 4- if not useful VP shunt