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

2. 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；

3. Optic nerve diseases

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

5. 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

6. 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：

7. 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).

8. 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.

9. 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：

10. 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.

11. 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

12. 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

13. 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

14. 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

15. Optic atrophy
Normal fudus Optic atrophy

16. 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

17. 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

18. 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

19. 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.

20. Papilledema Pathogenesis： Intracranial hypertension
The theory of axoplasma flow

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

22. Papilledema

23. 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

24. 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

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

26. Tumor of optic nerve
Papillary melanoma Papillary angioma

27. Tumor of optic nerve
Optic glioma

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

29. Abnormal development of optic disc
Optic pit

30. Abnormal development of optic disc
Morning-glory syndrome

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

32. 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.

33. 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.

34. 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.

35. 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.

36. Optic tract lesions
Optic tract

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

38. 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

39. 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

40. Thank you!