1. Optic Neuritis Optic Atrophy Optic compressive neuropathies

2. Inflammation of the Optic Nerve
An inflammation of the optic nerve is called OPTIC NEURITIS
It is of two types
Those affecting opthalmoscopically visible part of the disc
Papillitis
Neuroretinitis
Those affecting nerve proximal to the disc and show no opthalmoscopic changes
Retrobulbar neuritis

4. Aetiopathogenesis
It is a demyelinating disorder with inflammatory response
Most common cause is multiple sclerosis
Others include
Neuromyelitis optica
Acute disseminated encephalomyelitis
Epidemic encephalitis
Polio myelitis
Lebers disease

7. classification Idiopatic Demyelinating disorders
Associated with infections
Local
systemic
Immune mediated disorders
Systemic
Metabolic disorders

8. Clinical course Decreased vision
Starts improvement in vision in 2nd or 3rd week
Returns to near normal by 4th to 5th week
Colour vision, contrast sensitivity & visual fields take longer to recover

9. Clinical features
Visual loss over hrs to days and reaches a trough about 1 week after onset
Deep orbital retro ocular or brow pain usually aggrevated by eye movement
Neuralgia
Headache
Pulfrich’s phenomenon
Uhthoff”s sign

12. Visual function depression is more marked in the central 20 degrees
Marcus Gunn pupil :great diagnostic significance
In case papillitis blurred margins with swelling and edema of the disc can be seen
If post neuritic atrophy occur
Margins blurred
Floor has dirty grey coloured
Organised tissue on arteries perivascular sheaths

13. Differential diagnosis
Ischemic optic neuropathy
Papilloedema
Grade 4 hypertensive retinopathy
Lebers hereditary optic neuropathy
Toxic & metabolic optic neuropathy
Intracranial / orbital space occupying lesion

14. Treatment Based on the specific cause identified
In case of idiopathic / demyelinating disorder spontaneous recovery occur
In case of infections appropriate antimicrobials are taken

15. Parasitic infestations
Cysticercus cellulosae rarely effects optic nerve resulting in profound visual loss
Treatment include
High dose of steroids
Oral albendazole
Surgical removal of cyst with poor outcome

17. Sarcoid optic nueropathy
It include granulomatous infiltration of optic nerve
It results in white lumpy swellings of optic nerve head
Treatment include corticosteroids

18. OPTIC ATROPHY
Def:- it is the term usually applied to the condition of thedisc following degeneration of optic nerve
Injury to nerve fibers in any part of their course from retina to lateral geniculate body leads to degeneration of both cerebral side and ocular side

20. Various types
Consecutive optic atrophy follows extensive disease of retina from destruction of ganglion cells as in pigmentary retinal dystrophy or occlusion of central artery
Secondary/post neuritic atrophy break in continuity of the fibers may be at the disc itself such as results from strangulation occuring in
Pappilitis
Neuroretinitis
Papilloedema
# of base of skull
Severe retrobulbar neuritis

21. Primary atrophy without local disturbences but associated with general disease usually of C.N.S, toxic neuropathy or any discoverable cause
Glaucomatous atrophy accompanied by enlargement and excavation of optic disc cup

22. Aetiology Disease or poisoning of visual neuron proximal to disc
Multiple sclerosis
Lebers disease
Compressive space occuping lesions in orbit or cranium
Many exogenous poisons
Tabes  classical cause

23. Clinical features
Alteration in colour of the disc and changes in blood vessel
Pallor is not due to atrophy of nerve fibers but due to loss of vascularity, secondary to obliteration of vessels
Primary atrophy
Grey or white disc with greenish or bluish tint
Stippling of lamina cibrosa
Slight cupping distinguished from glaucomatous cupping

26. Secondary atrophy Consecutive atrophy Total optic atrophy
If pallioedema is present it is due to increased intra cranial pressure
It helps to differentiate whether it it attacked anormal disc or one which is chocked
Consecutive atrophy
Yellowish waxy apperence of the disc
Edges are less sharply defined
Vessels are markedly contracted
Total optic atrophy
Pupils dilated and do not respond to light
When unilateral consensual light reflex is exaggerated

28. Partial optic atrophy Treatment Central vision is depressed
There is concentric field contraction of the field
With or with out scotoma ; relative or absolute
Treatment
Not effective
Prognosis depends on early control of causal factors

29. Compressive neuropathys
Direct pressure on opti nerve or chiasma
Orbital masses
Pituitary tumours
Craniopharyngiomas
Meningiomas optic nerve tumours
Aneurysms arising from internal carotid arteries opthalmic artery

32. Clinical features Slowly progressive unilateral visual loss
Bilateral involvement occurs if posterior optic nerve or chaisma is effected
Critical signs  visual loss
Field deficits
Relative afferent pupillary defect
Optic disc is usually pale but can be normal initially or swollen and edematous
Other signs may be proptosis , opticociliary shunt vessels

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