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Which eye is the APD in a tract lesion and why?
- Contralateral eye has APD
- Because 55% of nasal fibers cross in chiasm
What is the blood supply of the chiasm?
internal carotid artery
Nasal nerve fiber bundle defect gives what type of VF?
temporal wedged shaped defect from the blind spot and doesn't respect the horizontal meridan.
How do you differentiate a optic nerve VF defect from a retrochiasmatic?
- Optic nerve originated from blind spot and respect the horizontal
- Retrochiasmtic origination from fixation and respect the vertical
Inferior ( lower) retinal fibers lie in the optic tract _____
Superior retinal fiber lie in the optic tract_____
- Lower lies laterally
- superior lies medially
A central bitemporal dectect is caused by a lesion located where?
macular crossing fibers in the posterior chiasm
What are disorders that cause VF defects that are maculopathies which can be confused with an optic nerve pathology?
- Idiopathic enlargement of the blind spot
- Vit A deficiency
- Cone Dystrophy
- Paraneoplastic Syndromes
- cancer associated retinopathy/ Melanoma associated retinopahty
Papillomacular fibers cause what type of VF defect?
- cecocentral-extend from fixation to blind spot
- paracentral-includeds a region next to fixation but not fixation
- central -fixation only
How do we differentiate acute papilledema from pseudopapilledema?
- Disc hyperemic
- microvasular disc abnormalities
- disc margin blurring
What are signs of chronic papilledema
- optocilliary shunt vessels
- refractile bodies
Dx of optic disc edema
- Vascular- Vein occlusion, NAION, AION
- Inflammatory-optic neuritis
- congenital- lebers
- Infection-cat scratch
- Endocrine-Thyroid orbitopathy
Causes of Idiopathic Intracranial Hypertension include
- Vit A
- Nalidixic acid
- Oral contraceptives
- Steriod withdrawal
What is is in the Dx of Idiopathic Intracranial Hypertension. What test to evaluate these entities?
- cerebral venous obstruction
- systemic/localized extracranial venous obstruction
- Dural AV malformation
- systemic vasculitis
- ALL these lead to decreased venous outflow thus increased ICP
- RULE OUT WITH MRI, MRV, LP
Treatment for Idiopathic Intracranial Hypertension (Psuedotumor)
- Medical- Diamox
- Surgical-optic nerve sheath fenestration but doesnt affect ICP
- Peritoneal shunt-decreases ICP
Arteritic Anterior Ischemic Optic neuropathy is occlusion of the____
Short posterior ciliary arteries
What is the equation to determine nl ESR in women and men
- Women =age +10/2
Pseudo-Foster Kennedy Syndrome is mcc by
- unilateral disc edema and contra optic atrophy
The Astrocytic Hamartoma is associated with what dz?
Tuberous sclerosis and NF
Lebers Hereditary Optic Neuropathy
age of onset
Lebers Hereditary Optic Neuropathy presents with
- acute monocular decrease in vision with later onset on other eye
- hyperemic thicken elevation of the optic disc with no leakage
Below are mitochondria mutations in Lebers Hereditary optic neuropathy
Which one is most frequent?
Which one worst prognosis?
Which one the best prognosis?
- Most frequent- 11778
- Worst prognosis- 11778
- Best prognosis-1448
What systemic condition is Lebers Hereditary optic neuropathy?
What should these patient avoid?
- Cardiac conduction ab-WPW
- Alcohol and smoking
What is the most common Hereditary optic Neuropathy?
Kjers Syndrome AKA Dominant Optic atrophy
Kjers Syndrome AKA Dominant Optic atrophy
age of onset
type of color vision deficits
- 1st decade
- Chr 3
- bilateral slow vision lost detected on school screening
Describe nerve findings in Optic nerve hypoplasia.
small nerve with increased pigmentation aka double ring sign
Associated condition with optic nerve hypoplasia and its findings
- Septo-optic Dysplasia "DeMorsier Syndrome"
- absent septum pellucidum
- pituitary deficiency-growth retardation
- sudden infant deaf during febrille illness
What are possible causes of optic nerve hypoplasia?
Describe the findings in the variant of optic nerve hypoplasia?
- superior segmental hypoplasia
- inferior VF defect
- found in insulin dependant monthers
Congentially tilted disc findings? What should it be differentiated from?
- inferior nasal colobomatous exacavation disc superior temporal VF defect
- doesn't respect the vertical
- defect improved with myopic correction
- Dx from chiamsal compression
Optic nerve pits are usually found where on the nerve? what can these cause?
- Inferior temporal
- Serous detachment
What is the cause of a coloboma
Incomplete closure of the embryonic fissue
What is morning glory disc? features
- staphylomatous excavation of the optic nerve with peripapillary retina
- emanation of retinal vessels from the periphery
Complications of morning glory disc?
- serous detachments
- trasnphernoidal basial encephaloceles
Associated sense finding with Optic Neuritis. Describe each one.
- Pulfrich-altered sense of motion pendulm appears eliptical
- Phosphenes-flashes of light associated with eye movement
- Photism-lights induced by noise, smell, taste, touch
Optic Neuritis Treatment Trial (ONTT)- What did the study show for IV steriods?
- rapid recovery of va
- no reduction in future attacks of optic neuritis
- decreased incidence of MS at 2 yrs no difference at 3yrs
Optic Neuritis Treatment Trial (ONTT)- What did the study show for oral steroids?
- higher rate of optic neuritis attacks
- higher rate of replases optic neuritis
Optic neuritis symptoms
- unilateral decrease vision
- pain with eye movement
- decreased color vision
- decreased contrast
- central scotoma
What did the CHAMPS study show?
Avenox (interferon Beta) 44% less likely to develop MS after 2 yrs.
Optic sheath menigioma are found in what population
- Neurofibromatosis Type 1
What is an optociliary shunt vessel and why does it occur?
It occurs secondary to chronic venous outflow from the CRV.