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Signs of ON dysfunction?
- reduce va
- acquired CV- R/G
- impaired brightness sens
- diminished CS
- VF defects
Mecahnical signs of ODE?
- blurring margings
- ant ext of ONH
- edema in NFL
- retina/choroidal folds
Vascular signs of ODE?
- venouse congestion
- pap haem
- hyperaemia of ONH
- hard exudates at ON
Primary optic atrophy?
- NO ON SWELLING
- caused by lesions affecting pathway
Signs of POA?
- OD: pale, flat, clear margins
- vessels: reduced no on disc surface, attenuation of peripap
- NFL: thinning
- lamina cribosa: visible
Causes of POA?
- following retrobulbar neuritis
secondary optic atrophy?
precdede by OD swelling
Features of 2nd optic atrophy
- disc: white/grey, slightly raised, blurred margins- gliosis
- reduced no of small bv
Causes of 2ndy OA?
follows papilledema, papillitis AION etc
Optic neuritis types?
- dyemyelinating, infectious, non inf, post viral
- retrobulbar: OD normal, MS
- papillitis: OD swollen
- neuroretinitis: Papillitis+ NFL inflammation
Retrobulbar (demyelinatin) optic neuritis?
W, 20-50, MS
Signs of retrobulbar?
- Disc: swollen, quiet
- Pain: with eye movements
- ON dysfunction signs
Prognosis of retrobulbar?
75% recover to 6/9 or better
Neuromyelitis Optic Neuritis cf MS?
- confined to ON and spinal cord
- more severe and worse prognosis
- (+) antibodies
Post viral optic neuritis?
- children, bi, inflammatory
- OD norm/swollen
- spontaneous recovery excellent, no tx
- steroid faster
optic neuritis and sarcoidosis
- + vitritis
- + granulomatous infiltration
- + responds to steroids
unilateral, painless loss of vision
Signs of neuroretinitis?
- Mild ON involvement
- macular: edema, exudates- star pattern
- deep whitish lesions at RPE
- central, centrocecal scotoma
Course of neuroretinitis?
- cont 6-12m
- normal va regained
- fellow eye
swelling of ONH 2nd to bi intracranial presseure/mass/bleed
intracranial pressure increase?
- obstruction due to lesions
- impaired absorption of CSF
symptoms of papilloedema?
- HA wake up
- diminshed conciousness
- amaurosis fugax
Signs of papdema
- musrhoom like elevation of ON towards vitrous: champagned cork
- tortuous veins
- flame haem, CWS
DDX of papilloedema
- CRVO: uni
- malignant hypertension
Idiopathic intracranial hypertension?
- raised intracranial pressure absence of lesion/mass
- female, fat
signs and symptoms of idiopathic intracranial hypertension?
- raised pressure
- course variable
Tx of idiopathic intracranial hypertension?
medications stop, VF, diuretics, weight loss, lumbar shunts, sleep apnoea
- more common, elderly
- optic nerve ischaemia at ONH
- structural crowding of nerve fibres-> reduce vasc supply/perfusion
- Predisposed: diabetes, hypertension, high cholesterol, sleep apnoea
Presentation of NAAION?
- sudden, painless, uni va loss
- in the morning
Signs of NAAION?
- VF inferior
- edema: disc pallor after edema resolves
Tx and prog of NAAION?
nothing, no further loss of vision, fellow eye +risk factors
caused by GCA- urgent blindness in fellow eye~weeks
Presentation of AAION
- sudden uni, vision loss + pain, amaurosis fugax
Signs of AAION
- tenderness, loss of pulsation of temporal arteries
- chalky white disc
- occlusion cilioretinal artery
- after swelling resolves- optic atrophy
Tests and tx of AAION?
- FA: hypo of choroid
- ESR CRP
post surgery, pial vessels not supplying post part of nerve
- rare: diabetes: ODE, ONdysfunction
- signs: mild disc edema&hyperaemia, telang disc surface, VF defects
- Prognosis: good, self resolving
- sudden, bi, PLV
- reduction in pupil reflex, normal OD, poor prog