25A. Optic Nerve Disorders

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sookylala
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246503
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25A. Optic Nerve Disorders
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2013-11-12 09:32:21
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Optic Nerve Disorders
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Optic Nerve Disorders
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  1. Signs of ON dysfunction?
    • reduce va
    • RAPD
    • acquired CV- R/G
    • impaired brightness sens
    • diminished CS
    • VF defects
  2. Mecahnical signs of ODE?
    • blurring margings
    • fillingĀ 
    • ant ext of ONH
    • edema in NFL
    • retina/choroidal folds
  3. Vascular signs of ODE?
    • venouse congestion
    • pap haem
    • CWS
    • hyperaemia of ONH
    • hard exudates at ON
  4. Primary optic atrophy?
    • NO ON SWELLING
    • caused by lesions affecting pathway
    • unilateral
  5. Signs of POA?
    • OD: pale, flat, clear margins
    • vessels: reduced no on disc surface, attenuation of peripap
    • NFL: thinning
    • lamina cribosa: visible
  6. Causes of POA?
    • glaucoma
    • traumatic
    • following retrobulbar neuritis
    • ION
    • toxic
    • leber
  7. secondary optic atrophy?
    precdede by OD swelling
  8. Features of 2nd optic atrophy
    • disc: white/grey, slightly raised, blurred margins- gliosis
    • reduced no of small bv
  9. Causes of 2ndy OA?
    follows papilledema, papillitis AION etc
  10. Optic neuritis types?
    • dyemyelinating, infectious, non inf, post viral
    • retrobulbar: OD normal, MS
    • papillitis: OD swollen
    • neuroretinitis: Papillitis+ NFL inflammation
  11. Retrobulbar (demyelinatin) optic neuritis?
    W, 20-50, MS
  12. Signs of retrobulbar?
    • Disc: swollen, quiet
    • Pain: with eye movements
    • ON dysfunction signs
  13. Prognosis of retrobulbar?
    75% recover to 6/9 or better
  14. Neuromyelitis Optic Neuritis cf MS?
    • confined to ON and spinal cord
    • more severe and worse prognosis
    • (+) antibodies
  15. Post viral optic neuritis?
    • children, bi, inflammatory
    • OD norm/swollen
    • spontaneous recovery excellent, no tx
    • steroid faster
  16. optic neuritis and sarcoidosis
    • + vitritis
    • + granulomatous infiltration
    • + responds to steroids
  17. Neuroretinitis presentation:
    unilateral, painless loss of vision
  18. Signs of neuroretinitis?
    • Mild ON involvement
    • macular: edema, exudates- star pattern
    • deep whitish lesions at RPE
    • central, centrocecal scotoma
    • papillitis
  19. Course of neuroretinitis?
    • cont 6-12m
    • normal va regained
    • fellow eye
  20. Papilloedema?
    swelling of ONH 2nd to bi intracranial presseure/mass/bleed
  21. intracranial pressure increase?
    • obstruction due to lesions
    • tumours/haem
    • impaired absorption of CSF
    • overproduction
  22. symptoms of papilloedema?
    • HA wake up
    • nausea+vomiting
    • diminshed conciousness
    • amaurosis fugax
  23. Signs of papdema
    • musrhoom like elevation of ON towards vitrous: champagned cork
    • gray-red
    • tortuous veins
    • flame haem, CWS
  24. DDX of papilloedema
    • CRVO: uni
    • papillitis
    • malignant hypertension
  25. Idiopathic intracranial hypertension?
    • raised intracranial pressure absence of lesion/mass
    • female, fat
  26. signs and symptoms of idiopathic intracranial hypertension?
    • HA
    • raised pressure
    • idiopathic
    • course variable
  27. Tx of idiopathic intracranial hypertension?
    medications stop, VF, diuretics, weight loss, lumbar shunts, sleep apnoea
  28. NAAION?
    • more common, elderly
    • optic nerve ischaemia at ONH
    • structural crowding of nerve fibres-> reduce vasc supply/perfusion
    • ODE
    • Predisposed: diabetes, hypertension, high cholesterol, sleep apnoea
  29. Presentation of NAAION?
    • sudden, painless, uni va loss
    • in the morning
  30. Signs of NAAION?
    • VF inferior
    • CV
    • edema: disc pallor after edema resolves
  31. Tx and prog of NAAION?
    nothing, no further loss of vision, fellow eye +risk factors
  32. AAION?
    caused by GCA- urgent blindness in fellow eye~weeks
  33. Presentation of AAION
    • sudden uni, vision loss + pain, amaurosis fugax
    • GCA
  34. Signs of AAION
    • tenderness, loss of pulsation of temporal arteries
    • chalky white disc
    • occlusion cilioretinal artery
    • after swelling resolves- optic atrophy
  35. Tests and tx of AAION?
    • FA: hypo of choroid
    • ESR CRP
    • corticosteroids
  36. PION?
    post surgery, pial vessels not supplying post part of nerve
  37. Diabetic papillopathy?
    • 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

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