Optic Neuropathy (overview).pptx

Optic neuroptahy by Dr Muneeb

1. Overview of optic neuropathy Dr Khuda bukhsh saleemi PGR1 Ophthalmology

2. Optic Nerve

3. Anatomical SUbdivisions

4. Optic Neuropathy is damage to the optic nerve from any cause

5. Causes

6. CLINICAL APPROACH History 1. The MODE OF ONSET of visual loss is an important clue to the etiology of the optic neuropathy. i.e. Rapid onset is characteristic of optic neuritis, ischemic optic neuropathy, inflammatory (non-demyelinating) and traumatic optic neuropathy. Gradual onset over months is typical of compressive toxic/nutritional optic neuropathy. History over years is seen in compressive and hereditary optic neuropathies.

7. CLINICAL APPROACH 2. ASSOCIATED SYMPTOMS In young patient H/O pain associated with eye movement, paresthesia, limb weakness, and ataxia is suggestive of demyelinating optic neuritis. In elderly patients transient visual loss, diplopia, temporal pain, jaw claudication, fatigue, weight loss and myalgia suggestive of AION.

8. CLINICAL APPROACH Symptoms such as diplopia and facial pain are suggestive of multiple cranial neuropathies seen in inflammatory or neoplastic lesions of the posterior orbit or parasellar region. Transient diplopia and headache should raise the suspicion of increased intra-cranial pressure.

9. CLINICAL APPROACH 3. DRUG HISTORY Ethambutol, amiodarone, alcohol Immunosuppressive medications such as methotrexate and Cyclosporine 4. MEDICAL HISTORY DM, HTN and hypercholesterolemia is common in patients with nonarteritic ischemic optic neuropathy (NAION).

10. Optic neuritis

11. Optic neuritis Symptoms: Monocular (Central Vision loss) •Pain (eye movement) •Altered colour vision •Flashes

12. Physical Signs

13. Treatment Steroid regimen I/V methylprednisolone sodium succinate 1 g daily for 3 days, followed by oral prednisolone (1 mg/kg daily) for 11 days, subsequently tapered over 3 days. Other immunomodulatory treatment options Interferon beta teriflunomide

14. Other Inflammatory Causes

15. Non ARTERITIC anterior Ischemic Optic Neuropathy ( NaAION ) Caused by occlusion of the short posterior ciliary arteries resulting in partial or total infarction of the optic nerve head. Risk Factors Age > 50 yr Structural crowding of optic nerve head Hypertension Diabetes Mellitus Hyperlipidaemia Collagen vascular disease

16. NaAION Symptoms: Sudden painless monocular visual loss; this is frequently discovered on awakening Signs: moderate to severe visual impairment Visual field defects are typically inferior altitudinal Dyschromatopsia is usually proportional to the level of visual impairment Diffuse or sectoral hyperaemic disc swelling

17. NaAION Investigations: blood pressure fasting lipid profile blood glucose

18. NaAION Treatment: There is no definitive treatment Any underlying systemic predispositions should be treated Aspirin is effective in reducing systemic vascular events Aspirin is frequently prescribed in patients with NAION

19. ARTERITIC ANTERIOR ISCHAEMIC OPTIC NEUROPATHY (AAION)

20. OCCULAR SIGNS OF AAION

21. ARTERITIC ANTERIOR ISCHAEMIC OPTIC NEUROPATHY (AAION) Diagnostic work up Erythrocyte sedimentation rate (ESR) >47mm C-reactive protein >2.45 mg/dL Fluorescein fundus angiographic (FFA): Critical diagnostic test for A-AION during the early stages  shows thrombosis and occlusion of the posterior ciliary artery in GCA Temporal Artery Biopsy Clinical Signs: Jaw Claudication, Neck Pain

22. ARTERITIC ANTERIOR ISCHAEMIC OPTIC NEUROPATHY (AAION) Treatment: (steroid therapy) It is aimed at preventing blindness of the fellow eye High dose systemic corticosteroid (IV methylprednisolone & oral prednisolone) for several months. Intravenous methylprednisolone, 500 mg to 1 g/day for 3 days followed by oral prednisolone 1–2 mg/kg/day. After 3 more days the oral dose is reduced to 50–60 mg (not less than 0.75 mg/kg) for 4 weeks or until symptom resolution and ESR/CRP normalization. Prognosis-POOR

23. Traumatic Optic Neuropathy

24. Diagnosis CT scan of the orbit is recommended to detect any bony fractures, fractures of the optic canal,and acute orbital hemorrhages

25. Traumatic Optic Neuropathy Treatment: High-dose steroid therapy Was adopted as a treatment because of their beneficial effect in studies on spinal cord injuries. May be harmful to the optic nerve if started 8 hours after the injury

26. Infiltrative optic neuropathy

27. Compressive Optic Neuropathy

28. Hereditary optic neuropathies

29. Nutritional optic neuropathies

30. Toxic optic neuropathies

31. Field Defects of Optic Neuropathies Demyelinating Central, cecocentral, arcuate Non-arteritic Ischemic Arcuate, altitudinal Arteritic Ischemic Arcuate Inflammatory Arcuate, central, cecocentral Hereditary Central, cecocentral Traumatic Arcaute, central or hemianopic Infiltrative Arcuate, hemianopic Compressive Arcuate, hemianopic Toxic/nutritional Central, cecocentral

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