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Visual acuity
Color vision
Visual fields defects
Contract sensitivity
Light Brightness appreciation.
Pupilary reactions
PAPILLEDEMA
TEN HALLMARKS
PATHOPHYSIOLOGY
As the optic nerve sheath is continuous with
the subarachnoid space of the brain , increased
pressure is transmitted through to the optic nerve.
However, the anterior end of the optic nerve stops
abruptly at the eye. Hence the pressure is
asymmetrical and this causes a pinching and
protrusion of the optic nerve at its head.
PSEUDO PAPILLEDEMA
Hypermetropia
Optic nerve head drusens
CAUSES
1. Pseudo-tumor cerebri.
2. Space-occupying intracranial lesions.
3. Microbial infection: meningitis, encephalitis.
4. Hypertensive encephalopathy
5. Intracranial vascular lesions: sub-arachnoid
hemorrhage, sagittal sinus thrombosis, etc.
6. Head-injury - long standing contusions,
carotid-cavernous fistula
7. Metabolic disorders: Addison's disease, , hypo-
parathyroidism, etc.
8. Blood dyscrasias : leukemia, polycythemia, etc.
Choroidal plexus tumour by hypersecretion.
9. Miscellaneous; serum sickness, status epilepticus,
sarcoidosis etc.
SYMPTOMS
General symptoms :
Headache - bifrontal/occipitonuchal, worse in the
morning and by coughing or straining.
Vomiting without nausea and without loss of appetite.
Focal neurological deficit with changes in level of
consciousness may be present.
Ocular symptoms:
Visual acuity remains fairly normal or decreased in
established papilloedema and grossly affected in
atrophic stage.
Amaurosis fugax - a transient, black out of vision for
few seconds may be present in some patients usually in
late stages due to enormous increase ICT.
SIGNS
Early Papilledema:
Earliest change is disc hyperemia and dilated capillaries.
Blurring of disc margins
Spontaneous venous pulsation is absent (does not
confirm papilledema because it is not present in 20 % of
normal population.)
Splinter hemorrhages at or just off the disc-margin.
ESTABLISHED PAPILLEDEMA:
d) ATROPHIC PAPILLEDEMA
Peripapillary retinal vessels are attenuated and
sheathed.
Dirty-white appearance of the optic disc.
Secondary optic atrophy.
Definition
Optic neuritis is
inflammationdisintegration and
demyelinaton of the optic nerve.
Causes
Demylinating diseases.
Multiple sclerosis
Device Disease4
Schilders Disease
Post Infectious
Post vaccination
Epidemiology
Highest incidence in
Caucasians
Countries with high latitudes: genetics?
Springtime
Ages 20-49
Women
CLINICAL FEATURES
Sub-acute, monocular visual loss
Clinical features
Painful extraocular movements
CLINICAL FEATURES
Decreased contrast sensitivity
CLINICAL FEATURES
Central scotomas
Paracentral scotomas
Altitudinal defects
CAUSES
Etiology
1.Local vascular lesion of papilla
2.Hypotension of eye or total body
3.Blood viscosity
4.High
5.Ocular hypertension
CLINICAL FEATURES
CLINICAL MANIFESTATION:
Clinical types
Areritic Anterior ischemic optic neuropathy: due to giant
cell arteritis
nonAreritic Anterior ischemic optic neuropathy 5060
years
TREATMENT
Treat systemic disease
General application of corticosteroid
vasodilator
Decrease IOP
Optic nerve sheath decompression