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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
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What is the blood supply of the chiasm?
internal carotid artery
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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.
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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
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Inferior ( lower) retinal fibers lie in the optic tract _____
Superior retinal fiber lie in the optic tract_____
- Lower lies laterally
- superior lies medially
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A central bitemporal dectect is caused by a lesion located where?
macular crossing fibers in the posterior chiasm
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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
- MEWDS
- Vit A deficiency
- Cone Dystrophy
- Paraneoplastic Syndromes
- cancer associated retinopathy/ Melanoma associated retinopahty
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Papillomacular fibers cause what type of VF defect?
Describe each.
- cecocentral-extend from fixation to blind spot
- paracentral-includeds a region next to fixation but not fixation
- central -fixation only
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How do we differentiate acute papilledema from pseudopapilledema?
- Disc hyperemic
- microvasular disc abnormalities
- disc margin blurring
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What are signs of chronic papilledema
- gliosis
- optocilliary shunt vessels
- refractile bodies
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Dx of optic disc edema
- Vindictive
- Vascular- Vein occlusion, NAION, AION
- Inflammatory-optic neuritis
- Neoplasm-glioma
- Drugs-lithium
- Infiltrative-sarcoid
- congenital- lebers
- trauma
- Infection-cat scratch
- HIV
- Endocrine-Thyroid orbitopathy
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Causes of Idiopathic Intracranial Hypertension include
- Vit A
- Tetracycline
- Nalidixic acid
- Cyclosporine
- Oral contraceptives
- Steriod withdrawal
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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
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Treatment for Idiopathic Intracranial Hypertension (Psuedotumor)
Medical
Surgical
- Medical- Diamox
- Surgical-optic nerve sheath fenestration but doesnt affect ICP
- Peritoneal shunt-decreases ICP
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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
- men=age/2
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Pseudo-Foster Kennedy Syndrome is mcc by
- AION
- unilateral disc edema and contra optic atrophy
-
The Astrocytic Hamartoma is associated with what dz?
Tuberous sclerosis and NF
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Lebers Hereditary Optic Neuropathy
age of onset
sex
-
Lebers Hereditary Optic Neuropathy presents with
symptoms
Fa findings
inheritance
- acute monocular decrease in vision with later onset on other eye
- hyperemic thicken elevation of the optic disc with no leakage
- mitochondria
-
Below are mitochondria mutations in Lebers Hereditary optic neuropathy
11778
3460
14484
Which one is most frequent?
Which one worst prognosis?
Which one the best prognosis?
- Most frequent- 11778
- Worst prognosis- 11778
- Best prognosis-1448
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What systemic condition is Lebers Hereditary optic neuropathy?
What should these patient avoid?
- Cardiac conduction ab-WPW
- Alcohol and smoking
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What is the most common Hereditary optic Neuropathy?
Kjers Syndrome AKA Dominant Optic atrophy
-
Kjers Syndrome AKA Dominant Optic atrophy
age of onset
Gene
Chromosome
symptoms
type of color vision deficits
- 1st decade
- OPA1
- Chr 3
- bilateral slow vision lost detected on school screening
- Blue-yellow
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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
- Diabetes/seizures
- sudden infant deaf during febrille illness
-
What are possible causes of optic nerve hypoplasia?
- Quinine
- Ethanolol
- Anticonvulsants
- LSD
-
Describe the findings in the variant of optic nerve hypoplasia?
Possible cause
- 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.
- Uhthoffs
- Pulfrich-altered sense of motion pendulm appears eliptical
- Phosphenes-flashes of light associated with eye movement
- Photism-lights induced by noise, smell, taste, touch
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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
- Women
- Neurofibromatosis Type 1
-
What is an optociliary shunt vessel and why does it occur?
It occurs secondary to chronic venous outflow from the CRV.
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