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Optic neuritis
- 1. Optic NeuritisOptic Neuritis Robert H. Spector, MDRobert H. Spector, MD
- 2. Visual Pathway Seeing Looking • Fixation When You are in Motion When the Object is in Motion When You and the Object are in Motion
- 3. Two optic nerves = 2.4 millionTwo optic nerves = 2.4 million fibersfibers Man is a SeeingMan is a Seeing Five SensesFive Senses SeeingSeeing HearingHearing TouchTouch SmellSmell TasteTaste Each ear = 30,000 nerveEach ear = 30,000 nerve fibersfibers HearingHearing Two ears = 60,000 nerveTwo ears = 60,000 nerve fibersfibers Seeing 2.4 millionSeeing 2.4 million Hearing 60,000Hearing 60,000 == 4040::11 SeeingSeeing Each optic nerve = 1.2 millionEach optic nerve = 1.2 million fibersfibers
- 4. Cerebral HemispheresCerebral Hemispheres CerebellumCerebellum BrainstemBrainstem Seeing and LookingSeeing and Looking
- 5. Response = Image Stimulus = Light Cerebral HemispheresCerebral Hemispheres Visual Reflex Stimulus Response
- 6. Seeing Eye Catches the Image In Peripheral Vision Looking Moves the Eyes to Find the Image and Lock on
- 9. Optic Nerve is White Matter In the Eye papilla or optic disc In the Eye papilla or optic disc Behind Eye retrobulbar retro=behind bulbar= eyeball Behind Eye retrobulbar retro=behind bulbar= eyeball
- 10. Papilla or Optic Disc macula
- 11. maculamacula
- 12. The Optic Disc
- 13. Inspection of the Optic Disk •Size •Color •Cup •Vessels •Nerve Fiber Layer
- 15. Normal NFL Loss of NFL
- 16. Nerve Fiber Layer Loss: subtleNerve Fiber Layer Loss: subtle
- 17. Visual Acuity Visual Field Color Vision Afferent Pupil “Depression of Central Vision” Hallmark of Optic Neuritis How Do We MeasureHow Do We Measure Central VisionCentral Vision How Do We MeasureHow Do We Measure Central VisionCentral Vision
- 18. Visual Acuity: Ability to discriminate a target in the very center of visual field: 2-4 degrees Loss of Visual Acuity Expressed as Ratio 20/20 20/100 distance/letter size
- 19. Visual Field: the expanse of vision looking straight ahead at a fixed target with one eye target
- 20. Visual Field “Island of Vision in a Sea of Blindness” ✈ ✈ ✈ ✈ ♂♂
- 22. Visual Acuity Visual Field Color Vision Afferent Pupil “Depression of Central Vision” Hallmark of Optic Neuritis How Do We MeasureHow Do We Measure Central VisionCentral Vision How Do We MeasureHow Do We Measure Central VisionCentral Vision
- 24. Afferent Pupil Defect (APD) or Marcus Gunn Sign QuickTime™ and a DV/DVCPRO - NTSC decompressor are needed to see this picture.
- 25. Visual Acuity Visual Field Color Vision Afferent Pupil “Depression of Central Vision” Hallmark of Optic Neuritis How Do We MeasureHow Do We Measure Central VisionCentral Vision How Do We MeasureHow Do We Measure Central VisionCentral Vision
- 26. Causes of Optic Neuropathy • MS • Infections: Lyme, Syphilis • Granulomatous: Sarcoid, Tuberculosis • Vascular: stroke • Neoplastic: cancer • Iatrogenic: postoperative complication • Inflammatory: systemic lupus erythematosus • Toxic: methylalcohol • Dietary: B12 deficiency • Traumatic
- 27. MS is But One Cause of Optic Neuritis It is Not the Only Cause Optic Neuritis = Inflammation of the Optic Nerve … itis = inflammation: meningitis, appendicitis, gastritis, hepatitis Syphilis Rocky Mt. Spotted Fever Systemic Lupus (SLE) MS Medication-induced Lyme disease Vasculitis Sarcoid Many Causes
- 28. • Loss of central visual field • Loss of visual acuity • Loss of color perception • Afferent Pupil retro=behind bulbar= eyeball Two Forms of Optic Neuritis • Papillitis • Retrobulbar Neuritis Optic NerveOptic Nerve Both Forms of Optic Neuritis papilla optic disc retrobulbar
- 29. Papillitis Optic Disc is Swollen •Loss of central visual field •Loss of visual acuity •Loss of color perception •Afferent Pupil
- 30. Retrobulbar Neuritis Optic Disc is Flat •Loss of central visual field •Loss of visual acuity •Loss of color perception •Afferent Pupil
- 31. •Accurate diagnosis •Further Evaluation •MRI, blood work, spinal fluid analysis •Acute Treatment: •Intravenous Methylprednisolone •Intramuscular ACTHAR • • •Clinically Isolated Syndrome Issues Regarding Optic Neuritis Syphilis Rocky Mt. Spotted Fever Systemic Lupus (SLE) MS Medication-induced Lyme disease Vasculitis Sarcoid
- 32. Issues Regarding Optic Neuritis • Accurate Diagnosis • Further Evaluation Syphilis Rocky Mt. Spotted Fever Systemic Lupus (SLE) MS Medication-induced Lyme disease Vasculitis Sarcoid
- 33. Conditions Often Misdiagnosed as Optic Neuritis Cat Scratch Optic Neuritis Exudates MS -- Not the Only Cause of Optic Neuritis full face t
- 34. Pitfalls in Ordering an MRI 46-yo woman with Progressive Visual Loss in her Left eye Interpretation: Normal MRI
- 35. Brain MRI
- 37. fat suppression contrast agent thin sections of the optic nerve MRI Scan Proper Technique For Identifying MS
- 38. MRI with Proper Technique Retrobulbar Neuritis
- 39. Acute Treatment of Visual Loss from Optic Neuritis • Intravenous Methylprednisolone • ACTHAR
- 40. Maintenance • Subcutaneous • Intramuscular • Intravenous • Oral • Symptomatic
- 41. MRI in MS•Initial Diagnosis •Predictive Value •Helps Determine Effectiveness of Therapy
Notas do Editor
- Vision system spans the brain; fiber count 1.2 million Point out gray-white junction; optic nerve=white matter Accounts for propensity for patients with MS to either present with or develop optic neuritis Optic nerve is a piece of the central nervous system Oph think brain=extension of the eye;neurol optic n=extension of the brain
- PM bundle, arcuate bundles, nasal retina