NEURO OPHTHALMOLOGY Pavel Stodlka VISUAL PATHWAY VISUAL PATHWAY

NEURO OPHTHALMOLOGY Pavel Stodůlka

VISUAL PATHWAY

VISUAL PATHWAY Clinical point of view: 1. RETINA 2. OPTICAL NERVE 3. CHIASMA 4. OTICAL TRACT 5. VISUAL CORTEX – area striata

VISUAL PATHWAY Anatomical point of view: 1. NEURON – cones & rods 2. NEURON – bipolar cells of retina 3. NEURON - ganglion cells (nervus opticus) 4. NEURON – cells from corpus geniculatum lat. (radiatio optica)

VISUAL PATHWAY

OPTIC HEAD PATHOLOGY 1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC HEAD ATROPHY

DIRECT OPHTHALMOSCOPE

INDIRECT OPHTHALMOSCOPE

DISC: sharp edges flat physiological colour

OPTIC HEAD PATHOLOGY 1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC HEAD ATROPHY

PAPILLEDEMA It is not a disease but a sign of increased intracranial (or intraorbital) pressure.

PAPILLEDEMA “Champane cork“ u prominence u blurry edges u haemorhagies

DISC: sharp edges flat physiological colour

PAPILLEDEMA

PAPILLEDEMA Obvious pathology on the disc but no visual problems.

Increased intracranial pressure Papilledema is present BILATERAL.

Increased intracranial pressure ? ?

Increased intracranial pressure Intracranial expansion

PAPILLEDEMA Absolute CONTRAINDICATION of lumbal puncture.

OPTIC HEAD PATHOLOGY 1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC HEAD ATROPHY

NEURITIS 1. NEURITIS INTRAOCULARIS 2. NEURITIS RETROBULBARIS

NEURITIS INTRAOCULARIS 1. blurry edges of optic head 2. haemorhagies 3. decreased visual accuity

neuritis intraocularis neuroretinitis

NEURITIS INTRAOCULARIS Ethiology: brain infections, meningitis, infectious diseases

NEURITIS RETROBULBARIS Marked visual deterioration, but no pathologies on optic head.

NEURITIS RETROBULBARIS Patient does not see anything, doctor does not see anything too.

NEURITIS RETROBULBARIS Ethiology: Sclerosis multiplex

OPTIC HEAD PATHOLOGY 1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC HEAD ATROPHY

OPTIC HEAD PATHOLOGY 1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC HEAD ATROPHY

NEUROPATHIES DEGENERATIONS

NEUROPAHTIES 1. inherited 2. acquired - a) exogenous - b) endogenous

EXOGENOUS NEUROPATHIES 1. ethanol 2. tabacco 3. psychopharmacs 4. methanol

METHANOL INTOXICATION Patient is sleepy the next day with vomiting and high heart rate. Delirium and spasms are signs of bad prognosis. If they survive they become blind.

METHANOL INTOXICATION Acute event with dramatic scenario. 10 ml of methanol is enough for intoxication.

How does methanol harm ? ?

METHANOL INTOXICATION Methanol molecule is been split and products are toxic for retinal ganglion cells.

NEUROPAHTIES 1. inherited 2. acquired - a) exogenous - b) endogenous

ENDOGENOUS NEUROPATHIES 1. diabetics 2. pregnancy and brest feeding 3. anaemia 4. undernourishment

OPTIC HEAD PATHOLOGY 1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC HEAD ATROPHY

OPTIC HEAD PATHOLOGY 1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC HEAD ATROPHY

Optic nerve atrophy Manifestation of pathology of 2. neuron of visual pathway.

Optic nerve atrophy pale disc

Optic nerve atrophy ATROPHIA SIMPLEX ATROPHIA GLAUCOMATOSA ATROPHIA FLAVA

Glaucomatous disc

Pavel Stodůlka, MD, Ph. D stodulka@lasik. cz www. LASIK. cz BREAK !