OPTIC NERVE DISEASES Papilloedema By Dr Suhail Mushtaq

OPTIC NERVE DISEASES (Papilloedema) By Dr. Suhail Mushtaq Boobak MBBS, DOMS, MCPS, ICO (UK), FCPS, FRCS Associate Professor Ophthalmology Sargodha Medical College, University of Sargodha

Classification A- Vascular disturbances – Papilloedema B – Inflammation a-Acute - Papillitis(optic neuritis) - Retrobulbar neuritis - Neuroretinitis b- Choronic—Toxic amblyopias

C- Degeneration– Optic atrophy D- Tumours E– Congenital anomalies a- Coloboma b- Myelinated nerve fibers

F- Miscellaneous 1 - Ant. ischemic optic neuropathy-Arteritic & non arteritic 2 - Diabetic papillopathy 3 - Herditary optic neuropathy

Papilloedema Swelling of optic nerve head, secondary to raised intracranial pressure

Cerebrospinal fluid circulation CSF formed in choroid plexus in the ventricles of brain Leaves the lateral ventricles to enter the 3 rd ventricle through the foramina of Munro Through sylvian aqueduct to the 4 th ventricle Through the foramin of Luschka and Magendie to enter the subarachnoid space Absorption into the cerebral venous drainage system through the arachnoid villi

Causes of raised intracranial pressure 1 -Space occupying intracranial lesions 2 - Meningitis , subarachnoid haemorrhage, cerebral trauma 3 - Idiopathic intracranial hypertension 4 - Blunt trauma 5 - Severe systemic hypertension 6 - congenital lesions

Clinical features 1 Headache 2 - Sudden nausea and vomiting 3 - Deterioration of consciousness 4 - Visual problem Transient visual obscurations Horizontal diplopia

Stages of papilloedema A-Early 1 - Visual symptoms may be absent 2 - Optic disc hyperemia and mild elevation

B- Established 1 -V. A may or may not be reduced 2 - Venous engorgement, peripallary flame- shaped haemorrhage, cotton-wool spots 3 - Enlargement of optic nerve head

Chronic 1 - V. A is variable 2 - Optic disc is markedly elevated 3 - Cotton wool spots and haemorrhages are absent

Atrophic 1 - V-A severely reduced 2 - Optic disc is dirty grey and atrophic

Causes of optic disc elevtion 1 - Papilloedema 2 - Anterior optic neuropathy Ischaemic inflammattion infiltrative compressive

3 - Intraocular disease CRVO, Post. Uveitis Post. Scleritis Hypotony 4 - Pseudo-oedema Optic disc drusen Hypermetropia

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