NEURO-OPHTHALMOLOGY

Dr. Gilbert WS Simanjuntak Bagian IP Mata FK-UKI SMF IP Mata RS PGI Cikini

 The eyes intimately related to the brain

frequently give important diagnostic clues to CNS disorders N2 is part of CNS Frequent visual disturbances because of destruction of or pressure upon some portion of the optic pathways N3,4,5,6 and 7

 Examination:
Perimetry static or kinetic Relative afferent pupillary defect CT Scan/MRI

Analysis of visual fields in localizing lesions in the visual pathways

Rule of thumb
Lesions anterior to the chiasm (retina or N2) cause unilateral field defects Lesions posterior to the chiasm (anywhere in the visual pathway) cause contralateral homonymous defects
Congruent (identical in size, shape, and location) Incongruent

Chiasmal lesions usually cause bitemporal defects

 Relative scotoma: spreading disease Absolute scotoma: steep borders, vascular disease/lesions The more congruous the homonymous field defects (ie, the more similar the two hemifields), the farther posterior the lesion is in the visual pathway The more posterior the lesion, the more likely there is to be macular sparing; maintenance of good visual acuity in both hemifields

Optic nerve disease

Optic neuritis (papillitis and retrobulbar neuritis)
Severe VA decreased, pain, rapd, central scotoma, hyperemia of the optic disk and distention of large veins

Ischemic optic neuropathy

Age persons (60-70s), VA decreased from mild to light perception, pale disk in resolved acute process, altitudinal or central scotoma (occasionally)

 Papilledema (Choked disk)

Associated with increased intracranial pressure (cerebral tumors, abscesses, subdural hematoma, acquired hydrocephalus, A-V malformations, malignant hypertension) Hyperemia of the disk, choroidal folds, hemorrhages, cotton-wool spots, VA relative normal

Optic nerve atrophy

Vascular, degenerative, secondary to papilledema, secondary to optic neuritis, pressure against the optic nerve, toxic, metabolic, traumatic, and glaucomatous

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