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Title: 00010

1 optic nerve its disoreders dranita kumari pg 2nd year ophthalmology
2 optic nerve 2nd cranial nerve starts from optic disc extends upto optic chiasma where two nerve meet backward continuation of nerve fiber layer of retina each optic nerve is composed of approximately 12 million axons from retinal ganglion cells lack neurilemma so unable to regenerate
3 parts of optic nerve intraocular 1mm intraorbital30mm intracanalicular69mm intracranial10mm optic nerve
4 intraocular part optic papillae or optic disc 15 mm in diameter passes through sclera choroid appears in eye as optic disc expands to 3 mm behind sclera due to presence of myelin sheath divided into 4 portions from anterior to posterior snfl prelaminar lamina cribrosa retrolaminar intraocular part
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6 surface nerve fiber layer composed of axonal bundles 94 nerve fibers of retina 5 astrocytes optic disc is covered by thin layered of astrocytes ilm of elschnig sepeates it from vitreous when central portion of membrane get thickened central meniscus of kuhnt near the optic nerve all layer of retina except nfl are separated from it by intermediate tissue of kuhnt
7 lamina cribrosa the nerve fibers forming the optic nerve exit the eye posteriorly through a hole in the sclera that occupied by a mesh like structure called the lamina cribrosa composed of fenestrated sheets of scleral connective tissue lined by glial tissue
8 retrolaminar region characterized by decrease in astrocytes acquisition of myelin supplied by oligodendrocytes addition of myelin sheath doubles the diameter of optic nerve from 15 to 3 mm as it passes through sclera axonal bundles are surrounded by connective tissue septa the posterior extent of retrolaminar region is not clearly defined
9 intraorbital part 25 mm length extend from eye ball to optic foramina optic nerve covered by dura arachnoid pia anteriory separated from eom by orbital fat post surround by annulus of zinn origin of 4 recti muscles superior rectus and medial rectus are adherent to sheath account for painful ocular movement in retrobulbar neuritis
10 0 intracanalicular part 69mm in length it is closely related to ophthalmic artery inferolaterally covered in dura sphenoid posterior ethmoid sinus lie medially and separated by thin bony lamina which accounts for retrobulbar neuritis following sinus infection within the canal and immediately post to canal meningeal tissue is adjacent to optic nerve so benign tumor of meninges or meninges or meningioma are common causes of compressive optic neuropathy in these location
11 1 intracranial part 1 cm in length ensheathed in piamater only but receive arachnoid and dural sheath at point of its entry into canal internal carotid artery runs at first below and than lateral to it the ophthalmic artery arises from internal carotid artery below the optic nerve
12 2 ophthalmoscopic features of optic nerve head optic disc part of nerve head visible with ophthalmoscope intra papillary parts optic cup neuroretinal rim
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14 4 disorders of optic nerve abnormal embryogenesis in utero leading to congenital anomalies swelling edema or accumulation of excess fluid in and around the nerve inflammation within or around the nerve direct injury by penetrating trauma or indirect injury ischemia by affecting the blood supply degeneration or atrophy of axons by direct compression or toxic effect
15 sensitivity visual field diminished light brightness sensitivity diminished contrast nerve dysfunction reduced light brightness sensitivity 5 signs of diminished contrast sensitivity rapd dyschromatopsia diminished signs of optic of optic nerve optic nerve dysfunction brightness sensitivity diminished dyschromatopsia diminished light reduced va rapd va rapd dyschromatopsia visual field defects contrast sensitivity visual dysfunction reduced va
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17 medullated nerve fibers 7 medullated nerve
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20 0 autofluoroscence of of disc drusen autofluoroscence of disc
21 1 morning glory morning glory syndrome
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23 deterioration of consciousness visual symptomshorizontal diplopia symptomshorizontal diplopia nearly etiologyaqueductal stenosis icsols but may be inflammationvascularcrvoaioninfiltrati ve etiologyaqueductal nearly always bilateral intracranial infection clinical secondary to raised features headache nausea intracranial pressureicp cause consciousness visual symptomshorizontal nausea vomiting deterioration infection clinical features bilateral but may onh secondary to of onh secondary icsols intracranial infection papilloedema swelling of always bilateral but of consciousness visual raised intracranial pressureicp cause inflammationvascularcrvoaioninfiltrati ve diplopia nearly always 3 papilloedema swelling stenosis icsols intracranial to raised intracranial pressureicp cause inflammationvascularcrvoaioninfiltrati ve etiologyaqueductal stenosis swelling of onh may be asymmetrical headache nausea vomiting vomiting deterioration of clinical features headache
24 4 stage of stage of papilledema
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26 6 rapd
27 idiopathic hereditary optic cough and glandular parainfectious optic neuritis disorder of optic neuritis is associated with measlesmumpschickenpox whooping disorders multiple sclerosis neuromyelitis optica parainfectious inflammatory and demyelinating optic neuritislebers disease etiology idiopathic hereditary optic neuritis includes measlesmumpschickenpox whooping cough and glandular fever hereditary optic neuritislebers multiple sclerosis neuromyelitis optic nerve etiology optic neuritis is demyelinating disorder of nerve etiology idiopathic 7 optic neuritis neuritis includes inflammatory neuritislebers disease demyelinating optica parainfectious optic whooping cough and is associated with disease demyelinating disorders sclerosis neuromyelitis optica includes inflammatory and demyelinating disorders multiple and demyelinating disorder associated with measlesmumpschickenpox of optic nerve
28 toxic optic neuritis fever syphilisduring primary neuritis sinus related optic neuritis sinus sinus related with or secondary stage aids toxic optic scratch fever syphilisduring and cryptococcal meningitis patients with aids lyme disease and in patients with with aids toxic cryptococcal meningitis in infectious optic neuritis associated with cat primary or secondary meningitis in patients related with acute cat scratch fever 8 infectious optic with acute ethoimiditis with cat scratch ethoimiditis or associated or associated with acute ethoimiditis or stage lyme disease disease and cryptococcal syphilisduring primary or secondary stage lyme
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32 or immunization infectious immunization infectious may noninfectious sarcoidosis sle classification demyelinating most zoster noninfectious sarcoidosis a viral infection infection or immunization conduction disrupted parainfectious relatedsyphilis herpes zoster follow a viral parainfectious may follow may follow a 2 etiological classification be sinus relatedsyphilis disrupted parainfectious may nerve conduction disrupted common nerve conduction herpes zoster noninfectious infectious may be sinus relatedsyphilis herpes may be sinus viral infection or most common nerve demyelinating most common etiological classification demyelinating
33 3 demyelinating optic demyelinating optic neuritis
34 visual loss sudden positive visual phenomenon eye ache pain exposure to heat clinical features visual loss sudden progressive heat pain mild visual obscuration in phenomenon altered perception of color vision bright light impairment vision on exposure object episodic transient progressive profound visual in bright light of moving object obscuration of vision dull eye ache of vision on pain mild dull episodic transient obscuration color vision positive on exposure to transient obscuration of mild dull eye obscuration in bright light impairment of impairment of color moving object episodic features visual loss on eye movement pain aggravate on sudden progressive profound profound visual obscuration perception of moving aggravate on eye 4 clinical features ache pain aggravate visual phenomenon altered vision positive visual altered perception of to heat pain
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36 with retinal exudates disc swelling with features absence of and peripallary haemorrhage absence of pain peripallary haemorrhage no loss npl vision marked disc swelling bilateral visual loss retinal exudates and spontaneous visual improvement exudates and peripallary of pain bilateral visual loss npl pain bilateral visual no spontaneous visual 6 atypical features npl vision marked swelling with retinal vision marked disc atypical features absence haemorrhage no spontaneous
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40 37 250mg every ranitidine 150mg bd 0 management iv 1 gday x 4 days 20mg gday x 37 and d4 antiulcer then taper over taper over 4 medications t ranitidine management iv methylprednisolone antiulcer medications t 250mg every 6 d2 and d4 hours then taper 6 hours then d1 10mg d2 t ranitidine 150mg methylprednisolone methylprednisolone 1 d4 antiulcer medications methylprednisolone 1 gday over 4 days x 37 250mg 10mg d2 and every 6 hours days 20mg d1 iv methylprednisolone methylprednisolone 20mg d1 10mg
41 interferon beta1alpha within of developing ms ms in 15 chance of developing developing ms in lesions demonstrating demyelination within 28 days of developing ms beta1alpha within 28 white matter lesions 72 chance of periventricular white matter ontt periventricular white days if mri 25 chance of critical for assessing assessing risk of most critical for of developing ms if mri shows ms within 5 for assessing risk 15 year period 1 refer neurologist more demyelinating lesions or more demyelinating more 72 chance ms zero lesions 28 days if one lesion or years one lesion risk of developing chance of developing lesions from ontt demyelination most critical lesion or more 2 or more or more 72 shows 2 or matter lesions demonstrating refer neurologist for demonstrating demyelination most mri shows 2 developing ms within from ontt periventricular neurologist for possible developing ms zero zero lesions 25 in 15 year 5 years one demyelinating lesions from for possible interferon within 5 years lesions 25 chance possible interferon beta1alpha
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44 lesion over 6 effects noted reduction latest research higher 6 month follow methylprednisolone 500mg monthly iv dexamethasone equally iv methylprednisolone showed easier to administer tapering reduces inflammatory and 6 times 4 latest research clinically relevant side effective as iv inflammatory activity without to administer 200mg statistical benefits iv oral tapering reduces reduction in no enhanced lesion over over 6 month gadolinium enhanced lesion higher dose of research higher dose month follow up activity without clinically 6 times cheaper without clinically relevant monthly with 3 times cheaper iv benefits iv dexamethasone showed no statistical as iv methylprednisolone dose and 6 relevant side effects in no of of iv methylprednisolone methylprednisolone easier to days oral tapering 3 days oral equally effective as dose of iv no statistical benefits administer 200mg od methylprednisolone showed no noted reduction in 500mg monthly with side effects noted 200mg od dose no of gadolinium cheaper iv methylprednisolone dexamethasone equally effective iv methylprednisolone 500mg of gadolinium enhanced reduces inflammatory activity with 3 days iv methylprednisolone easier od dose and
45 ethanol tobaccoarsenic quinineethambutol acby dyschromatopsia centrocecal appear normal later nutritional toxic optic visual loss acby may not be ensue any toxinmethanol normal later atrophy progressive always bl any toxinmethanol ethanol field defect rapd disc initially appear always bl visual defect rapd may apperant disc initially bl visual loss initially appear normal optic neuropathy gradual later atrophy will toxic optic neuropathy loss acby dyschromatopsia toxinmethanol ethanol tobaccoarsenic 5 nutritional toxic not be apperant atrophy will ensue dyschromatopsia centrocecal visual rapd may not centrocecal visual field will ensue any visual field defect neuropathy gradual painless gradual painless progressive be apperant disc painless progressive always
46 6 pathogenesis
47 7 temporal paleness
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49 9 splinter haemorrhage splinter haemorrhage hyperaemic hyperaemic disc swelling haemorrhage hyperaemic disc
50 traumatic optic neuropathy nerve s intraorbital neuropathy trauma induced traumatic optic neuropathy nerve occurring anywhere optic nerve occurring causes rta falls optic nerve avulsion direct ton indirect anywhere along the 0 traumatic optic ton optic nerve indirect ton optic injury to optic the nerve s along the nerve rta falls assault to intracranial length sports traumatic optic induced injury to falls assault sports optic neuropathy direct intraorbital to intracranial ton indirect ton s intraorbital to assault sports traumatic intracranial length causes optic neuropathy trauma neuropathy direct ton length causes rta to optic nerve occurring anywhere along trauma induced injury
51 1 space
52 optic nerve after injury 6 week nerve after injury after injury 6 2 optic nerve 6 week later
53 20 years transmitted be mildly hyperaemic by progressive visual in acute stage transmitted by female eventually bilateral optic fundus is initially mildly hyperaemic with neuropathy affect male of 20 years around age of disc may be microangiopathy eventually bilateral or in acute 3 lebers hereditary stage disc may bilateral optic atrophy telangiectatic microangiopathy eventually visual failure fundus years transmitted by by female carriers may be mildly failure fundus is optic neuropathy affect with telangiectatic microangiopathy is initially normal hereditary optic neuropathy lebers hereditary optic age of 20 progressive visual failure affect male around chzted by progressive optic atrophy ensues male around age normal or in female carriers chzted carriers chzted by hyperaemic with telangiectatic acute stage disc initially normal or
54 leber hereditary optic hereditary optic atrophy 4 leber hereditary
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56 optic chiasma and point from retrolaminar occurs as an to lateral geniculate chiasma and optic the lateral geniculate atrophy degeneration of retrolaminar portion of optic nerve which and optic tract nerve to the optic nerve to anterior to optic axons in anterior 6 optic atrophy body primary optic an end result lateral geniculate body which occurs as pathological process that body lesion anterior atrophy those involve retinal ganglion cells from retrolaminar portion any pathological process primary optic atrophy nerve which occurs pathways at any the visual pathways head lesion affecting nerve head lesion system ie from antecedent swelling of ie from retinal lateral geniculate body anterior visual system atrophy occurs without optic atrophy degeneration of optic nerve chiasma unilateral optic swelling of optic ganglion cells to portion of optic lesion anterior to tract bilateral changes unilateral optic atrophy process that damage geniculate body lesion occurs without antecedent as an end optic tract bilateral without antecedent swelling optic atrophy occurs optic chiasma unilateral end result of optic atrophy those in anterior visual to the lateral visual system ie at any point those involve optic optic nerve head to optic chiasma any point from visual pathways at of optic nerve damage axons in lesion affecting the degeneration of optic affecting the visual of optic nerve involve optic chiasma cells to lateral of any pathological that damage axons geniculate body primary from retinal ganglion result of any
57 or aneurysms hereditary clearly delineated margin retinal vessels and disc surface retinal vessels and surrounding aneurysms hereditary optic atrophy flat white optic neuritis trauma primary optic atrophy vessels on disc margin reduction in causes optic neuritis normal causes optic disc with clearly white disc with small blood vessels delineated margin reduction surrounding retina are retina are normal 7 primary optic reduction in no with clearly delineated optic atrophy flat neuritis compression by compression by tumor in no of blood vessels on flat white disc surface retinal vessels tumor or aneurysms optic neuritis compression of small blood by tumor or no of small on disc surface are normal causes and surrounding retina hereditary optic neuritis
58 greyish disc with and venous tortuosity disc with poorly chronic papilloedema ischaemic 8 secondary optic optic atrophy preceded of optic nerve margin due to raised white or to disc sheathing sheathing of arterioles nerve head raised temporal to disc by long standing present causes chronic head raised white due to excessive long standing swelling preceded by long may be present causes chronic papilloedema white or greyish atrophy preceded by ischaemic optic neuropathy poorly delineated margin excessive gliosis peripapillary tortuosity may be to excessive gliosis retinochoroidal folds temporal folds temporal to arterioles and venous with poorly delineated disc sheathing of of arterioles and peripapillary circumferential retinochoroidal optic nerve head be present causes papilloedema ischaemic optic venous tortuosity may gliosis peripapillary circumferential circumferential retinochoroidal folds or greyish disc standing swelling of secondary optic atrophy swelling of optic delineated margin due
59 preserved architecture causes or its blood disc appear waxy appear waxy pallor inner retina or atrophy caused by caused by disease by disease of supply disc appear waxy pallor with retina or its retinal photocoagulation retinitis causes extensive retinal architecture causes extensive its blood supply photocoagulation retinitis pigmentosa pallor with preserved optic atrophy caused with preserved architecture disease of inner of inner retina 9 consecutive optic extensive retinal photocoagulation blood supply disc consecutive optic atrophy
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61 and pathway disorders optic chiasma and chiasma and pathway 1 optic chiasma
62 sella tursica the position of optic neoplastic most common wall of the most common is cavernous sinuses etiology of the sella lesions anatomical position the diaphragm of chiasma are neoplastic 2 optic chiasma is variably situated chiasma is variably diseases that affect aneurysm tumor of pituitary tumors next sella meningiomacraniopharyng iomaanterior top of the the top of most diseases that the cavernous sinuses the anterior wall the third ventricle a lie just iomaanterior communicating aneurysm are tuberculum sella the chiasma are lamina terminalis forms laterally adjacent to sinuses etiology most next are tuberculum carotid a lie of optic chiasma the lamina terminalis internal carotid a common is pituitary diaphragm of the optic chiasma optic just laterally adjacent variably situated near communicating aneurysm tumor etiology most diseases anatomical position of are neoplastic most chiasma optic chiasma affect the chiasma of the diaphragm chiasma lesions anatomical tumors next are the internal carotid the sella tursica adjacent to the optic chiasma lesions third ventricle the anterior wall of optic chiasma is ventricle the internal tuberculum sella meningiomacraniopharyng lie just laterally that affect the meningiomacraniopharyng iomaanterior communicating of the third to the cavernous forms the anterior situated near the tumor of third terminalis forms the of third ventricle is pituitary tumors tursica the lamina near the top
63 hemianopsiaearly these defects optic chiasma lesions are typically incomplete blurred visionbilateral defect are often asymmetric manifestation blurred visionbilateral typically incomplete and of visual fieldbitemporal defects are typically fieldbitemporal hemianopsiaearly these chiasma lesions clinical visionbilateral defect of defect of visual and are often 3 optic chiasma visual fieldbitemporal hemianopsiaearly clinical manifestation blurred incomplete and are these defects are lesions clinical manifestation
64 tonic pupil when atrophy may occur homonymous hemianopia wernickes wernickes hemianopia tonic optic tract lesions when hemianopia side pupil when hemianopia secondary optic atrophy lesions contralateral of hemianopia side retina lately secondary optic bilateral homonymous hemianopia to slit lightpupil hemianopia wernickes hemianopia constrict lately secondary lightpupil doesnt constrict hemianopia tonic pupil of lesion bilateral doesnt constrict lately lesion bilateral homonymous side retina exposed contralateral of lesion tract lesions contralateral 4 optic tract optic atrophy may exposed to slit slit lightpupil doesnt retina exposed to
65 hemianopia lately secondary body lesions contralateral geniculate body lesions lately secondary optic lesions contralateral of atrophy may occur lesionbilateral homonymous hemianopia optic atrophy may homonymous hemianopia lately secondary optic atrophy 5 lateral geniculate lateral geniculate body of lesionbilateral homonymous contralateral of lesionbilateral
66 of cerebrum lesion hemianopia macular sparing congruous bilateral homonymous hemianopia tonic pupil homonymous hemianopia macular no optic atrophy wernickes hemianopia tonic field loss no visual field loss optic atrophy and temporal crescentshaped visual sparing temporal crescentshaped tonic pupil accompany and wernickes hemianopia radiation lesions congruous atrophy and wernickes with symptoms of macular sparing temporal lesions congruous bilateral loss no optic 6 optic radiation accompany with symptoms symptoms of cerebrum crescentshaped visual field pupil accompany with optic radiation lesions bilateral homonymous hemianopia
67 fundus and vep occipital lobe infarctions artery supply anterior normal pupillary responses character congruous bilateral cerebral artery supply sparing of the the macula feature lobe infarctions bilateral or severe loss bilateral homonymous hemianopia macula feature of of the macula feature of posterior supply anterior part bilateral complete or hemianopia with sparing complete or severe cortical blindnessbilateral occipital occipital lobe lesions of posterior cerebral cortex cortical blindnessbilateral lobe lesions character blindnessbilateral occipital lobe congruous bilateral homonymous normal fundus and part of cortex anterior part of responses normal fundus severe loss of posterior cerebral artery 7 occipital lobe with sparing of pupillary responses normal loss of vision infarctions bilateral complete lesions character congruous of vision normal of cortex cortical vision normal pupillary homonymous hemianopia with
68 8 thank you
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