Objektivn

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NEURO OPHTHALMOLOGY
Pavel Stodulka
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VISUAL PATHWAY
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VISUAL PATHWAY
Clinical point of view
1. RETINA 2. OPTICAL NERVE 3. CHIASMA 4. OTICAL
TRACT 5. VISUAL CORTEX area striata
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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)
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VISUAL PATHWAY
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OPTIC HEAD PATHOLOGY
1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC
HEAD ATROPHY
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DIRECT OPHTHALMOSCOPE
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INDIRECT OPHTHALMOSCOPE
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DISC sharp edges flat physiological colour
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OPTIC HEAD PATHOLOGY
1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC
HEAD ATROPHY
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PAPILLEDEMA
It is not a disease but a sign of increased
intracranial (or intraorbital) pressure.
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PAPILLEDEMA
Champane cork

• prominence
• blurry edges
• haemorhagies

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DISC sharp edges flat physiological colour
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PAPILLEDEMA
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PAPILLEDEMA
Obvious pathology on the disc but no visual
problems.
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Increased intracranial pressure
Papilledema is present BILATERAL.
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Increased intracranial pressure ??
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Increased intracranial pressure
Intracranial expansion
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PAPILLEDEMA
Absolute CONTRAINDICATION of lumbal puncture.
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OPTIC HEAD PATHOLOGY
1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC
HEAD ATROPHY
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NEURITIS
1. NEURITIS INTRAOCULARIS 2. NEURITIS
RETROBULBARIS
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NEURITIS INTRAOCULARIS
1. blurry edges of optic head 2. haemorhagies 3.
decreased visual accuity
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neuritis intraocularis
neuroretinitis
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NEURITIS INTRAOCULARIS
Ethiology
brain infections, meningitis, infectious diseases
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NEURITIS RETROBULBARIS
Marked visual deterioration, but no pathologies
on optic head.
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NEURITIS RETROBULBARIS
Patient does not see anything, doctor does not
see anything too.
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NEURITIS RETROBULBARIS
Ethiology
Sclerosis multiplex
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OPTIC HEAD PATHOLOGY
1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC
HEAD ATROPHY
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OPTIC HEAD PATHOLOGY
1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC
HEAD ATROPHY
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NEUROPATHIES
DEGENERATIONS
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NEUROPAHTIES
1. inherited 2. acquired - a) exogenous
- b) endogenous
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EXOGENOUS NEUROPATHIES
1. ethanol 2. tabacco 3. psychopharmacs 4.
methanol
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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.
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METHANOL INTOXICATION
Acute event with dramatic scenario. 10 ml of
methanol is enough for intoxication.
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How does methanol harm ??
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METHANOL INTOXICATION
Methanol molecule is been split and products are
toxic for retinal ganglion cells.
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NEUROPAHTIES
1. inherited 2. acquired - a) exogenous
- b) endogenous
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ENDOGENOUS NEUROPATHIES
1. diabetics 2. pregnancy and brest feeding 3.
anaemia 4. undernourishment
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OPTIC HEAD PATHOLOGY
1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC
HEAD ATROPHY
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OPTIC HEAD PATHOLOGY
1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC
HEAD ATROPHY
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Optic nerve atrophy
Manifestation of pathology of 2. neuron of visual
pathway.
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Optic nerve atrophy
pale disc
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Optic nerve atrophy
ATROPHIA SIMPLEX ATROPHIA GLAUCOMATOSA ATROPHIA
FLAVA
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Glaucomatous disc
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Pavel Stodulka, MD, PhD stodulka_at_lasik.cz www.LASI
K.cz
BREAK !