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N14 Neurology
Neuro-Ophthalmology Toronto Notes 2019 Neuro-Ophthalmology
Optic Neuritis
• seeOpticDiscEdema,MultipleSclerosis,N52
Anterior Ischemic Optic Neuropathy (AION)
NAION can be caused by use of sildenafil (Viagra®) in rare cases
If you suspect the diagnosis of giant cell arteritis do not wait for biopsy results, begin treatment immediately
• seeOpticDiscEdema
• non-arteritic(NAION):duetoatherosclerosis
• arteritic(AAION):duetogiantcellarteritis(seeRheumatology,RH20)
Amaurosis Fugax
• seeOphthalmology,OP35andStroke,N48
Optic Disc Edema
Table 7. Common Causes of Optic Disc Edema
Age Vision
Symptoms
Pupil Fundus
Etiologies Investigations
Treatment
Optic Neuritis
<50 yr
Rapidly progressive monocular central vision loss (acuity and colour vision) with recovery
Pain (especially with eye movement)
RAPD
Disc swelling if anterior Normal disc if retrobulbar
MS, viral
MRI with gadolinium
IV methylprednisolone
Papilledema
Any
Late visual loss
H/A, N/V, local neurological deficits
No RAPD
Bilateral disc swelling, retinal hemorrhage, no venous pulsations
Increased ICP
Emergent CT; LP if CT is normal to measure opening pressure
Treat cause
AION
>50 yr but usually >70 yr
Painless unilateral acute field defect over hours to days withcolour vision
If GCA: H/A, scalp tenderness, jaw claudication, weight loss, fatigue
RAPD
Pale segmental disc edema, retinal dot, flame hemorrhages
Arteritic: giant cell arteritis Non-arteritic: atherosclerosis
CBC, ESR, CRP, temporal artery biopsy
Consider ASA if non- arteritic; steroids if arteritic
CRVO
>50 yr
Painless unilateral variable vision loss
Cardiovascular risk factors
± RAPD
Swollen disc, venous engorgement, retinal hemorrhage
Associated with vasculopathy, thrombus
Fluorescein angiogram and coherence tomography
Optimize risk factors, reduce IOP, ± laser, ± VEGF inhibitors
Optic Disc Atrophy
• etiologies:glaucoma,AION,compressivetumour,opticneuritis,Leber’shereditaryopticneuropathy, congenital
• presentation:discpallor,lowvisualacuity,peripheralvisiondefect,decreasedcolourvision
• treatment:none(irreversible),aimtoprevent