OPTIC NEURITIS

Astrid feliasari
I 11107063

DEFINITION

Optic neuritis is an inflammation of the optic

nerve, the structure that connects the eye to the
brain.

EPIDEMIOLOGY
Optic neuritis occurs most frequently in adults
between the ages of 20 and 45.
Women are more frequently affected than men.
20-40 % of all patients with optic neuritis
develop diffuse multiple sclerosis.

ETIOLOGY 1
Papillitis.
1. Inflammatory processes
These include infectious diseases such as lyme
disease, malaria, and syphilis, and
manifestations in the optic nerve of inflammation
of the orbit, paranasal sinuses, or base of the
skull.
2. Autoimmune disorders
These include lupus erythematosus,
polychondritis, regional enteritis (Crohns
disease), ulcerative colitis, nodular
panarteritis,cand Wegeners granulomatosis.

ETIOLOGY 2
Retrobulbar optic neuritis.
The primary causes of this disorder are
demyelinating diseases of the central nervous
system such as diffuse encephalitis.
In 20% of all cases, retrobulbar optic neuritis is
an isolated early symptom of diffuse encephalitis.
However, a differential diagnosis should always
also consider the other causes of papillitis
mentioned above.

DEMYELINATION

SYMPTOMS
The cardinal symptom is :
loss of vision
The field of vision is typically impaired by a
central scotoma , paracentral scotomas, a
centrocecal scotoma involving the macula and
blind spot, and wedge-shaped visual field defects
up to and including complete blindness.
Other symptoms include pain that increases in
extreme positions of gaze and when pressure is
applied to the globe, and reduced perception of
color intensity.

DIAGNOSTIC CONSIDERATIONS 1
Ophthalmoscopic

findings in papillitis include

edema and hyperemia of the head of the optic
nerve.
This flattens the optic cup and obscures the
margin of the optic disk.
Bleeding at the margin of the optic disk may
ormay not be present. The elevation of the
optic disk is considerably less than in
papilledema.

DIAGNOSTIC CONSIDERATIONS 2
The

optic disk will appear normal in

retrobulbar optic neuritis. Other findings
upon examination include an afferent
pupillary defect, red-green color vision
defect, and delayed latency in the visual
evoked potential.

DIFFERENTIAL DIAGNOSIS
Papilledema
Initially there is no loss of function.
Ischemic optic neuropathy
The central scotoma is lacking, and patients are
usually over the age of 60.

TREATMENT
high doses of steroids
1000mg of oral prednisolone daily for
three days and 1mg of oral prednisolone
per kilogram of body weight on days four
through fourteen.
However, this treatment only leads to
more rapid restoration of vision.
Final visual acuity after one year is
identical with or without high-dose steroid
therapy.

RETINAL DETACHMENT

DEFINITION

A retinal detachment is a separation of the

sensory retina from the underlying retinal
pigment epithelium (RPE).

CLASSIFICATION 1
Rhegmatogenous

The most common type of retinal detachment

Results from a break in the sensory retina. The
break is most often caused by vitreous traction on
the surface of the retina.
This traction physically pulls a small section of
the sensory retina away from the pigment
epithelium, resulting in what is called a "retinal
tear." Traction at the site of a tear can initiate
retinal detachment surrounding the tear by
pulling on the surface of the adjacent retina.

CLASSIFICATION 2
The

break in the retina may also allow

fluid from the vitreous cavity to percolate
into the potential subretinal space.
a rhegmatogenous retinal detachment
caused by a retinal tear is the result of
both vitreous traction and fluid ingress
between the sensory retina and the
pigment epithelium.

CLASSIFICATION 3
Tractional

because of fibrous or fibrovascular tissue

which is caused by an injury,
inflammation or neovascularization.
Exudative
is a serious retinal detachment which can
be occurred due to inflammation, injury or
vascular abnormalities.

RISK FACTOR
The most common risk factors for retinal
detachments are :
myopia (40%-55%)
aphakia (30%-40%)
ocular trauma (10%-20%)

ETIOLOGY
Rhegmatogenous retinal detachment.
This

disorder develops from an existing

break in the retina. Usually this break is
in the eripheral retina, rarely in the
macula.
Two types of breaks are distinguished :
Round breaks: A portion of the retina has
been completely torn out due to a posterior
vitreous detachment.
Horseshoe tears: The retina is only slightly
torn.

Tractional retinal detachment.

This develops from the tensile forces exerted on
the retina by preretinal fibrovascular strands
especially in proliferative retinal diseases such as
diabetic retinopathy.

Exudative retinal detachment.

The primary cause of this type is the
breakdownof the inner or outer blood retina
barrier, usually as a result of a vascular disorder
such as Coats disease. Subretinal fluid with or
without hard exudate accumulates between the
neurosensory retina and the retinal pigment
epithelium.

SYMPTOMS
Loss of visual acuity
Floaters (floating object fisibility)
Photopsia /light flashed (flashes of light)
dark shadow in the visual field
Black rain

DIAGNOSTIC CONSIDERATIONS 1
The

lesion is diagnosed by stereoscopic

examination of the fundus with the pupil
dilated.
The detached retina will be white and
edematous and will lose its transparency.
Ophthalmoscopy will reveal a bullous
retinal detachmen, in rhegmatogenous
retinal detachment, a bright red retinal
break will also be visible.

DIAGNOSTIC CONSIDERATIONS 2
The tears in rhegmatogenous retinal
detachment usually occur in the superior half of
the retina in a region of equatorial degeneration.
In tractional retinal detachment, the bullous
detachment will be accompanied by preretinal
gray strands.
In exudative retinal detachment, one will
observe the typical picture of serous
detachment; the exudative retinal detachment
will generally be accompanied by massive fatty
deposits and often by intraretinal bleeding.

TREATMENT

argon laser coagulation.

The retina surrounding the break is fused to
the underlying tissue whereas the break itself is
left open. The scars resulting from argon laser
therapy are sufficient to prevent any further
retinal detachment

 retinal

tamponade with an elastic

silicone sponge

that is sutured to the outer surface of the sclera,

a so-called budding procedure. It can be
sutured either in a radial position
(perpendicular to the limbus) or parallel to the
limbus.
This indents the wall of the globe at the retinal
break and brings the portion of the retina in
which the break is located back into contact with
the retinal pigment epithelium. The indentation
also reduces the traction of the vitreous body on
the retina.

REATTACHING A DETACHED
RETINA WITH A SILICONE SPONGE
TAMPONADE.
a.

The ocular muscles

are retracted and
the eye is brought
into the proper
position for the
operation.

The tamponade is
sutured to the outer
surface of the sclera.

b Cross section of the

eye with the
tamponade in place:
The globe is indented
at the site of the
tamponade.

C. Wedged beneath the

horseshoe tear (arrow)
is a radial tamponade
(arrowhead). The
retina is again in
contact with the
underlying tissue.

PROPHYLAXIS

High-risk patients above the age of 40 with a

positive family history and severe myopia should
be regularly examined by an ophthalmologist,
preferably once a year.

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