Visual impairment and neurological disorders - PowerPoint Presentation

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Visual impairment and neurological disorders

SR ANATOMYJNMCH, AMU, ALIGARH

DR. NOOR US SABA

Vision loss approach

Mono ocular or binocular Transient, progressive, or non progressiveSudden onset or gradual onsetPainless or painful

Acute painless vision loss

Stroke

Epilepsy Transient visual obscurations

Central Retinal Artery Occlusion

Central Retinal Vein Occlusion

Methyl Alcohol

Amblyopia

Vitreous Hemorrhage

Retinal detachment

Acute painful vision loss

Optic NeuritisPituitary Apoplexy Migraine

Acute Congestive GlaucomaAcute iridocyclitis

Chemical Injuries to the Eye

Mechanical Injuries to the Eye

Gradual painless loss of vision

Optic Atrophy- nutritional and toxicChronic

papilledema

Chorioretinal

Degenerations

Predominant Night Blindness

Intracranial Space Occupying Lesions (ICSOLs)

Corneal Degenerations/ Dystrophies

Senile Cataract

Age related macular degeneration

Refractory errors

Diabetic retinopathy

Gradual painful loss of vision

Intracranial Space Occupying Lesions (ICSOLs)Chronic Iridocyclitis

Corneal UlcerationChronic simple glaucoma

Examination

Visual AcuityColor VisionVisual Field ChartingDirect Ophthalmoscopy

Pupillary AbnormalitiesReaction/ Paralysis

RAPD (relative afferent pupillary defect)

Integrity of

Extraocular

Muscles

Lesion site

Acuity

RAPD

Colour

vision

Optic disc

Optic nerve

Decreased

Present

Abnormal

Pale if chronic

Optic chiasm

Decreased

Present

Abnormal

Atrophy

Optic tract

Normal

In eye with greater field loss

Normal

Ipsilateral

temporal pallor and

contralateral

bow tie pallor

LGN

Normal

Absent

Normal

None

Visual field defects

Visual field defects

Intraorbital mass

Unilateral sudden onset transient vision loss- ocular causes 1) Angle closure glaucoma

In subacute attacksClue is halo around lights

May not be associated with redness or pain

2) Partial retinal vein occlusion

Bilateral transient vision loss

Papilledema causing transient visual obscurationsMigraine – Visual auras most common cause

Epilepsy

Cerebral hypoperfusion due to hypotension, hyper-viscosity, vascular compression or thrombo-embolism

Mono ocular acute onset non progressive vision loss

Ischemic optic neuropathy

Most common ON in patients older than 50 yrs

Anterior ischemic optic neuropathy (AION)

90% cases, disc edema present

Posterior ischemic optic neuropathy

No disc edema

Rare

Nonarteritic

AION

94% of AION

Arteritic

AION

6% of AION

Mono ocular acute onset non progressive vision loss- ocular causes

Vitreous HemorrhageRetinal detachmentCentral Serous Retinopathy

Gradual onset progressive mono ocular vision loss

For compressive lesions, it is the field that is damaged first, and acuity loss occurs as a later eventIn intraorbital

lesion papilledema develops early, but in intracranial lesion affecting optic pathway it occur late when ICT is raised

Gradual onset progressive binocular vision loss

Toxic and nutritional optic neuropathyProgressive symmetric vision lossClassic defect is

cecocentral scotoma

Colour

vision affected early

Disc – normal or hyperemic. Later pale

Toxins

Nutritional deficiencies

Alcohol

B 12

Tobacco

Thiamine

Ethelene

glycol

Niacin

Lead

Folate

Organic solvents

Ethambutol,linezolid,amiodarone

Cortical visual disorders

Cortical blindnessVertebrobasilar ischemiaDemyelinating disease

Occipital mass

Cortical visual disorders

Visual hallucinationsMetabolic derangementAlcohol withdrawalNeurodegenerative disorders (Alzheimer’s disease, Parkinson’s disease, Huntington’s disease).

Release hallucinations after vision lossOccipital lobe epilepsy

Migraine aura

Patient sees nothing, you find nothing

Retrobulbar NeuritisPatient sees everything, you find disc edemaPapilledemaPatient sees nothing, you find disc edema

Optic NeuritisRetinal Vascularity

 : Ischemic (AION/ PION/ CRAO)

 : Venous (CRVO)

Patient sees nothing, you cannot see inside

Local/ Intraocular lesion

Direct Ophthalmoscopy Maxims