normal fundus ophthalmoscopy direct indirect normal fundus

normal fundus

ophthalmoscopyophthalmoscopy

Direct

Indirect

normal fundus

normal fundus

Optical Coherence Tomography (OCT) uses a light beam the same way that B-scan Optical Coherence Tomography (OCT) uses a light beam the same way that B-scan ultrasonography uses a sound beam to image the retina in a microscopic slice. ultrasonography uses a sound beam to image the retina in a microscopic slice.

Congenital fundus anomalies

Opaque retinal nerve fibers-myelinated retinal nerve fibers;

bright, white patch adjanced to the disc often obscuring the retinal

vessels running in the white patch.

Congenital fundus anomalies

• Opaque retinal nerve fibers

Congenital fundus anomalies Congenital fundus anomalies

Myopic crescent-Myopic crescent-1.1. white with black pigmented borders rimwhite with black pigmented borders rim of of atrophic choroid revealing the underlying white atrophic choroid revealing the underlying white

sclera in a crescent shape;sclera in a crescent shape;2.2. usually temporal to the disc but may usually temporal to the disc but may

completely surround it; completely surround it; 3.3. in pathological myopia often associated with in pathological myopia often associated with

myopic choroidoretinal degeneration.myopic choroidoretinal degeneration.

Congenital fundus anomaliesCongenital fundus anomalies

• Myopic crescent

Senile changesSenile changes

Age related macular degeneration (AMD)Age related macular degeneration (AMD)1.1. the most common cause of registrable blindness the most common cause of registrable blindness

in Western countries;in Western countries;2.2. bilateral gradual deterioration of central vision over bilateral gradual deterioration of central vision over

several years (sometimes sudden), often with several years (sometimes sudden), often with symptoms of distortion; symptoms of distortion;

3.3. the earliest mainifestation, risk factor of AMD - drusen the earliest mainifestation, risk factor of AMD - drusen (small yellow spots in macular region, associated with (small yellow spots in macular region, associated with

pigment speckling, consist of hyaline, between the pigment speckling, consist of hyaline, between the retinal pigment epithelium and Bruch`s maembrane, retinal pigment epithelium and Bruch`s maembrane,

usually cause no visual symptoms).usually cause no visual symptoms).

drusendrusen


Age related macular degeneration (AMD)Age related macular degeneration (AMD)4.4. non- exudative (dry or atrophic):non- exudative (dry or atrophic):

bilateral progressive atrophy of RPE and the bilateral progressive atrophy of RPE and the choriocapllares in the macular region choriocapllares in the macular region

secondary to arteriosclerotic degeneration secondary to arteriosclerotic degeneration of choroidal vessels; speckled pigmentation of choroidal vessels; speckled pigmentation

followed by the apperance of areas of retinal followed by the apperance of areas of retinal atrophy with visibility of choroidal vessels; atrophy with visibility of choroidal vessels;

typically slow gradual to modearte loss typically slow gradual to modearte loss of vision; of vision;


Age related macular degeneration (AMD)Age related macular degeneration (AMD)

5.5. exudative (dry or atrophic): exudative (dry or atrophic):

in early stages retinal oedema (distortion in early stages retinal oedema (distortion

of central vision); less common than non- of central vision); less common than non- exudative but causes more severe visual exudative but causes more severe visual

loss!!!; two important features- detachment loss!!!; two important features- detachment

of RPE and choroidal neovascularisation which of RPE and choroidal neovascularisation which may haemorrhage and leads to a fibrous may haemorrhage and leads to a fibrous

disciform scar at the macula; disciform scar at the macula;



Wet AMD is associated with new blood vessels Wet AMD is associated with new blood vessels (neovascularization) that originate (neovascularization) that originate in the choroid and break through Bruch's membrane in the choroid and break through Bruch's membrane and the RPE layer. and the RPE layer. OCT image below indicates the RPE layer that has OCT image below indicates the RPE layer that has been broken through by the choroidal been broken through by the choroidal new blood vessels. new blood vessels.



The end result is scarring and a loss of retinal The end result is scarring and a loss of retinal function in the area affected. function in the area affected. Ninety percent of the cases of severe vision loss Ninety percent of the cases of severe vision loss from AMD results from wet AMD. from AMD results from wet AMD.

Senile changes- Senile changes- Amsler grid as it might appear to

someone with age-related macular degeneration.


Age related macular degeneration (AMD)Age related macular degeneration (AMD)TreatmentTreatment

Non- exudative:Non- exudative: no treatment no treatment

Exudative:Exudative: argon laser photocoagulation argon laser photocoagulation

to destroy a choroidal neovascular membrane,to destroy a choroidal neovascular membrane,

photodynamic therapy- PDT (Visudine),photodynamic therapy- PDT (Visudine),

Injections into vitreous body (steroids- Injections into vitreous body (steroids- Triamcinolone, antineovascularization agents- Triamcinolone, antineovascularization agents-

Macugen, Lucentis, Avastin),Macugen, Lucentis, Avastin),

nutrient supplementsnutrient supplements (vitamin C and E, zinc, (vitamin C and E, zinc, cuprum, betacarotene, lutein).cuprum, betacarotene, lutein).


Macular HoleMacular Hole

generally middle- aged woman;generally middle- aged woman;

sudden reduction in central vision to sudden reduction in central vision to around the 6/60 level;around the 6/60 level;

small round retinal hole centered on the small round retinal hole centered on the fovea;fovea;

Vitreous traction;Vitreous traction;

Treatment- vitrectomyTreatment- vitrectomy

Macular HoleMacular Hole


Myopic DegenerationMyopic Degeneration

High myopia= large eyeball with all retinal High myopia= large eyeball with all retinal layers stretched and thinned;layers stretched and thinned;

primary choroidal atrophy may affect the primary choroidal atrophy may affect the macular region, or breaks in Bruch`s macular region, or breaks in Bruch`s membrane (laquer cracks) through membrane (laquer cracks) through

which choroidal neovascularisation and which choroidal neovascularisation and subsequent disciform scarring may subsequent disciform scarring may develop in a similar manner to AMDdevelop in a similar manner to AMD

Retinal detachmentRetinal detachment

Separation of the retina from its pigment Separation of the retina from its pigment epithelial layer.epithelial layer.

The separation occurs at this site for The separation occurs at this site for embryological reasons: the two walls embryological reasons: the two walls

of the embryonic optic vesicle become of the embryonic optic vesicle become apposed and form respectively the RPE apposed and form respectively the RPE

and neuroretina.and neuroretina.


rhegmatogenous RDrhegmatogenous RD

-- most common type of RD;most common type of RD;

-- secondary to a tear or hole in the retina, secondary to a tear or hole in the retina, which often arises as a consequence which often arises as a consequence

of posterior vitreous detachmentof posterior vitreous detachment

Retinal detachmentRetinal detachmentnon- rhegmatogenous RD (exudative and non- rhegmatogenous RD (exudative and

tractional)tractional)

-- an ucommon type of RD;an ucommon type of RD;

-- there is no defect in retina;there is no defect in retina;

-- result of exudative processes beneath result of exudative processes beneath the retina (e.g. scleritis or choroidal the retina (e.g. scleritis or choroidal neoplasm) or as result of vitreous neoplasm) or as result of vitreous tractional forces pulling the retina tractional forces pulling the retina forward (e.g. proliferative diabetic forward (e.g. proliferative diabetic

retinopathy).retinopathy).


risk factorsrisk factors

-- age (over 50);age (over 50);

-- high myopia;high myopia;

-- trauma (younger patients);trauma (younger patients);

-- systemic conective tissue disorders systemic conective tissue disorders (Marfan`s syndrome)(Marfan`s syndrome)


symptomssymptoms

-- sudden onset of floating specks or sudden onset of floating specks or spots associated with flashes of light spots associated with flashes of light

(typical for posterior vitreous (typical for posterior vitreous detachment and/ or retinal tear detachment and/ or retinal tear

formation);formation);

-- „shadow” or „curtain” in the visual field „shadow” or „curtain” in the visual field that gradually extends to cover the that gradually extends to cover the

whole visual field (the same day or days whole visual field (the same day or days or weeks later);or weeks later);


signssigns

-- visual field loss corresponding to the visual field loss corresponding to the area of detached retina (the temporal area of detached retina (the temporal retina generally detaches first- nasal retina generally detaches first- nasal

field defect);field defect);

-- reduction in visual acuity (if the macular reduction in visual acuity (if the macular region becomes detached);region becomes detached);


signssigns

-- grey retinal folds which quiver as the grey retinal folds which quiver as the eye moves;eye moves;

-- the blood vessels on the detached retina the blood vessels on the detached retina have deeper red colour than normal;have deeper red colour than normal;

-- easy contrast between the normal easy contrast between the normal fundus colour and the greyish detached fundus colour and the greyish detached

part of retina;part of retina;


signssigns

-- retinal break will be seen at the retinal break will be seen at the periphery of detached fundus in the periphery of detached fundus in the

form of a tear (arrowed or „U” shaped), form of a tear (arrowed or „U” shaped), hole hole

or dialysis (typical for traumatic RD)or dialysis (typical for traumatic RD)


preventionprevention

laser photocoagulation or retinal laser photocoagulation or retinal cryotherapy in patients with retinal tears cryotherapy in patients with retinal tears and holes and with symptoms of flashes and holes and with symptoms of flashes

and floaters !!!and floaters !!!


tratmenttratment

surgerysurgery

Aim:Aim: to seal the retinal break by inducing to seal the retinal break by inducing retinal scarring with laser or cryotherapy retinal scarring with laser or cryotherapy and to relieve vitreous traction over the and to relieve vitreous traction over the break, either by break, either by attaching an indenting attaching an indenting

implant of silastic to the scleraimplant of silastic to the sclera

or by or by vitrectomyvitrectomy..


prognosisprognosis

the visual prognosis depends on the the visual prognosis depends on the duration of the detachment and whether duration of the detachment and whether

the macula has been detached!!!the macula has been detached!!!

RetinalRetinal detachmentdetachment

Posterior vitreousPosterior vitreous detachmentdetachment

opacities in the vitreousopacities in the vitreous

Angioid StreaksAngioid Streaks

-- an ophthalmoscopic apperance similar an ophthalmoscopic apperance similar to blood vessels;to blood vessels;

-- irregural, reddish streaks extend irregural, reddish streaks extend outwards from the optic disc (cracks in outwards from the optic disc (cracks in

Bruch`s membrane);Bruch`s membrane);

-- usually asymptomatic (unless they usually asymptomatic (unless they affect macular region);affect macular region);


-- compicationscompications: neovascularisation, : neovascularisation, disciform scars;disciform scars;

-- May be May be associated withassociated with: : pseudoxanthoma elasticum, Ehlers- pseudoxanthoma elasticum, Ehlers- Danlos syndrome, Paget`s disease, Danlos syndrome, Paget`s disease,

sickle- cell anaemi;sickle- cell anaemi;

Fundus inflammationFundus inflammation

main informationsmain informations::

(choroiditis/ psterior uveitis)(choroiditis/ psterior uveitis)

-- rapid blurring of vision (usually in one rapid blurring of vision (usually in one eye);eye);

-- spots and hazines over the whole visual spots and hazines over the whole visual field (inflammatory cells in vitreous);field (inflammatory cells in vitreous);

-- inflammations of the choroid always inflammations of the choroid always affect the overlying retina to produce affect the overlying retina to produce

a chorioretinitisa chorioretinitis


toxoplasmosistoxoplasmosis::

The parasite (The parasite (Toxoplasma gondiiToxoplasma gondii) probably ) probably causes choroiditis by its entry into the causes choroiditis by its entry into the

bloodstream via ingested infected bloodstream via ingested infected material from material from catscats. Toxoplasma may be . Toxoplasma may be transmitted across the placenta causing transmitted across the placenta causing

congenital toxoplasmosis.congenital toxoplasmosis.



Many people are unaware they have had Many people are unaware they have had toxoplasmosis chorioretinitis toxoplasmosis chorioretinitis

in childchood or from birth until in childchood or from birth until

a characteristic old fundus is noted a characteristic old fundus is noted

on routine examination in later years.on routine examination in later years.



Primary infection in adults:Primary infection in adults:

-- mild febrile illness;mild febrile illness;

-- the eye symptomsthe eye symptoms



Signs and symptoms:Signs and symptoms:

-- reduced vision;reduced vision;

-- very hazy view of the fundus very hazy view of the fundus (inflammatory cells in vitreous);(inflammatory cells in vitreous);

-- localised white fluffy area in the fundus;localised white fluffy area in the fundus;



forms:forms:

-- reccurent episode (the active focus reccurent episode (the active focus arieses from an area adjanced arieses from an area adjanced

to pigmented choroidal scar);to pigmented choroidal scar);

-- primary episode;primary episode;



It is very important to distinguish reccurent It is very important to distinguish reccurent from primary disease in pregnancy from primary disease in pregnancy

because there is very high risk because there is very high risk

of congenital toxoplasmosis in primary of congenital toxoplasmosis in primary infection!!!infection!!!



diagnosis:diagnosis:

Serum antitoxoplasma antibody:Serum antitoxoplasma antibody:

1.1. IgM- 2 to 6 months after initial infection, IgM- 2 to 6 months after initial infection, 2.2. IgG after 6 months) IgG after 6 months)

Fundus inflammationFundus inflammationtoxoplasmosistoxoplasmosis::

treatment:treatment:

Is usually commenced in severe vitritis Is usually commenced in severe vitritis

and if active lesion is close to the macula and if active lesion is close to the macula

or optic disc.or optic disc.

Systemic corticosteroids (p.o. or i.v) +Systemic corticosteroids (p.o. or i.v) +

Pyrimethamine;Pyrimethamine;

Sulphadiazine;Sulphadiazine;

or Clindamycine.or Clindamycine.

Fundus inflammationFundus inflammationtoxoplasmosistoxoplasmosis::

Fundus inflammationFundus inflammationToxocariasis (Toxocariasis (Toxocara canisToxocara canis))::

Infection- Infection- contact with dog`s infected contact with dog`s infected excreta; eggs of toxocara hatch in the excreta; eggs of toxocara hatch in the gut and the larvae migrate throughout gut and the larvae migrate throughout the body via the blood and lymphatic the body via the blood and lymphatic

system.system.

In children In children larvae invading the eye may larvae invading the eye may causecause a focal chorioretinitisa focal chorioretinitis oror an an

edophtalmitis edophtalmitis andand leucocoria. leucocoria.

Fundus inflammationFundus inflammationAcquired Immunodeficiency Acquired Immunodeficiency

Syndrome(Syndrome(AIDSAIDS))::

Human immunodeficiency virus (HIV) Human immunodeficiency virus (HIV)

an RNA retrovirus which infects T- helper an RNA retrovirus which infects T- helper lymphocytes impairing their function lymphocytes impairing their function

and causing a state and causing a state

of immunodeficiency.of immunodeficiency.

Fundus inflammationFundus inflammationAIDS- ocular manifestationsAIDS- ocular manifestations::

1.1. HIV retinopathy (especially cotton wool HIV retinopathy (especially cotton wool spots, less frequently microaneurysms spots, less frequently microaneurysms

and oedema like in diabetic retinopathy);and oedema like in diabetic retinopathy);

Fundus inflammationFundus inflammationAIDS- ocular manifestationsAIDS- ocular manifestations::

2.2. Opportunistic ocular infectionsOpportunistic ocular infections – –Cytomegalovirus (CMV) retinitis= 25% Cytomegalovirus (CMV) retinitis= 25%

of AIDS patients; usually asymptomatic until of AIDS patients; usually asymptomatic until the macula or optic nerve the macula or optic nerve

is affected. The clinical apperance is affected. The clinical apperance

is of slowly progressive, necrotising retinitis.is of slowly progressive, necrotising retinitis.

Fundus: white areas of retinal infiltrate and Fundus: white areas of retinal infiltrate and necrosis and haemorrhage within and necrosis and haemorrhage within and

along necrotic area (pizza fundus) along necrotic area (pizza fundus)


AIDS- ocular manifestationsAIDS- ocular manifestations::

CMV retinitisCMV retinitis

Treatment:Treatment:

Antiviral treatment-Antiviral treatment-

Ganciclovir or foscarnet (intravenously Ganciclovir or foscarnet (intravenously

or by intravitreal injection or implant. or by intravitreal injection or implant.

CMV retinitisCMV retinitis

ARN syndromeARN syndrome

PORNSPORNS



3.3. Kaposi sarcomaKaposi sarcoma

A purple or red higly vascular lesion (vascular A purple or red higly vascular lesion (vascular malignancy) which may occur on the malignancy) which may occur on the

eyelids or conjunctiva.eyelids or conjunctiva.

Treatment- Radiotherapy.Treatment- Radiotherapy.

Retinal dystrophiesRetinal dystrophies

Retinitis pigmentosa (RP)Retinitis pigmentosa (RP)::

-- an inherited primary retinal degeneration;an inherited primary retinal degeneration;

-- sometimes associated with systemic sometimes associated with systemic disorders (Usher`s syndrome= RP + disorders (Usher`s syndrome= RP + congenital senorineural deafness)congenital senorineural deafness)



Symptoms:Symptoms:

-- night blindnessnight blindness in childchood in childchood

or adolescence (initial symptom);or adolescence (initial symptom);

-- gradual and progressive peripherial visual gradual and progressive peripherial visual field loss leading to field loss leading to tunnel visiontunnel vision..



Signs:Signs:

-- Fundus-Fundus- classical mid- periphery scattered classical mid- periphery scattered bone spicule pigmentationbone spicule pigmentation, marked , marked

narrowing of the retinal vesselsnarrowing of the retinal vessels and and optic optic atrophyatrophy;;

-- Visual field-Visual field- ring scotoma (early stages), ring scotoma (early stages), tunnel vision (advanced RP).tunnel vision (advanced RP).



Signs:Signs:


• Pigment degeneration and pigment clumping of a retina

suffering from retinitis pigmentosa.



treatment:treatment:

-- at the present time there is no known at the present time there is no known effective treatment.effective treatment.


Macular dystrophiesMacular dystrophies

Hereditary, progressive degeneration of the Hereditary, progressive degeneration of the macula in children and young adults macula in children and young adults

leading to leading to slow deterioration in central slow deterioration in central visionvision (Best`s disease, Stargard`s disease, (Best`s disease, Stargard`s disease,

cone dystrophy, pattern dystrophy);cone dystrophy, pattern dystrophy);


Macular dystrophiesMacular dystrophies

Signs-Signs- Reduced visual acuity; Reduced visual acuity;

Fundus-Fundus- abnormal deposits or pigmentation abnormal deposits or pigmentation at the macula (Bulls eye);at the macula (Bulls eye);

Diagnosis-Diagnosis- electrophysiological tests; electrophysiological tests;

Treatment-Treatment- no; no;

Low vision aids (telescopic spectacles)Low vision aids (telescopic spectacles)

Stargard`s diseaseStargard`s disease

Neuro- ophthalmologyNeuro- ophthalmology

Optic disc swellingOptic disc swelling

Swelling of the optic disc is produced Swelling of the optic disc is produced

by oedema within the nerve head.by oedema within the nerve head.


Optic disc drusenOptic disc drusen

Neuro- ophthalmologyNeuro- ophthalmologyOptic disc swelling- causes:Optic disc swelling- causes:

1.1. Raised intracranial pressure- tumors or Raised intracranial pressure- tumors or impaired CSF drainage; raised intracranial impaired CSF drainage; raised intracranial pressure is transmitted to the meningeal pressure is transmitted to the meningeal

sheath surrounding the optic nerve sheath surrounding the optic nerve (papillooedema); normal axoplasmic flow (papillooedema); normal axoplasmic flow

is interrupted with consequent intra- is interrupted with consequent intra- axonal swelling. axonal swelling.

The vascular featuresThe vascular features (hyperaemia, venous (hyperaemia, venous congestion and haemorrhage) congestion and haemorrhage) are all are all

secondary.secondary.


• The initial change in the The initial change in the ophthalmoscopic examination in a ophthalmoscopic examination in a patient with increased intracranial patient with increased intracranial pressure is the loss of pulsations of the pressure is the loss of pulsations of the retinal vessels. This is followed by retinal vessels. This is followed by blurring of the optic disc margin and blurring of the optic disc margin and possibly retinal hemorrhages. possibly retinal hemorrhages.


Optic disc swelling- causes:Optic disc swelling- causes:

2.2. Ischaemic optic neuropathy- arteritic, Ischaemic optic neuropathy- arteritic, embolic or atherosclerotic blockage of the embolic or atherosclerotic blockage of the posterior ciliary arteries which supply the posterior ciliary arteries which supply the

optic nerve head (ONH); ischaemia of optic nerve head (ONH); ischaemia of ONH, interruption of axoplasmic flow and ONH, interruption of axoplasmic flow and

disc swelling (central retinal vein disc swelling (central retinal vein occlusion, malignant hypertension).occlusion, malignant hypertension).

ANTERIOR ISCHEMIC OPTIC ANTERIOR ISCHEMIC OPTIC

NEUROPATHY (AION)NEUROPATHY (AION)



3.3. Inflammation- papillitis or optic neuritis; Inflammation- papillitis or optic neuritis; idiopathic or associated with multiple idiopathic or associated with multiple

sclesosis, diabetes or post viral.sclesosis, diabetes or post viral.



4.4. Compression- raised intraorbital pressure Compression- raised intraorbital pressure (Graves` disease, retrobulbar hemorrhage, (Graves` disease, retrobulbar hemorrhage,

orbital tumors).orbital tumors).



5.5. Infiltration- lymphoma.Infiltration- lymphoma.



6.6. Toxic- steroids, ethambutol, tobacco; optic Toxic- steroids, ethambutol, tobacco; optic disc swelling and its pallor.disc swelling and its pallor.



7.7. Trauma- direct or indirect optic nerve Trauma- direct or indirect optic nerve trauma; optic disc swelling and its atrophy.trauma; optic disc swelling and its atrophy.


Optic disc swelling:Optic disc swelling:

The term The term papillooedemapapillooedema should be restricted should be restricted to a swollen optic disc due to raised to a swollen optic disc due to raised

intracranial pressure!!!intracranial pressure!!!


Optic disc swelling- symptoms:Optic disc swelling- symptoms:

1.1. Impaired visionImpaired vision- very rapid and severe - very rapid and severe visual loss is typical for visual loss is typical for ischaemicischaemic or or

inflammatoryinflammatory optic disc swelling. optic disc swelling.

Raised intracranial pressure may causes no Raised intracranial pressure may causes no visual symptoms (they are rather visual symptoms (they are rather

secondary);secondary);



2.2. Visual field lossVisual field loss- - ishaemic optic ishaemic optic neuropathyneuropathy- altitudinal visual field defect; - altitudinal visual field defect;

compressioncompression and and toxicitytoxicity- central or - central or centrocaecal visual field defect.centrocaecal visual field defect.

Raised intracranial pressure may causes no Raised intracranial pressure may causes no syptomatic field loss (sometimes syptomatic field loss (sometimes enlargement of the blind spot);enlargement of the blind spot);



3.3. Impaired colour visionImpaired colour vision- - particularly to red particularly to red stimuli;stimuli;

4.4. Pain on eye movements- retrobulbar optic Pain on eye movements- retrobulbar optic neuritis!!!neuritis!!!


Optic disc swelling- signs:Optic disc swelling- signs:-- dilatation of the retinal veins;dilatation of the retinal veins;

-- reddish disc colour, blurred and raised disc reddish disc colour, blurred and raised disc margins;margins;

-- absence of physiological optic disc cup;absence of physiological optic disc cup;

-- small haemorrhages at the disc margin;small haemorrhages at the disc margin;

-- abnormal pupill reflexes;abnormal pupill reflexes;

-- enlarged blind spot or other charakteristic visual enlarged blind spot or other charakteristic visual field defects;field defects;

-- impaired colour visionimpaired colour vision


Optic disc swelling- hypertensive retinopathy:Optic disc swelling- hypertensive retinopathy:

-- the ocular apperances depend on the the ocular apperances depend on the sevserity and duration of the blood sevserity and duration of the blood

pressure elevation;pressure elevation;

-- only an acute severe rise (grades III and IV) only an acute severe rise (grades III and IV) in blood pressure cause visual symptoms;in blood pressure cause visual symptoms;



Grading:Grading:Grade I- Grade I- mild ht (arteriolar attenuation, copper mild ht (arteriolar attenuation, copper

wiring);wiring);

Grade II- Grade II- moderate ht (AV nipping, silver wiring, moderate ht (AV nipping, silver wiring, occasional hard exudate or haemorrhage);occasional hard exudate or haemorrhage);

Grade III- Grade III- severe ht (flame haemorrhages, hard severe ht (flame haemorrhages, hard exudates, cotton wool spots);exudates, cotton wool spots);

Grade IV- Grade IV- malignant ht- as for grade III with optic malignant ht- as for grade III with optic disc swelling.disc swelling.



Grades III and IV can usually be reversed by Grades III and IV can usually be reversed by adequate blood pressure control.adequate blood pressure control.

Grades I an II are more resistant to reversal, Grades I an II are more resistant to reversal, even if blood pressure is normalised.even if blood pressure is normalised.


Optic disc swelling- Multiple Sclerosis (MS):Optic disc swelling- Multiple Sclerosis (MS):

-- most common in temperate climates;most common in temperate climates;

-- young adults (15- 35 years);young adults (15- 35 years);

-- F > M;F > M;

-- aetiology- unknown (virus infection of CNS);aetiology- unknown (virus infection of CNS);- optic neuritis (ON) is the main ophthalmological optic neuritis (ON) is the main ophthalmological

sign which arises as a result of demyelination sign which arises as a result of demyelination

of optic nerve axons.of optic nerve axons.


Optic disc swelling- Multiple Sclerosis (MS):Optic disc swelling- Multiple Sclerosis (MS):symptoms:symptoms:

-- blurring of vision in one eye occuring over a few blurring of vision in one eye occuring over a few days (the visual loss from minimal to even light days (the visual loss from minimal to even light

perception- usually about 0,1);perception- usually about 0,1);

-- central scotoma in visual field;central scotoma in visual field;

-- pain on moving the eye;pain on moving the eye;

-- RAPD (relative afferent pupil defect);RAPD (relative afferent pupil defect);

-- gradual recovery of vision (even without gradual recovery of vision (even without

a treatment, over several weeks)a treatment, over several weeks)


Optic disc swelling- Multiple Sclerosis (MS):Optic disc swelling- Multiple Sclerosis (MS):symptoms:symptoms:

-- the disc swelling is not typical for ON the disc swelling is not typical for ON

in MS because in more cases it is in MS because in more cases it is

a retrobulbar neuritis; there is no fundus a retrobulbar neuritis; there is no fundus anomaly in retrobulbar ON!!!anomaly in retrobulbar ON!!!


Optic disc swelling- Multiple Sclerosis (MS):Optic disc swelling- Multiple Sclerosis (MS):Neurological signs:Neurological signs:

-- ataxia,ataxia,

-- parashesiae,parashesiae,

-- nystagmus,nystagmus,

-- strabismus;strabismus;

-- plaques of demyelination in MRI scans;plaques of demyelination in MRI scans;


Optic disc swelling- Multiple Sclerosis (MS):Optic disc swelling- Multiple Sclerosis (MS):

Following an isolated attack of adult optic Following an isolated attack of adult optic neuritis the risk of developing MS neuritis the risk of developing MS

is approximately 50 per cent!!!is approximately 50 per cent!!!


Optic Atrophy:Optic Atrophy:

Any damage to the optic nerve from whatever Any damage to the optic nerve from whatever cause, will result in cause, will result in degeneration of the degeneration of the

optic nerve fibresoptic nerve fibres and and destruction of their destruction of their myelin nerve sheathsmyelin nerve sheaths. The dead nerve fibre . The dead nerve fibre axons are replaced by glia which give the axons are replaced by glia which give the atrophic disc its typical ophthalmoscopic atrophic disc its typical ophthalmoscopic

pale apperancepale apperance..



Primary-Primary- often hereditary basis; often hereditary basis;

Secondary-Secondary- any cause of optic disc swelling any cause of optic disc swelling may be followed by the development of may be followed by the development of

optic atrophy!!!, several of these diseases optic atrophy!!!, several of these diseases may cause optic atrophy without an may cause optic atrophy without an

observed episode of disc swelling (optic observed episode of disc swelling (optic nerve compression, toxic optic nerve compression, toxic optic

neuropathy).neuropathy).



Secondary-Secondary- certain retinal disorders don`t certain retinal disorders don`t cause optic disc swelling but do cause cause optic disc swelling but do cause

optic atrophy (glaucoma- typical ON optic atrophy (glaucoma- typical ON atrophy with cupping of the ONH!!!, atrophy with cupping of the ONH!!!,

retinitis pigmentosa, central retinal artery retinitis pigmentosa, central retinal artery occlusion).occlusion).


Optic Atrophy- signs and symptoms:Optic Atrophy- signs and symptoms:

-- focal or generalised disc pallor;focal or generalised disc pallor;

-- sharper disc margins;sharper disc margins;

-- diminished visual acuity;diminished visual acuity;

-- visual field defects;visual field defects;


Optic Atrophy- signs and symptoms:Optic Atrophy- signs and symptoms:

normal fundus ophthalmoscopy direct indirect normal fundus

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