OPTIC NEURITISAstrid feliasari I 11107063

DEFINITIONOptic neuritis is an inflammation of the optic nerve, the structure that connects the eye to the brain.

EPIDEMIOLOGYOptic 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 1Papillitis.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.Autoimmune disordersThese include lupus erythematosus, polychondritis, regional enteritis (Crohns disease), ulcerative colitis, nodular panarteritis,cand Wegeners granulomatosis.

ETIOLOGY 2Retrobulbar 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

SYMPTOMSThe cardinal symptom is : loss of visionThe 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 1Ophthalmoscopic 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 2The 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 DIAGNOSISPapilledemaInitially there is no loss of function.Ischemic optic neuropathyThe central scotoma is lacking, and patients are usually over the age of 60.

TREATMENT high doses of steroids1000mg 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

DEFINITIONA retinal detachment is a separation of the sensory retina from the underlying retinal pigment epithelium (RPE).

CLASSIFICATION 1RhegmatogenousThe most common type of retinal detachmentResults 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 2The 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 3Tractional 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%)

ETIOLOGYRhegmatogenous 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.

SYMPTOMSLoss of visual acuityFloaters (floating object fisibility)Photopsia /light flashed (flashes of light)dark shadow in the visual fieldBlack rain

DIAGNOSTIC CONSIDERATIONS 1The 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 2The 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.

TREATMENTargon 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.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.

PROPHYLAXISHigh-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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