NEURONEURO

OPHTHALMOLOGYOPHTHALMOLOGY

NEURONEURO

OPHTHALMOLOGYOPHTHALMOLOGY

Pavel StodůlkaPavel Stodůlka

VISUAL PATHWAY

VISUAL PATHWAYVISUAL PATHWAY

1. 1. RETINARETINA

2. 2. OPTICAL NERVEOPTICAL NERVE

3. CHIASMA3. CHIASMA

4. 4. OTICAL TRACTOTICAL TRACT

5. 5. VISUAL CORTEX – area striataVISUAL CORTEX – area striata

Clinical point of view:

VISUAL PATHWAYVISUAL PATHWAY

1. 1. NEURON – cones & rodsNEURON – cones & rods

2. 2. NEURON – bipolNEURON – bipolar cells of retinaar cells of retina

33. NEURON - gangli. NEURON - ganglionon cellscells ((nervus opticusnervus opticus))

44. NEURON – . NEURON – cells from corpus cells from corpus

geniculatum lat. geniculatum lat. (radiatio optica)(radiatio optica)

Anatomical point of view:

VISUAL PATHWAY

OPTIC HEAD PATHOLOGYOPTIC HEAD PATHOLOGY

1. PAPIL1. PAPILLEDEMALEDEMA

2. NEURITI2. NEURITISS

3. NEUROPAT3. NEUROPATHYHY

4. 4. OPTIC HEAD OPTIC HEAD ATROATROPHYPHY

DIRECT DIRECT OPHTHALMOSCOPEOPHTHALMOSCOPE

INDIRECT OPHTHALMOSCOPEINDIRECT OPHTHALMOSCOPE

DDISCISC::sharp edgessharp edgesflatflatphysiological colourphysiological colour

OPTIC HEAD PATHOLOGY

OPTIC HEAD PATHOLOGY

1. 1. PAPILLEDEMAPAPILLEDEMA

2. NEURITI2. NEURITISS

3. NEUROPAT3. NEUROPATHYHY

4. 4. OPTIC HEAD OPTIC HEAD ATROATROPHYPHY

PAPILLEDEMAPAPILLEDEMA

It is not a disease It is not a disease

butbut a sign of increased a sign of increased

intracranial (or intraorbital) pressure.intracranial (or intraorbital) pressure.

PAPILLEDEMAPAPILLEDEMA

prominenceprominence

blurry edgesblurry edges

haemorhaemorhhagies agies

““Champane corkChampane cork““

DDISCISC::sharp edgessharp edgesflatflatphysiological colourphysiological colour

PAPILPAPILLEDEMLEDEMAA

PAPILLEDEMAPAPILLEDEMA

Obvious pathology on the disc Obvious pathology on the disc

but no visual problemsbut no visual problems..

Increased intracranial pressure

Increased intracranial pressure

PPapilapilledemledemaa is present is present

BILATERALBILATERAL..

Increased intracranial pressure ??

Increased intracranial pressure ??

Increased intracranial pressure

Increased intracranial pressure

Intracranial expansionIntracranial expansion

PAPILLEDEMAPAPILLEDEMA

AbsoluteAbsolute

CCONTRAINDIONTRAINDICATIONCATION

of of lumblumbalal pun puncturecture..

OPTIC HEAD PATHOLOGY

OPTIC HEAD PATHOLOGY

1. PAPIL1. PAPILLEDEMLEDEMAA

2. NEURITI2. NEURITISS

3. NEUROPAT3. NEUROPATHYHY

4. 4. OPTIC HEAD OPTIC HEAD ATROATROPHYPHY

NEURITISNEURITIS

1. NEURITIS 1. NEURITIS INTRAINTRAOCULARISOCULARIS

2. NEURITIS 2. NEURITIS RETRORETROBULBARISBULBARIS

NEURITIS INTRAOCULARIS

NEURITIS INTRAOCULARIS

1. 1. blurry edges of optic headblurry edges of optic head

2. h2. haaemorhagieemorhagiess

3. 3. decreased visual accuitydecreased visual accuity

neuritis intraocularisneuritis intraocularis

neuroretinitisneuroretinitis

NEURITIS INTRAOCULARIS

NEURITIS INTRAOCULARIS

brain infectionsbrain infections, meningitis, , meningitis,

infectious diseasesinfectious diseases

Ethiology:

NEURITIS RETROBULBARIS

NEURITIS RETROBULBARIS

Marked visual deteriorationMarked visual deterioration, ,

but no pathologies on optic head.but no pathologies on optic head.

NEURITIS RETROBULBARIS

NEURITIS RETROBULBARIS

Patient does not see anythingPatient does not see anything,,

doctor does not see anything too.doctor does not see anything too.

NEURITIS RETROBULBARIS

NEURITIS RETROBULBARIS

Sclerosis multiplexSclerosis multiplex

Ethiology:

OPTIC HEAD PATHOLOGY

OPTIC HEAD PATHOLOGY

1. PAPIL1. PAPILLEDEMLEDEMAA

2. NEURITI2. NEURITISS

3. NEUROPAT3. NEUROPATHYHY

4. 4. OPTIC HEAD OPTIC HEAD ATROATROPHYPHY

OPTIC HEAD PATHOLOGY

OPTIC HEAD PATHOLOGY

1. PAPIL1. PAPILLEDEMLEDEMAA

2. NEURITI2. NEURITISS

3. NEUROPAT3. NEUROPATHYHY

4. 4. OPTIC HEAD OPTIC HEAD ATROATROPHYPHY

DEGENERATIONSDEGENERATIONS

NEUROPATNEUROPATHIESHIES

NEUROPAHTIESNEUROPAHTIES

1. 1. inherited inherited

2. 2. acquiredacquired - a) - a) exogenexogenousous

- b) endogen- b) endogenousous

EXOGENOUS NEUROPATHIES

EXOGENOUS NEUROPATHIES

1. 1. ethanolethanol

2. 2. tabaccotabacco

3. psycho3. psychopharmacspharmacs

4. 4. mmetethanolhanol

METHANOL INTOXICATION

METHANOL INTOXICATION

Patient is sleepy the next day with Patient is sleepy the next day with

vomiting and high heart rate.vomiting and high heart rate.

Delirium and spasms are signs of bad Delirium and spasms are signs of bad

prognosis.prognosis.

If they survive they become blind.If they survive they become blind.

Acute event with dramatic scenario. Acute event with dramatic scenario.

10 ml of methanol is enough for intoxication.10 ml of methanol is enough for intoxication.

METHANOL INTOXICATION

METHANOL INTOXICATION

How does methanol harm ??How does methanol harm ??

MetMethhanol anol molecule is been split and molecule is been split and

products are toxic products are toxic

for retinal ganglion cells. for retinal ganglion cells.

METHANOL INTOXICATION

METHANOL INTOXICATION

NEUROPAHTIESNEUROPAHTIES

1. 1. inherited inherited

2. 2. acquiredacquired - a) exogen - a) exogenousous

- - b) endogenb) endogenousous

ENDOGENOUS NEUROPATHIESENDOGENOUS

NEUROPATHIES

1. 1. diabeticsdiabetics

2. 2. pregnancy and brest feedingpregnancy and brest feeding

3. an3. anaaememiaia

4. 4. undernourishmentundernourishment

OPTIC HEAD PATHOLOGY

OPTIC HEAD PATHOLOGY

1. PAPIL1. PAPILLEDEMLEDEMAA

2. NEURITI2. NEURITISS

3. NEUROPAT3. NEUROPATHYHY

4. 4. OPTIC HEAD OPTIC HEAD ATROATROPHYPHY

OPTIC HEAD PATHOLOGY

OPTIC HEAD PATHOLOGY

1. PAPIL1. PAPILLEDEMLEDEMAA

2. NEURITI2. NEURITISS

3. NEUROPAT3. NEUROPATHYHY

4. 4. OPTIC HEAD OPTIC HEAD ATROATROPHYPHY

Optic nerve atrophyOptic nerve atrophy

Manifestation of pathology of Manifestation of pathology of

2. neuron of visual pathway. 2. neuron of visual pathway.

pale discpale disc

Optic nerve atrophyOptic nerve atrophy

ATROATROPHPHIA SIMPLEXIA SIMPLEX

ATROATROPHPHIA GLAUCOMATOSAIA GLAUCOMATOSA

ATROATROPHPHIIAA FLAVA FLAVA

Optic nerve atrophyOptic nerve atrophy

GlaucomatousGlaucomatousdiscdisc

BREAKBREAK ! !

Pavel Stodůlka,Pavel Stodůlka, MD, MD, PhDPhD

stodulkastodulka@@lasiklasik.cz.cz

www.LASIK.czwww.LASIK.cz