The term optic neuropathy is used for all conditions affecting the optic nerve.
1. Inflammatory (demyelinating, infectious, autoimmune)
2. Ischemic optic neuropathies
3. Compressive-infiltrative
4. Toxic-nutritional
5. Traumatic
6. Due to radiation
7. Hereditary causes
Inflammatory Optic Neuropathies
Optic Neuritis
The initial complaint is pain with eye movements.
After a few days, vision decreases and color vision deteriorates. Relative afferent pupillary defect occurs (RAPD+).
The sense of depth is reduced.
Typically, in multiple sclerosis, vision is impaired when playing sports or when body temperature rises (Uhthoff sign).
Visual field defects in optic neuritis: Central scotoma, centrocecal scotoma .
Optic neuritis is divided into three:
1. Retrobulbar neuritis
It is an inflammation of the posterior part of the optic nerve.
The most common comorbid disease is multiple sclerosis.
For retrobulbar neuritis; It is said that neither the doctor sees nor the patient sees.
2. Papillitis
It is the most common type of optic neuritis in childhood.
It often starts post-infectious and unilateral.
Papilledema, candle flame hemorrhages are seen.
3. Neuroretinitis
There is a star appearance in the papillitis and macula.
Cat-scratch disease is responsible for 60%. 25% idiopathic, other causes are syphilis, Lyme, mumps, leptospirosis.
Ischemic optic neuropathies
It is a picture characterized by optic nerve head ischemia, edema and secondary optic atrophy in the chronic phase as a result of occlusion in the short posterior ciliary arteries. Altitudinal visual field defects are observed.
Anterior ischemic optic neuropathy
1. Arteritic anterior ischemic neuropathy:
Optic nerve infarction develops as a result of closure of the short posterior ciliary arteries due to granulomatous necrotizing arteritis associated with giant cell arteritis.
Seen in temporal arteritis and SLE
Steroids are used for treatment.
2. non-arteritic anterior ischemic neuropathy
It is an optic nerve head infarction caused by occlusion of the short posterior ciliary arteries.
Common in hypertension and diabetes
steroids are useless
Toxic optic neuropathies
Anterior toxic neuropathy generally has bilateral optic disc swelling and scotomas involving the blind spot.
Chloramphenicol
Ethambutol
isoniazid
Lead
Retrobulbar toxic optic neuropathy, on the other hand, is progressive, bilateral, scotomas and pallor of the temporal part of the optic disc.
Vitamin B deficiency
o Malabsorptions
o Cigarette-alcohol addicts (tobacco-alcohol amblyopia)
o Antipyrine
o Digital
o Quinine
o Streptomycin
