First clinical college of ZZU

The diseases of visual pathway

视 路 疾 病
Neuro-ophthalmology
First clinical college of ZZU Introduction

• Ⅰ Anatomy of visual pathway

• Ⅱ Symptoms and signs of visual pathway
disorders
• Ⅲ Diagnosis of visual pathway disorders
• Ⅳ Therapy of visual pathway disorders
 First clinical college of ZZU Introduction
Ⅰ. visual pathway includes
from retina to cerebral visual cortex
• Retina: The rods and cones –
bipolar cells –ganglion cells (1.2 m)
• Axons of the ganglion cells converge
First clinical college of ZZU

Anatomy of visual pathway

 optic nerve, optic chiasm,
 optic tract, lateral geniculate body
 optic radiations
 bilateral occipital lobe cortex
First clinical college of ZZU

Ⅱ. Symptoms and signs visual pathway disorders

 Visual loss 视力丧失
 Visual field defects 视野缺损
 Pupil reflex abnormal: RAPD 瞳孔异常
 Fundus: changes of optic disc 视盘改变
Other examinations
 Colour test 色视觉检查
 VEP 视觉诱发电位
 CT and MRI
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Ⅲ. Diagnosis of visual pathway disorders

 History ( present and past )
 Clinical manifestation:
visual loss, visual field defects,
pupil reflex abnormal, Fundus changes
 other test: colour test, FFA, VEP
 Neuroimaging: CT, MRI
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Ⅲ. Diagnosis of visual pathway disorders

根据病变的部位
• Diseases of optic nerve 视神经疾病
from optic disc to optic chiasm
• Diseases of optic chiasm 视交叉疾病
• Diseases of retrachiasmatic optic pathwa
y 视交叉后疾病
First clinical college of ZZU

Ⅲ. Diagnosis of visual pathway disorders

Common causes
• Infection and inflammation 感染和炎症
• Degeneration 变性
• Ischemia and infarct 缺血和梗死
• Tumor 肿瘤
• Trauma 外伤
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Ⅳ. Therapy of visual pathway disorders

 Medication 药物治疗
 Surgery 手术治疗
 Radiotherapy 放射治疗
 Chemotherapy 化疗
 First clinical college of ZZU Visual field 视野

White isoptes
• Superior 55 degree
• Media 60
• Inferior 70
• Lateral 90
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Analysis of visual fields in visual pathway lesions

 lesions before chiasm
Total blindness(unilateral visual field defect)
 chiasmal lesions
bitemporal defects
hemianopia
 lesions after chiasm
homonymous defects
First clinical college of ZZU
First clinical college of ZZU

Diseases of visual pathway 视路疾病

1. optic neuritis
2. Anterior ischemic optic neuropathy
3. Optic glioma
4. Meningioma
5. Chiasm Tumors
6. Lesions of retrochiasmatic visual pathway
First clinical college of ZZU 1. optic neuritis
 Clinical types: papillitis 35% 视神经炎
临床类型 retrobulbar neuritis 65%
球后视神
经炎
 Etiology:
demyelination 脱髓鞘
virus infection 病毒感染
inflammation 炎症
remain unknown, above 50% 不明原因
 First clinical college of ZZU 1. optic neuritis
Manifestations in papillitis
 acute vision loss 急性视力下降
 pupil dilated: 瞳孔散大
relative afferent
pupillary defect
 disc edema and hyperemia
blured disk margin
retinal edema and exudate
 First clinical college of ZZU 1. optic neuritis
Manifestations in retrobulbar neuritis
 subacute monocular or bilateral vision loss
 optic disc: maybe normal
 pupil dilated: relative afferent pupillary defect
 Periorbital pain: particularly while eye
movement
 visual fields: diffuse loss within central 30 field
or isolated central scotoma
 VEP: P100 delay
First clinical college of ZZU 1. optic neuritis

 Treatment 治疗
corticosteroid, iv 糖皮质激素
antibiotic 抗生素
vasodilator and vitamin B 扩血管药

 Prognosis: 20/40 or better in 95% cases

recurrence rate in 28% cases
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 2. Anterior ischemic optic neuropathy
First clinical college of ZZU (AION)

• Etiology: infarction of retrolaminar optic ne

rve
compromise of optic disc microcirculation
• Patients: mean age, 60 years (AION)

• 前段缺血性视神经病变
 First clinical college of ZZU (AION)
Manifestations
 Acute vision loss– painless momocular,
>0.1 in 60%, patients
 Fundus: disc edema, splinter hemorrhages
 Visual field defect : arcuate scotoma
 RAPD: relative afferent pupillary defect
 FFA: decreased perfusion in optic disc disk leakage
First clinical college of ZZU (AION)

Therapy
 no effective therapy
 The goal of therapy: prevent
contralateral viaual loss
 steroid, low-dose aspirin
vasodilator
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 First clinical college of ZZU 3. Optic glioma
视神经胶质瘤
 Optic glioma: the most common primary tumor of
the optic nerve in childhood
 Signs: proptosis, visual loss, optic disc pallor, dis
c edema, strabismus
 CT, MRI: enlargement of optic disc
 Treat: excision, radiotherapy
chemotherapy
First clinical college of ZZU 3. Optic glioma
First clinical college of ZZU 4. meningioma

meningioma in optic nerve sheath

 Onset age: Usually occur in 40-50 years adult
 Manifestation: Painless, slowly progressive
monocular visual loss
 Fundus: Optic edema or atrophy
Optociliary shunt vessels
 Treatment: Radiation therapy with vision
surgical excision without vision
First clinical college of ZZU
First clinical college of ZZU
First clinical college of ZZU 5. Chiasm Tumors

Chiasm Tumors
 pituitary adenoma
 craniopharyngioma
 suprasellar meningioma
 chiasmatic glioma
First clinical college of ZZU 5. Chiasm Tumors

Symptoms and Signs

 vision loss
 bitemporal hemianopia defect
 pituitary dysfunction
 extraocular muscle nerve palsies
First clinical college of ZZU
First clinical college of ZZU 5. Chiasm Tumors

• CT and MRI
sellar or suprasellar tumor
• Therapy: radiotherapy
surgery
medicion: bromocriptine
First clinical college of ZZU
First clinical college of ZZU

6. Lesions of retrochiasmatic visual pathway

Etiology
 cerebrovascular diseases
 tumors
 trauma
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• Minifestation:
 homonymous fiel
d defect
 headach
 disk swelling
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Diagnosis 诊断
 CT
 MRI
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6. Lesions of retrochiasmatic visual pathway

　 Therapy
 Neurosurgery and Radiotherapy
if tumors and trauma
 Neurology: if cerebrovascular diseases
medical therapy
First clinical college of ZZU
First clinical college of ZZU
First clinical college of ZZU