retrobulbar optic neuritis
Introduction
Introduction to posterior optic neuritis Retrobulbar neuritis (Retrobulbarneuritis) is generally divided into acute and chronic, and the latter are more common. Because the optic nerve is invaded by different parts, the posterior optic nerve can be divided into many different types. The lesion most often invades the optic disc macular bundle fiber. Because the bundle fiber is in the central part of the optic nerve in the posterior segment of the ball, it is also known as axial neuritis. When the lesion is invaded by the nerve sheath through the surrounding fiber bundle of the optic nerve, it is called the neuritis around the nerve. This is only a pathological change. It is not easy to be diagnosed clinically. If the optic nerve fiber is involved in the whole cross-cut, there is no light perception. Transverse optic neuritis. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: optic atrophy
Cause
Posterior optic neuritis
Multiple sclerosis (30%):
About one-third of such patients develop optic neuritis during their disease. About 15% of patients with multiple sclerosis have optic neuritis, and then gradually develop other symptoms. Demyelinating lesions of multiple sclerotic nerve fibers often lead to severe visual impairment. Although visual acuity can be partially restored after a few weeks, it can recur after a period of time. Repeated episodes can make vision worse and worse. Although the incidence of demyelinating diseases such as multiple sclerosis in China is low, there has been an increasing trend in recent years.
B vitamin deficiency (30%):
It can cause bilateral optic neuritis, but people with normal life rarely have vitamin deficiency. Therefore, this disease occurs mostly in people who have been drinking too much for a long time and those who are hungry. Lack of vitamin B1, the metabolism of carbohydrates in the body will be disordered, can not complete its normal tricarboxylic acid cycle, resulting in the accumulation of excessive pyruvic acid in the body, this substance is easy to damage the optic nerve, especially the macular bundle fiber that maintains acute central vision .
Poisoning (20%):
Poisoning can damage the optic nerve, especially if the patient has both malnutrition. Long-term use of dry smoke or pipes, especially those who have excessive drinking or malnutrition at the same time. Because tobacco contains cyanide, the latter will destroy the vitamin B12 in the blood, leading to the deficiency of vitamin B12, causing optic nerve damage and optic neuritis. Some people think that such patients may be deficient in the cyanide detoxification function inherent in their body, which leads to the accumulation of cyanide. Vitamin B12 can be combined with cyanide to make it lose its toxicity.
Prevention
Posterior optic neuritis prevention
The onset of the disease is rapid, and the visual acuity is seriously degraded. Once diagnosed, the combination of Chinese and Western methods should be actively used to rescue vision. During the illness, care should be taken to avoid emotional stimuli. If it is due to lactation, it should be weaned immediately. Postpartum disease, pay attention to strengthen nutrition.
Complication
Posterior optic neuritis complications Complications optic atrophy
Multiple sclerosis can occur concurrently, leading to optic atrophy and even blindness in the advanced stage.
Symptom
Posterior optic neuropathy symptoms Common symptoms Responsive inferior ball optic neuritis
Often monocular onset, can also affect both eyes, more rapid vision loss, or even no light perception, pupil dilated, direct response to light or disappear, eye movements have traction pain or deep pain, early fundus normal, late There may be different shades of the disc, the center of the field of view, the center and the dumbbell-shaped dark spots, as well as the reduction of the surrounding field of view, should emphasize the inspection of the central field of view rather than the surrounding field of view, while emphasizing the use of red, as much as possible Small visual inspection.
Examine
Posterior optic neuritis examination
1. Fundus changes: visual papillary congestion, mild elevation (below 3D), marginal dysfunction, disappearance of physiological depression, retinal vein filling and distortion, retinal edema around the nipple, flaming hemorrhage and yellow-white exudation Sometimes it can affect the macula and cause reflex edema and wrinkles in the macula. In the posterior optic neuritis, the early fundus is basically normal, the color of the late optic papilla is lightened, and the optic nerve is atrophied.
2. Visual field change: manifested as a central dark spot or a side dark spot.
3. Electrophysiological examination: visual evoked potentials showed prolonged P wave latency and decreased amplitude.
4. Fundus fluorescein angiography: Early venous nipple surface fluorescence leakage and blurred edges in papillitis. Intense venous phase. It can be used to identify diseases with similar changes in the fundus and confusion, because the examination of the optic nerve patients is normal.
Diagnosis
Diagnosis and differentiation of retrobulbar optic neuritis
diagnosis
Diagnosis can be performed based on clinical performance and laboratory tests.
Differential diagnosis
The disease should be considered for identification with the following diseases:
1, ametropia: especially hyperopia and astigmatism, may have eye pain, headache and unclear vision, optic disc changes similar to optic discitis, easily misdiagnosed, optometry can confirm that the glasses can be sexually conscious symptoms.
2, corneal thin sputum or crystal posterior sac is slightly confused: mostly due to negligence in clinical examination, can be diagnosed by slit lamp examination.
3, rickets black Mongolian: no change in the pupil, there are paroxysmal features, visual field examination spiral reduction, a clear history of inducement, can be treated by suggestive therapy.
4, fraud: Although the complaint has obvious visual impairment, but long-term objective examination has no positive findings, a variety of fraud tests can help identify, VEP can be immediately ruled out.
5, intracranial tumors: especially the saddle area occupying lesions, early can be retrobulbar optic neuritis changes, visual field and head X-ray can help diagnosis, head CT and MRI are more helpful for early detection.
