optic disc
Introduction
Introduction to optic discitis Optic discitis is an acute inflammation of the optic nerve in the immediate vicinity of the eyeball segment. The acute visual impairment of the onset is severely affected by both eyes and is easily confused with optic disc edema. Optic discitis mainly manifests as severe visual impairment. Most patients have blurred vision in both eyes (several or single eye), severe visual impairment in one or two days, and even no light perception. There are many reasons for optic discitis, such as meningitis, pneumonia, influenza, scarlet fever, sepsis, viral infection with lead or other drug poisoning, eyelid cellulitis, uveitis, tuberculosis syphilis, and breast-feeding anemia. basic knowledge The proportion of illness: 0.3% Susceptible people: no specific population Mode of infection: non-infectious Complications: meningitis, influenza, measles, typhoid, syphilis
Cause
Cause of optic discitis
(1) Causes of the disease
There are many reasons for optic discitis, such as meningitis, pneumonia, influenza, scarlet fever, sepsis, viral infection, lead or other drug poisoning, eyelid cellulitis, uveitis, tuberculosis, syphilis, and breastfeeding, anemia, etc. In addition, about half of the cases are still unable to detect the cause by the current examination method. In addition, demyelinating diseases of the central nervous system, such as multiple sclerosis, optic neuromyelitis (Devic disease), can also be manifested as optic discitis. Domestic idiopathic occupants account for about 1/2, which is thought to be related to allergic allergic reactions, which are common in children due to upper respiratory tract infections.
(two) pathogenesis
The pathogenesis is unknown.
Prevention
Optic discitis prevention
Usually should avoid tobacco, alcohol, spicy, spicy, fried food. You should choose some light, digestible, and nutritious foods in your life. In general, you should pay attention to eating more fresh fruits, vegetables, and cold vegetarian dishes. In life, you should pay attention to eating more animal liver, milk, egg yolk, but do not overeating. Eat more foods containing vitamin B1, do not eat a lot of sweets.
Complication
Optic discitis complications Complications meningitis influenza measles typhoid syphilis
Common in systemic acute or chronic infectious diseases, such as meningitis, influenza, measles, typhoid, mumps, tuberculosis, syphilis, etc., can also be secondary to inflammation of the eyelids, sinuses, teeth, etc., can also have optic disc atrophic changes .
Symptom
Symptoms of optic discitis common symptoms visual field defect nausea black nodular response slow dizziness
Vision is drastically reduced. In the short term (2 to 5 days), it is possible to go to Hei Meng, and there is also a loss of vision. In the early stage (1 to 2 days), there was pain in the forehead, deep pain in the eyeballs and eyelids, and traction pain in the movement of the eyeballs. It rarely exceeds 10 to 14 days, otherwise the diagnosis should be reconsidered. Vision often begins to recover within 1 to 4 weeks, lasting for 7 months, and 48% can be improved. The pupils are often scattered, directly responding to light or disappearing, and indirectly reacting to light. Inspection with an infrared pupil is more objective and quantitative. The incubation period of the pupillary cycle is significantly prolonged. Fundus examination of the fundus was congested, mildly bulged, the edges were unclear, the sieve plate was blurred and the physiological depression disappeared. The omental edema around the optic disc was radially streaked, there was small bleeding on the surface and edge of the optic disc, and the retinal vein was angulated and sheathed. When retinal edema affects the macula, and there is bleeding and exudate, it is called optic retinitis. After 4 to 6 weeks, the optic disc can undergo secondary atrophy.
Symptom
Most patients have double eyes (a few can also be single eyes), sudden vision blur, severe visual impairment in a day or two, or even no light perception, before or at the onset of the disease, the swelling of the optic nerve affects the muscles near the muscle cone. The muscle sheath produces the feeling of pain in the back of the eyeball or pain after the ball turns. A small number of patients have headaches and dizziness, but there is no nausea and vomiting.
2. Signs
The external eye is generally normal, but the pupil has a large degree of divergence; the direct and indirect light reflection of the pupil disappears completely in the absence of light in both eyes; in the case of severe visual impairment, the light reflection of the pupil is obviously weakened or retarded, and the monocular patient suffers from The lateral pupil may have a relative pupillary afferent disorder (Marcus Gunn sign).
Fundus examination: the optic disc is congested, the boundary is blurred, and the optic disc is edema, but the degree of edema is generally mild, the degree of bulging is no more than 2 to 3 diopters, the retina around the optic disc is also edema, retinal vein filling, varicose veins, arteries generally no significant change Sometimes there are a few small flaming hemorrhage around the optic disc, and there is less exudation. Some patients with edema are not limited to the optic disc and the retina nearby. The retina of the posterior fundus has obvious edema, grayish white, and enhanced reflection, called optic nerve. Retinitis (neuroretinitis), some patients have some inflammatory cells in the vicinity of the optic disc or in the posterior vitreous of the posterior fundus.
In the secondary atrophy of the late optic nerve, the color of the optic disc is diminished, the arteries become thinner, and there may be pigmentation on the retina. These changes may begin 2 to 3 weeks after the onset of the disease.
Examine
Optic discitis check
Exclusion laboratory tests can be performed on the primary disease that causes optic discitis.
1. Visual field examination The visual field change of optic discitis is mainly due to the appearance of a huge central dark spot. The central dark spot is large and dense; the surrounding visual field generally does not change much, but it can also have a slight centripetal narrowing, a physiological blind spot is slightly larger, and the inflammation is severe. At the time, the surrounding visual field can also have obvious centripetal contraction. When the disease is serious, there is no light perception, and the affected eye is completely blind.
2. Fundus fluorescein angiography is valuable for the identification of burial hyaline membrane disease with pseudo-opic discitis and optic disc.
According to vision, fundus and visual field are generally not difficult to diagnose, but should be differentiated from optic disc edema (Table 1). Color vision examination has certain auxiliary diagnostic significance. It is also valuable for observing the condition and treating treatment effect. Color vision disorder can be improved with the condition. And improvement, contrast sensitivity measurement, visual transmission power generation level, etc. have certain diagnostic value, in order to rule out the possibility of oppressive optic neuropathy, if necessary, should be performed by sand skull X-ray or CT examination, optic neuritis with normal vision, should pay attention Check the presence or absence of cells in the vitreous, the visual field defects of the nerve fiber bundle and the Marcus-Gunn pupillary phenomenon. If the retinal vein is added, there are also vitreous cells, sarcoidosis and multiple sclerosis and other systemic diseases must be suspected.
Diagnosis
Disc diagnosis of discitis
According to vision, fundus and visual field, it is not difficult to diagnose, but it should be differentiated from optic disc edema. Color vision examination has certain auxiliary diagnostic significance. It is also valuable for observing the condition and treatment effect. Color vision disorder can be improved with the improvement of the condition. Sensitivity measurement, visual permeation power generation, etc. have certain diagnostic value. In order to eliminate the possibility of oppressive optic neuropathy, sand cranial X-ray or CT examination should be performed if necessary. Normal optic neuritis should be checked for vitreous presence. Cell, nerve fiber bundle visual field defect and Marcus-Gunn pupil phenomenon, such as the discovery of retinal vein sheathing, and vitreous cells, sarcoidosis and multiple sclerosis and other systemic diseases must be suspected.
The differential diagnosis between optic discitis and optic disc edema is that the latter has many headaches, vomiting and other history. Even if the optic disc edema is as high as 6 to 9 diopters, its visual function is normal, or there is a special history of paroxysmal erythema. Common, exudation is also common, the physiological blind spot is enlarged and the surrounding visual field is normal. The fluorescein angiography image of optic discitis is very similar to optic disc edema. It is not possible to distinguish optic discitis from optic disc edema based on fluorescein angiography.
