retrobulbar optic neuritis
Introduction
Introduction Retrobulbar neuritis is generally divided into acute and chronic, and the latter is 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 of fibers in the posterior segment of the posterior segment of the optic nerve, 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 neuritis around the nerve. This is only a pathological change and is not easily diagnosed clinically.
Cause
Cause
Acute cases are mostly caused by adjacent inflammatory lesions, such as sinusitis, especially in the posterior group of ethmoid sinus and sphenoid sinus inflammation or cysts are more likely to be misdiagnosed. Lead, arsenic, methanol, ethanol and other poisoning, sputum cellulitis, skull base meningitis, etc. can be caused; chronic patients are mostly lack of vitamin B family, pregnancy and breastfeeding, diabetes, demyelinating disease (multiple sclerosis is not in China) Rare, but it is still significantly less than in the West. Optic neuromyelitis is now considered to be a multiple sclerosis variant), and idiopathic spondylosis caused by familial optic atrophy (Leber disease) still accounts for about 1/2.
Examine
an examination
Related inspection
Visual field examination fundus inspection vision
According to vision and fundus, especially visual field examination, typical is easy to diagnose. Color vision contrast sensitivity test and VEP examination have certain diagnostic significance. Abnormal cells in the cerebrospinal fluid, increased -globulin, increased viral antibody titer, etc., should be suspected to be multiple sclerosis. Monoclonal antibodies in cerebrospinal fluid can be increased by 90%, but non-specific HLA-A3 and B7 are also helpful in diagnosis.
Often a single eye disease, but also can affect both eyes, more rapid vision loss, or even no light. The pupil is moderately large and directly responds to light or disappears. There is traction pain or deep pain during eye movement. Early fundus is normal, late, may have varying degrees of degree of optic disc. The field of view has a center, a side center and a dumbbell-shaped dark spot, and the surrounding field of view is also reduced. Emphasis should be placed on examining the central field of view rather than the surrounding field of view, while emphasizing the use of red, as much as possible with small visual targets. When exercising or bathing, there is a temporary blurred vision, and when the temperature is cold or drinking, the vision can be improved. This phenomenon is called Unthoff. More common in multiple sclerosis and Leber disease caused by optic neuritis, this is also seen in other optic neuritis. It is speculated that the sign and the increase in body temperature can directly interfere with the transmission of axonal and release chemical substances.
Diagnosis
Differential diagnosis
The disease should be considered for identification with the following diseases:
1, ametropia: especially for 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 symptomatic of sexually transmitted diseases.
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: the pupil has no change, there are seizure characteristics. The visual field examination is spiraled down. There is a clear history of incentives. It 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.
