Ischemic optic disc disease

Introduction to ischemic optic disc disease Ischemic optic neuropathy (ischemicoptico-neuropathy) refers to an acute dystrophic disease of the vascular circulatory dysfunction of the optic nerve. Generally, the central retinal artery enters the optic nerve about 9 to 11 mm behind the ball, and is divided into the anterior segment and the posterior segment. Segmental ischemic optic neuropathy. The circulatory disorder of the posterior ciliary artery supplying the optic disc causes acute ischemia and hypoxia of the optic disc, resulting in optic disc edema, not only the optic disc, but also the nerve fibers behind the sieve plate and the sieve plate can be involved, called the anterior segment ischemic optic neuropathy ( Anteriorischemicoptico-neuropaty, AION), ischemic changes from the inner segment of the optic nerve to the optic chiasm, called posterior ischemic optic neuropathy (PION), no optic disc edema. basic knowledge The proportion of illness: 0.0003% - 0.0005% Susceptible people: no specific population Mode of infection: non-infectious Complications: optic atrophy

Causes of ischemic optic disc disease

Giant cell arteritis (30%):

Vasculitis-type giant cell arteritis, nodular polyarteritis, systemic lupus erythematosus, Buergers disease, allergic vasculitis, post-viral vasculitis, vaccination, syphilis, and radiation necrosis. Giant cell arteritis (GCA) used to be called cranial arteritis, temporal arteritis, and granulomatous arteritis. Later, it was recognized that any large artery in the body can be affected, but named after its pathological features. The cause of GCA is unknown and is the most common systemic vasculitis in adults. The disease mainly involves the extracranial branch of the carotid artery in patients over 50 years old. The most serious complication of GCA is irreversible visual loss.

Systemic vascular disease (30%):

Systemic vascular disease hypertension, atherosclerosis, diabetes, migraine, arteritis, carotid artery obstructive disease. Migraine is a type of periodic attack that has a family-like onset. A paroxysmal pulsatile headache with nausea, vomiting, and shame, recurring after a period of rest. Headache relieves in a quiet, dark environment or after sleep. It can be accompanied by neurological and mental dysfunction before or during a headache.

Blood diseases (20%):

Blood diseases, polycythemia vera, sickle cell disease, acute hypotension (shock), G-6-PD deficiency.

Postoperative cataract, low intraocular pressure, glaucoma.

More common in the elderly, over 60 years old, the age of domestic onset is earlier than that of foreign countries, women are more common than men, single or both eyes have been ill, any systemic disease or eye disease that can make the optic disc insufficient for knowledge can cause the disease, systemic disease Such as hypertension, arteriosclerosis, temporal arteritis, carotid artery occlusion, diabetes, leukemia and polycythemia, etc., low or too high intraocular pressure can cause imbalance between the perfusion pressure of the small vessel of the optic disc and the intraocular pressure, due to Changes in blood components and blood viscosity increase, resulting in slower blood circulation and lower oxygen carrying capacity, resulting in hypoxia of the optic disc.

Ischemic optic disc disease prevention

1 control the primary disease or some risk factors such as high blood pressure, high blood sugar, high blood fat,

2 improve the microcirculation state of ischemic tissue, and carry out nutritional support treatment, such as the use of pancreatic kallikrein.

3 reduce the chance of complications such as macular degeneration and neovascular disease, close follow-up, timely laser treatment.

Ischemic optic disc disease complications Complications optic atrophy

Ischemic optic disc disease can have complications of optic atrophy.

Symptoms of ischemic optic disc disease Common symptoms Blind spot hemianopia Low blood pressure Hypertension Eye pain Demyelination Posterior optic neuritis Visual field defect

Where the age is greater than 40 years old, the visual acuity suddenly drops, and the visual field defect is not tangent, the possibility of ischemic optic neuropathy should be considered, but the optic neuropathy, demyelinating disease and hereditary diseases must be excluded.

The diagnosis of anterior ischemic optic neuropathy can be based on: 1 sudden drop in visual acuity, typical visual field defect; 2 headache, eye marks, especially due to iliac arteritis; 3 optic disc edema; 4 fundus fluorescein angiography showing optic disc low fluorescence or fluorescence Filling slowly or not filling; 5 Raynaud phenomenon in the hands and feet; 6 eyeball compression test has a significant rate of intraocular pressure recovery.

The diagnosis of posterior ischemic optic neuropathy can be based on: 1 sudden decrease in visual acuity and visual field defect; 2 no headache, eye pain; 3 normal fundus or slight nasal side of the optic disc, clear border; 4 age greater than 40 years old, often with hypertension , hypotension, arteriosclerosis or changes in blood composition; Raynaud phenomenon is less than 40 years old, or history of trauma or panic.

It should be pointed out that clinical diagnosis of posterior ischemic optic neuropathy is often difficult, and most of them are presumed to be difficult to identify with posterior optic neuritis. There are operational references such as abnormal ocular flow patterns or confirmed cerebral infarction in head CT.

Generally, the visual acuity is not heavy. For example, those caused by iliac arteritis are heavier or even have no light sensation. The incidence is sudden. The early optic disc is slightly reddened by light, which is caused by the expansion of the capillaries on the surface of the disc. Limited to a certain quadrant of the optic disc, consistent with visual field defects, rare on both sides, a small amount of nerve fiber layer bleeding around the optic disc, self-resolved within 1 to 2 weeks, flocculous exudate is also visible, 1 to 2 months After optic atrophy, it can be a cup-shaped glaucoma optic atrophy.

Secondary to retinal blood vessels caused by giant cell arteritis or arteriosclerosis, retinal blood vessels are generally normal, and those with hypertension or arteriosclerosis may have retinal arteriosclerosis changes. If both eyes are followed, that is, a secondary optic nerve is caused by optic disc edema. Atrophy, optic disc edema in another eye, a global Foster-Kennedy comprehensive film, immune to the intracranial tumor, because the posterior ciliary artery branch supply disc is zonal, the disease field of vision defect often has a short bundle of dark spots Connected to the physiological blind spot, which means that the damaged optic nerve starts from the optic disc, and the lesion on the road is generally blind or blunt, and is not connected with the physiological blind spot. The above dark spots can be stretched to appear with a large piece of god defect. Occurs below or below the field of view, generally occupying a "quadrant". It can also occur in several quadrants, horizontally and vertically, and quadrant blind, but the change is not bounded by horizontal and vertical, so it is different. In the upper part of the visual field, the quadrant bounded by the midline is blind or hemian, and the visual field defect of the disease generally bypasses the macular gaze area, so there is no central darkness. .

Fundus fluorescein angiography has the common characteristics in the early stage, that is, the asymmetry of the fluorescence intensity of the obstruction zone and the small unobstructed zone on the same optic disc. See the fluorescence filling delaying defect. This asymmetry is roughly equivalent to the visual field defect site, and the visual field defect is There is a localized low-fluorescence appearance in the vicinity of the optic disc, and the choroid at this site also exhibits a fluorescent filling delay.

Examination of ischemic optic disc disease

Fundus examination: the optic disc is slightly raised, the color is slightly light or normal, sometimes slightly congested, the edge is blurred and grayish white, there may be a few bleeding points in the retina near the optic disc, the retinal blood vessels are unchanged, the macular is normal, and the late (after 1 to 2 months) optic disc The bulge subsides, the edge is clear, the color is limited, and the optic disc can also be upper (lower) half or all pale, showing primary optic atrophy, also known as chronic atrophic optic disc edema.

Diagnosis and diagnosis of ischemic optic disc disease

Visual papillitis: acute onset, severe visual impairment, nipple congestion, edema, exudation, visual field with dark spots can be distinguished.

Foster-Kennedy syndrome: severe visual loss, one of the optic nerve head edema caused by intracranial frontal space occupying lesions, the other optic nerve atrophy, CT, MRI can confirm intracranial space-occupying lesions.

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