Often hazy blurry vision

Introduction Compressive optic neuropathy, unilateral progressive and painless occult vision loss is a major clinical feature. Vision often has a haze-like ambiguity, and temporary erythema can occur immediately when looking at a certain position, due to direct compression of the optic nerve or blood vessels. Compressive optic neuropathy (compressive optic neuropathy) due to direct compression or infiltration of intraorbital or intracranial tumors or metastatic cancer, clinically sometimes misdiagnosed, should be alert.

Cause

In the eye, it includes optic glioma, meningioma, hemangioma, lymphangioma, teratoma and malignant tumor (cancer, lymphoma, sarcoma, multiple myeloma) and the like. In the intracranial area, the saddle area is more common. Such as pituitary adenoma, craniopharyngioma, etc., other front wings, sphenoid winglet middle, saddle nodule, sphenoid ridge and olfactory meningioma are also missing. An internal aneurysm in which the internal carotid artery is bent, hardened, or occurs in the terminal branch of the internal carotid artery or the anterior cerebral artery or anterior communicating artery may gradually compress the unilateral optic nerve. Metastatic cancer such as nasopharyngeal carcinoma, lymphoreticular intracellular tumor (He Jiejin's disease) and frontal glioma and astrocytoma, hamartoma, tuberculoma, syphilis, cryptococcal disease, nodules Disease, cancerous meningeal lesions, etc. can be caused. Pituitary stroke can cause sudden disappearance of monocular vision. Sinus cysts, polyps compression, especially the sphenoid sinus and posterior ethmoid sinus are more concealed. Thyroid lesions cause hypertrophy of the eye muscles, post-sacral edema and skeletal deformities can oppress the optic nerve.

an examination

Related inspection

Eye and sacral area CT examination of infants' visual acuity apolipoprotein E genotyping

It is difficult to diagnose with clinical symptoms and signs alone, and there is no difference between optic neuritis and retrobulbar optic neuritis due to inflammation. Neuroradiology is of great value for sacral and cranial space-occupying lesions. Eyelids, flat slices or multi-layer sections, optic nerve holes and other films are of considerable value. The late development of head CT and MRI is more epoch-making, and can be diagnosed for changes in intraorbital and intracranial space-occupying diseases. Carotid angiography should be performed in patients with suspected arterial disease, and there are misunderstandings of CT films that can diagnose all lesions in the brain. Small meningiomas are 1 cm in diameter, and all examinations can be negative. Ultrasound exploration should be followed to identify characteristic lesions of the apex. Contrast sensitive test has certain value for oppressive optic neuropathy. Sometimes, although the visual acuity is normal, there may be abnormal changes, even earlier than visual field and color vision test. When other tests find abnormalities, the test is more visible in each spatial frequency. Both are generally down. Electrophysiological examination is helpful for diagnosis and can be characterized, but it has certain difficulties in positioning. It is more normal for vision and optic disc, and only visual blur is more meaningful, especially the contrast of both eyes can be clearly diagnosed. In middle-aged people, if the monocular is progressive optic atrophy, the history is short, and the visual field defect progresses vertically, and the glaucoma, vascular disease or myeloma can be excluded, the presence of meningioma should be considered. Intracranial compression lesions should be considered for the disappearance of bilateral vision and no myelitis. It is worth noting that, similar to posterior optic neuritis, and visual volatility, should consider the possibility of craniopharyngioma and aneurysm, the former due to cyst treatment can be improved temporarily, the latter may have instability changes.

In short, for unexplained unilateral or bilateral progressive vision loss, no improvement in treatment or temporary improvement in visual acuity, clinical diagnosis of optic neuritis, retrobulbar optic neuritis or optic atrophy, etc., should consider intracranial space Sexual lesions, the possibility of oppression of the optic nerve.

Unilateral progressive and painless occult vision loss is a major clinical feature. Vision often has a haze-like ambiguity, and temporary erythema can occur immediately when looking at a certain position, due to direct compression of the optic nerve or blood vessels. The disappearance of vision is often found by chance. Aneurysm may cause eye pain. There is no change in the early fundus, and the color of the optic disc can be found in one year or more. Finally, the optic nerve is pale and can be cup-shaped. The person near the optic disc can be less accompanied by optic disc edema. A rare central retinal vein thrombosis is present. Because intracranial tumors (especially the olfactory sulcus meningioma at the base of the frontal lobe) can oppress the optic nerve atrophy caused by the ipsilateral optic nerve, the optic disc edema can be present in the lateral eye due to the intracranial hypertension. It is often called Foster kennedy syndrome. Visual field examination is of great significance. The central dark spot can be seen at an early stage, and it can be quickly expanded to the peripheral part. It can maintain one stage of vision, retain the peripheral edge, and finally the vision will disappear. In some cases, due to different compression sites, it can cause segmental visual field defects, which are early features, inward expansion, and finally affect central vision. The visual field defects above the contralateral side are often mild, which is caused by the involvement of the cross-nasal fibers. The lower fiber squats forward, close to the front end of the optic tract, and the dark spot of the ipsilateral center exists. If the sign appears, it can be considered as a compression optic neuropathy, which is diagnostic. Occasionally, the ipsilateral hemianopia is due to the involvement of the ipsilateral optic tract, and the paracentral arch, vertical nasal and temporal hemianopia are still visible.

Pituitary dysfunction is a common symptom of saddle-occupying lesions, especially pituitary adenomas, craniopharyngiomas, amenorrhea, impotence, smooth skin, pubic hair loss, etc., but no endocrine in meningiomas and aneurysms .

Differential diagnosis

It must be differentiated from the visual acuity of optic neuritis and retrobulbar optic neuritis caused by inflammation.

It is difficult to diagnose with clinical symptoms and signs alone, and there is no difference between optic neuritis and retrobulbar optic neuritis due to inflammation. Neuroradiology is of great value for sacral and cranial space-occupying lesions. Eyelids, flat slices or multi-layer sections, optic nerve holes and other films are of considerable value. The late development of head CT and MRI is more epoch-making, and can be diagnosed for changes in intraorbital and intracranial space-occupying diseases. Carotid angiography should be performed in patients with suspected arterial disease, and there are misunderstandings of CT films that can diagnose all lesions in the brain. Small meningiomas are 1 cm in diameter, and all examinations can be negative. Ultrasound exploration should be followed to identify characteristic lesions of the apex. Contrast sensitive test has certain value for oppressive optic neuropathy. Sometimes, although the visual acuity is normal, there may be abnormal changes, even earlier than visual field and color vision test. When other tests find abnormalities, the test is more visible in each spatial frequency. Both are generally down. Electrophysiological examination is helpful for diagnosis and can be characterized, but it has certain difficulties in positioning. It is more normal for vision and optic disc, and only visual blur is more meaningful, especially the contrast of both eyes can be clearly diagnosed. In middle-aged people, if the monocular is progressive optic atrophy, the history is short, and the visual field defect progresses vertically, and the glaucoma, vascular disease or myeloma can be excluded, the presence of meningioma should be considered. Intracranial compression lesions should be considered for the disappearance of bilateral vision and no myelitis. It is worth noting that, similar to posterior optic neuritis, and visual volatility, should consider the possibility of craniopharyngioma and aneurysm, the former due to cyst treatment can be improved temporarily, the latter may have instability changes.

In short, for unexplained unilateral or bilateral progressive vision loss, no improvement in treatment or temporary improvement in visual acuity, clinical diagnosis of optic neuritis, retrobulbar optic neuritis or optic atrophy, etc., should consider intracranial space Sexual lesions, the possibility of oppression of the optic nerve.

Unilateral progressive and painless occult vision loss is a major clinical feature. Vision often has a haze-like ambiguity, and temporary erythema can occur immediately when looking at a certain position, due to direct compression of the optic nerve or blood vessels. The disappearance of vision is often found by chance. Aneurysm may cause eye pain. There is no change in the early fundus, and the color of the optic disc can be found in one year or more. Finally, the optic nerve is pale and can be cup-shaped. The person near the optic disc can be less accompanied by optic disc edema. A rare central retinal vein thrombosis is present. Because intracranial tumors (especially the olfactory sulcus meningioma at the base of the frontal lobe) can oppress the optic nerve atrophy caused by the ipsilateral optic nerve, the optic disc edema can be present in the lateral eye due to the intracranial hypertension. It is often called Foster kennedy syndrome. Visual field examination is of great significance. The central dark spot can be seen at an early stage, and it can be quickly expanded to the peripheral part. It can maintain one stage of vision, retain the peripheral edge, and finally the vision will disappear. In some cases, due to different compression sites, it can cause segmental visual field defects, which are early features, inward expansion, and finally affect central vision. The visual field defects above the contralateral side are often mild, which is caused by the involvement of the cross-nasal fibers. The lower fiber squats forward, close to the front end of the optic tract, and the dark spot of the ipsilateral center exists. If the sign appears, it can be considered as a compression optic neuropathy, which is diagnostic. Occasionally, the ipsilateral hemianopia is due to the involvement of the ipsilateral optic tract, and the paracentral arch, vertical nasal and temporal hemianopia are still visible.

Pituitary dysfunction is a common symptom of saddle-occupying lesions, especially pituitary adenomas, craniopharyngiomas, amenorrhea, impotence, smooth skin, pubic hair loss, etc., but no endocrine in meningiomas and aneurysms .

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