By Sohan Singh Hayreh
"No attainment is ever ultimate" Vascular problems of the optic disc and nerve are very important not just to the ophthalmologist but in addition to the neurologist and the internist. To the 1st distinctiveness workforce they signify one reason behind blindness or critical visible impairment; to the second one crew the optic disc edema and optic atrophy visible in those problems can pose severe difficulties of prognosis, or supply indica tions of the involvement of the cerebral circulate; whereas to the final workforce they're often indicative of systemic affliction, relatively of the cardiovas cular method. fresh advances in our wisdom of the blood provide of the optic nerve head have shed an important new mild at the topic. With the hot introduction of fluorescein fundus angiography, an additional measurement has been further to the examine of the ocular and optic disc circulations, and now we have entered right into a new period within the figuring out of ocular vascular issues "in vivo". within the pre-angiography period, postmortem injection reviews, even supposing very helpful, didn't thoroughly show the vascular trend of the optic disc within the residing, in well-being, and sickness. The ophthalmoscope, definitely, has been worthwhile in assessing optic disc lesions, yet couldn't provide us informa tion at the circulate of the attention and optic disc "in vivo".
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Extra info for Anterior Ischemic Optic Neuropathy
14 a-i. Both eyes of a 65-year-old woman with temporal arteritis, bilateral anterior ischemic optic neuropathy and no perception of light in either eye. a, b, c) Right fundus on day after onset of blindness. a) Fundus photograph showing chalky-white swelling of the optic disc, with a small superficial retinal hemorrhage above. b and c) Fluoresceinfundus angiograms b) Retinal arterial phase showing non-filling of the optic disc, peripapillary choroid and watershed zone inferiorly. c) Retinal venous phase showing non-filling of the optic disc.
B) In Anterior Ischemic Optic Neuropathy Due To Arteriosclerosis This group included 14 of the 25 patients in Category I (p. 25), in addition to most eyes in Category II (p. 25). Most of these discs resembled (a2) above (Figs. 19a, 20a, 21 a, 22a, 23b, 24i, 31) frequently with minor or no pallor, and only rarely (a 1) (in 2 of 12 eyes examined at a very early stage-Figs. 24a, 25a). Thus, during early stages of anterior ischemic optic neuropathy, if ophthalmoscopic examination of the optic disc reveals a chalky-white swollen disc with no superficial congestion of capillaries and none or minor hemorrhage, the disease is most probably due to temporal arteritis.
Thus, anterior ischemic optic neuropathy, glaucoma, and low-tension glaucoma are manifestations of ischemia of the optic nerve head and retrolaminar optic nerve due to interference with posterior ciliary artery circulation as a result of an imbalance between perfusion pressure in the posterior ciliary arteries and intraocular pressure. If the process is sudden, it produces anterior ischemic optic neuropathy with infarction of the optic nerve head and retrolaminar region. If it is chronic (as in glaucoma and 10wtension glaucoma), it produces slow degeneration of neural tissue in the optic nerve head and retrobulbar region, resulting in cupping of the optic disc and cavernous degeneration of the retrolaminar optic nerve.