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Neuromyelitis optica spectrum disorders (NMOSD) are a spectrum of autoimmune diseases characterized by acute inflammation of the optic nerve (optic neuritis, ON) and the spinal cord . [1] [2] [3] Episodes of ON and myelitis can be simultaneous or successive. A relapsing disease course is common, especially in untreated patients. [1] [4]
Hypertropia is a condition of misalignment of the eyes (), whereby the visual axis of one eye is higher than the fellow fixating eye. Hypotropia is the similar condition, focus being on the eye with the visual axis lower than the fellow fixating eye.
Impairment of cranial nerve IV, which can be congenital, causes the associated eye to drift up and perhaps slightly inward. Sixth nerve palsy causes the associated eye to deviate inward and has many causes due to the relatively long path of the nerve. Increased cranial pressure can compress the nerve as it runs between the clivus and brain stem.
The optic tract is a continuation of the optic nerve that relays information from the optic chiasm to the ipsilateral lateral geniculate nucleus (LGN), pretectal nuclei, and superior colliculus. [14] The optic tract represents the first stage in the visual pathway in which visual information is transferred in a homonymous nature. [ 15 ]
The optic nerve can be damaged when exposed to direct or indirect injury. Direct optic nerve injuries are caused by trauma to the head or orbit that crosses normal tissue planes and disrupts the anatomy and function of the optic nerve; e.g., a bullet or forceps that physically injures the optic nerve.
Dominant optic atrophy was first described clinically by Batten in 1896 and named Kjer’s optic neuropathy in 1959 after Danish ophthalmologist Poul Kjer, who studied 19 families with the disease. [3] Although dominant optic atrophy is the most common autosomally inherited optic neuropathy (i.e., disease of the optic nerves), it is often ...
Andrew G. Lee has divided optic chiasmal syndromes into anterior, middle and posterior locations. [6] Anterior chiasmal syndrome affects the junction of the optic nerve and chiasm. Middle chiasmal syndrome relates to the decussating fibers in the body of the optic chiasm while posterior chiasmal syndrome involves the caudal fibers.
The exact mechanism of optic nerve ischemia in these cases remains unclear, but contributing factors may include hypotension, anemia, hypoxia, and changes in the autoregulation of optic nerve arterial blood flow. The incidence of ischemic optic neuropathy leading to vision loss following general surgeries ranges between 0.1% and 0.002%.
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