Diabetic Neuropathy
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
Vision loss with both forms of ischemic optic neuropathy usually occurs quickly over minutes to days, and is painless. With giant cell arteritis, additional symptoms include general malaise, headaches over the temples, muscle aches and pains, jaw claudication, pain when combing the hair, and tenderness over the temporal artery. These symptoms sometimes do not occur until vision is already lost. There is reduced visual acuity and an afferent pupillary defect. The optic disk swells and becomes elevated. Swollen nerve fibers obscure the thin surface vessels of the optic nerve. Hemorrhages may surround the optic disk in many cases. The disk is often pale in the arteritic form, but hyperemic in the nonarteritic form. With both forms, a visual field examination often reveals a central defect, an altitudinal defect, or both.
Examination of the Nervous System
John W. Scadding, Nicholas A. Losseff in Clinical Neurology, 2011
Lesions in the region of the optic nerve, optic chiasm and optic tract lie close to, and may arise from, the pituitary, and to the adjacent hypothalamus above. Accordingly, such parapituitary lesions often produce disturbances other than visual field defects, including abnormalities of eye movement, hypopituitarism and diabetes insipidus. The effect of damage to the optic nerve on the pupillary reaction to light was described earlier, and any lesion in this region causing damage to central vision may produce an afferent pupillary defect. However, if the field defect is a hemianopia, sufficient vision remains in the intact half of the macular region to preserve visual acuity as normal, and the pupillary reaction likewise will be normal.
Inflammatory Disorders of the Nervous System
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Reduced visual acuity, which varies from a slight dulling of color vision to complete monocular blindness, together with pain around or behind the eye that is exacerbated by eye movement or touching the eye, are symptoms of optic neuritis. Flashes of light on eye movement may occur (phosphenes). The signs include a central or paracentral scotoma in most patients, particularly using a red target (most of the optic nerve fibers transmit information from the macula), and a swollen optic disc (papillitis) in the acute phase if there is demyelination of the anterior part of the optic nerve. A unilateral afferent pupillary defect may be observed. Optic disc pallor due to optic atrophy ensues later.
Don’t Miss This! Red Flags in the Pediatric Eye Exam: Pupils
Published in Journal of Binocular Vision and Ocular Motility, 2019
Jennifer E. Lambert, Stephen P. Christiansen, Crandall E. Peeler
An afferent pupillary defect results from asymmetric conduction of a light stimulus between the 2 eyes, most often due to optic nerve dysfunction but occasionally as a result of retinal disease. In children, both acquired and congenital optic neuropathies such as optic nerve glioma, Leber hereditary optic neuropathy (acquired), optic nerve hypoplasia, and morning glory disc (congenital) can cause an afferent pupillary defect. Retinal disease in children may also lead to afferent pupillary abnormalities. For example, retinoblastoma in early childhood or congenital retinitis pigmentosa may cause afferent pupil defects. An afferent pupillary defect in the setting of an otherwise normal eye exam warrants MR imaging of the orbits to rule out a compressive lesion. When optic nerve hypoplasia or a morning glory disc is seen, more extensive imaging of the brain is required to rule out midline defects or vascular abnormalities.
Static and dynamic pupil characteristics in pseudoexfoliation syndrome and glaucoma
Published in Clinical and Experimental Optometry, 2020
Kemal Tekin, Hasan Kiziltoprak, Mehmet Ali Sekeroglu, Esat Yetkin, Serdar Bayraktar, Pelin Yilmazbas
Glaucoma is an optic neuropathy characterised by progressive and chronic loss of retinal ganglion cells and their axons. Analysis of pupillary light reflex is one way to assess the integrity of afferent visual pathways and abnormalities in pupillary light reflex usually present as a relative afferent pupillary defect.1995 The relative afferent pupillary defect might be observed in the conditions of asymmetrical retinal or optic nerve diseases including glaucoma. Measurement of pupillary response via infrared pupillography was introduced by Lowenstein and Loewenfeld,1958 and the recent developments in automated pupillometry devices have enabled quantitative, objective, non‐invasive, and repeatable measurements of pupil diameter in addition to the pupillary kinetics.2018 Various studies have shown that primary open‐angle glaucoma is associated with impairments in pupillary responses by using automated pupillometry.2011 It is also well known that pupillary changes such as poor mydriasis, due to the iris infiltration and fibrosis, are associated with PES.
Mitochondrial Impairment in Antibiotic Induced Toxic Optic Neuropathies
Published in Current Eye Research, 2018
Jeffrey J. Yu, Daniel H. Lee, Shea P. Gallagher, M. Cristina Kenney, Chantal J. Boisvert
LION typically presents as painless bilateral vision loss with central or cecocentral scotomas.26 Visual acuity and color vision are impaired. Visual defects can occur on their own or in conjunction with peripheral neuropathy.27 Funduscopic exam may reveal optic disc edema and pallor but can be normal in earlier stages of the disease.28 Relative afferent pupillary defect is generally not observed in these patients, likely due to symmetric optic nerve involvement.10 Visual decline is progressive until withdrawal of linezolid, after which some degree of improvement occurs in most, but not all cases.29 Other than withdrawal of linezolid, there are no known treatments for LION. The use of corticosteroids does not appear to be effective and has been reported to exacerbate vision loss in at least one case.13
Related Knowledge Centers
- Anisocoria
- Optic Nerve
- Optic Tract
- Retina
- Lesion
- Signs & Symptoms
- Swinging Light Test
- Optic Chiasm
- Ophthalmology
- Pupillary Light Reflex