Important topics in diagnosis of neuro-ophthalmologic diseases / 眼科

Neuro-ophthalmology is a subspecialty of both neurology and ophthalmology concerning visual problems that are related to the nervous system. As the rapid development of computer technology, information technology and radiology, the development of neuro-ophthalmology is in the best period in history. The following important topics are worthy of attention: 1) the diagnosis and therapy of carotid artery stenosis related ophthalmopathy;2)the relationship between papilledema and cranial venous sinus thrombosis; 3) the diagnosis of optic canal fracture with high resolution computer tomography;4)the relationship between optic neuritis and multiple sclerosis.

Endoscopic Optic Canal Decompression

The visual loss owing to acute optic nerve injury after blunt head trauma has been reported about 5% at the incidence. But it has been real circumstances that we still don`t have the exact knowlege about surgical indication, operation time and steroid dosage for this candidate. Lately, endoscopic surgery was introduced for treatment of orbital disease instead of classic external approach and we have performed and report endoscoic endonasal optic canal decompression followed by megadose steroid injection in 5 patients who experienced visual loss due to optic canal fracture following trauma.

Clinical Evaluation of Treatment of the Optic Nerve Damage

Clinical signs of the optic nerve injury are characterized by absent or diminished light reaction of the pupil on the affected side, a wound in the lateral part of the eyebrow and bleeding from the nose. On X-ray studies, the optic canal fracture can be noticed occasionally. In this study, eleven cases of the optic nerve damage due to a blunt head trauma were studied for 6 to 30 months(average 9 months). Of these, the optic canal fracture was revealed in 5 cases. Among the 5 cases, three cases received surgical decompression of the optic canal through frontotemporal approach with visual improvement in 2 cases(66%). Eight cases were treated by medical therapy with visual improvement in 5 cases(63%). Visual recovery of the optic nerve injury with optic canal fracture(60%, 3/5) was similar to those with no optic canal fracture(66%, 4/6). On the bases of our study, the optic nerve damage should be treated by intensive medical treatment and if the optic canal fracture exists, early surgical intervention should be performed.