Patient's question:
Eyeache and throbbing, sudden vision loss, poor light sensitivity, one week of viral infectionDoctor's answer:
Disease Analysis: The optic disc is the intraocular part of the optic nerve. On one hand, it is a continuation of the axons of retinal ganglion cells; on the other hand, it becomes the posterior or intraorbital part of the optic nerve through the scleral foramen. Therefore, inflammation of the optic disc rarely affects the adjacent retina or the posterior optic nerve. However, when the main inflammatory lesions are primarily observed in the optic disc under ophthalmoscopy, it is referred to as optic discitis (apillitis). If there are also significant inflammatory lesions in the retina, it is called optic disc-retinitis (apilla-retiitis). Similar to optic discitis, the former can cause significant visual impairment in the early stages of inflammation, often accompanied by mild vitreous opacity and retroorbital pain.Guidance:
I. Clinical Manifestations: The disease primarily occurs in young and middle-aged individuals, accounting for 86% of cases, and is also not uncommon in children. It is less frequent in the elderly. Approximately two-thirds of cases involve both eyes, with a rapid onset, often leading to loss of light perception within days. Initially, there may be a dull ache or tightness in the forehead or retrobulbar area, which tends to lessen as visual impairment worsens. In cases of bilateral blindness, the pupils are dilated, and the light reflex is negative. If some vision remains, the pupils remain unchanged, but the light reflex is not sustained (jumping phenomenon). In patients with residual vision, a visual field examination may reveal central scotomas, paracentral scotomas, quadrant defects, or concentric constriction. Using red-green targets, these changes become more pronounced. Visual evoked potential (VEP) values are reduced. On ophthalmoscopy, the optic disc appears congested, swollen, slightly elevated, and poorly defined. Retinal veins are dilated and tortuous, while arterial diameters are normal. However, slight pressure on the globe may reveal arterial pulsation. Edema, flame-like hemorrhages, and yellowish-white exudate spots may be observed around the optic disc. In some cases, the macula may be affected, leading to radial edema and wrinkling of the macular fibers of the fovea. Over time, this may progress to a star-like appearance (at which point it is termed optic disc-retinitis). Posterior vitreous, especially in front of the optic disc, often appears dusty and cloudy.
II. Etiology: The causes of optic discitis are highly complex and include the following:
1. Local Inflammation:
1》Ocular inflammation, such as uveitis, chorioretinitis, or retinitis, may spread to the optic disc.
2》Viral infections, particularly orbital infection, sinusitis (e.g., maxillary, ethmoid, and sphenoid sinuses), dental caries, or tonsillitis.
2. Systemic Diseases: Tuberculosis, syphilis, demyelinating diseases, and acute infections such as meningitis, influenza, mumps, typhoid, or measles; nutritional and metabolic disorders such as pregnancy, lactation, vitamin deficiencies, anemia, or diabetes.
3. Toxicity: Arsenic, lead, or quinine poisoning.
III. Prognosis: The prognosis for optic discitis and optic disc-retinitis is generally poor. However, with timely and appropriate treatment, some vision may gradually recover, even fully. If the condition is left uncontrolled, the optic disc typically exhibits varying degrees of depigmentation, appearing as poorly defined pale areas. This may ultimately lead to secondary optic atrophy.
IV. Treatment:
1. Etiological Treatment: If the cause is identified, such as bacterial infection, antibiotics that can cross the blood-brain barrier should be used. For syphilis or tuberculosis, specific antimicrobial or antitubercular medications are required. If caused by dental caries or tonsillitis, the underlying focus should be eliminated.
2. Symptomatic Treatment: High-dose corticosteroid pulse therapy is initially administered.
3. Supportive Therapy: Vitamin B complex.
V. Nursing Points: Acute patients should rest in bed, stay hydrated, avoid spicy foods, and abstain from alcohol and smoking. Wearing sunglasses outdoors is recommended. Active treatment of the underlying disease is essential.
Note: Provide fundus photographs showing typical visual field changes in the early stages of inflammation (e.g., dumbbell-shaped fields, central scotomas, concentric constriction), during the retinitis phase, and in the atrophy phase of the optic disc. The VEP is often abnormal during inflammation and atrophy.