Causes and Diagnosis of Blurred Optic NeuropathyProfessor Hyunjin Shin, Department of Ophthalmology, Konkuk University Hospital

Optic neuropathy with blurred vision, causes and diagnosis

 

 

 

 

 

 

 

 

 

 

 

1. Differences between optic neuropathy and glaucoma

The nerves in our body are responsible for transmitting information from the brain to the extremities, and vice versa, for relaying sensory information from the extremities back to the brain. If this nerve is damaged, it's as if the power went out, and you can't do anything even if your limbs are intact.

Therefore, the nerves in our body are very important, and there are also nerves in the eyes. The nerves in the eye are called the optic nerve, and the optic nerve is responsible for transmitting information from the eye to the brain. So, when optic neuropathy occurs, which is a breakdown of the optic nerve, various symptoms occur.

 

First, let's talk about glaucoma, which you are familiar with. Glaucoma is a peripheral disruption of vision. Because central vision is preserved, tunnel vision is a symptom of glaucoma, in which the visual field gradually narrows around the periphery. However, optic neuropathy is characterized by a blurred appearance from the beginning, as if it were a blur, obscuring the object or location you are trying to see. In addition, in some cases, the upper or lower half of the optic neuropathy is also characteristic of optic neuropathy. Many people complain of color vision disorders. The optic nerve is particularly sensitive to color vision, so if you have optic neuropathy, you may not be able to see its full color.

 

2. Causes and Diagnosis of Optic Neuropathy

 

Optic neuropathy can be divided into many causes, including ischemia, compression, inflammation, infection, trauma, precursor, genetics, metabolism, and infiltration. Ischemia is literally the lack of blood. If there is a tumor around the optic nerve around the eye, it can compress the optic nerve, which can lead to a decrease in the function of the optic nerve. And then if you have optic neuritis, the inflammation can also cause the optic nerve to function less. Infections, especially sinusitis, can invade the eyes and cause vision loss. They may get injured or become genetically ill. Excessive alcohol consumption or drinking toxic substances such as methanol can also cause problems with the optic nerve. And if you have cancer, cancers throughout your body may infiltrate the optic nerve. In this case, we can also develop optic neuropathy.

 

As such, optic neuropathy refers to all of these general causes, so it is necessary to distinguish the cause well. What happens if it's congenital? If you are born with a bad optic nerve, you may have had a bad optic nerve since you were born.Ischemic, what about not being able to bleed? Just as a person suddenly loses the use of his limbs when he has a stroke, his eyesight suddenly loses blood and the condition progresses all the time.And what about genetics? In the case of genetics, we have a disease called LHON (Leber's Hereditary Optic Neuropathy) and Lever's Optic Neuropathy. These diseases start in the 10~20s and at most 30s, and continue without improvement due to subacute deterioration of vision. And in the case of inflammatory, optic neuritis is typical. If the disease persists subacutely and gradually improves, it can be assumed that it is optic neuritis. In addition, when compressed by a tumor, the optic nerve slowly progresses and worsens.

 

So, just by knowing the tempo of the symptoms, we can identify the cause of this optic neuropathy. And we can do more accurate tests. Optic neuropathy is usually tested by an ophthalmologist in three ways. First of all, in the doctor's office, in addition to an eye test, color vision test, and visual field test, fundus examination is performed to check for swelling of the optic nerve.

 

Then there are the specific antibodies that cause optic neuropathy. Originally, the role of antibodies is to fight the virus when it comes in from outside. Some of these antibodies may mistake the optic nerve for an enemy and attack it. This can be a sign of poor eyesight, such as MOG antibodies, Aquaporin-4 antibodies, and so on. So you can do a blood test. And finally, they do another imaging test, usually an MRI. An MRI is performed to check for abnormalities or inflammation of the optic nerve and brain structures. These three tests are used to diagnose optic neuropathy.

 

3. Cases of diagnosis of optic neuropathy

 

Here are a few examples: There is a 40-year-old male patient who was treated for meningioma of the optic nerve. I have had subacute visual impairment without pain for about a month. His vision was 0.4 on his left side, his optic nerve was swollen and there was bleeding around it. He had hyperthyroidism. When I did the imaging tests, I found that the muscles around my eyes were very thick. If you have hyperthyroidism, the muscles around your eyes thicken, so this thickened muscle can sometimes compress this optic nerve. That's why it's compressive optic neuropathy. So he was able to diagnose us with compressive optic neuropathy, which is caused by muscle thickening caused by hyperthyroidism.

There are also such people. The patient was a 50-year-old male patient who had started pain about a month ago, blurred vision, a feeling of heat around his eyes, and bleeding. His eyesight had dropped to 0.1 on his left side. When I had an MRI scan, I found that there was a contrast enhancement around the middle optic nerve on the left side compared to the right. In this way, he was able to diagnose optic neuritis caused by orbititis.

Finally, I would like to introduce the case of a 56-year-old male patient who came to us with subacute deterioration in his right eye without pain. I had about 0.7 vision on my right and my optic nerve was swollen. This is a person who responded well to steroids because his eyesight improved immediately, but when he took steroids, the swelling of his optic nerve went down and his vision improved again, and when he took the steroids, his optic nerve swelled again and his vision decreased. Eventually, a blood test diagnosed blood cancer. If there is cancer in the body, the cancer cells can invade the optic nerve, causing vision loss.

 

4. Arrangement