Symptoms and diagnosis of retinal neuropathy

Eyes are very important to each of us, but eye diseases bring troubles to our lives. In most late stages of optic neuritis, attention should be paid to retinal neuropathy, and problems such as headaches caused by the lesions should be addressed. Especially during the process of eye disease, the pain is more intense. Patients should pay attention to the obvious pain in the eyes and seek medical attention in time.

1. Symptoms of retinal neuropathy

1) Metamorphopsia. It is a special symptom of retinal diseases including macular degeneration. This phenomenon occurs because the originally neatly arranged retinal photoreceptor cells are displaced due to retinal deformation and edema, the distance between cone cells increases, and the patient will experience smaller vision (micropsia). Because the cones in the fovea are already closely arranged, it is difficult for lesions to cause the distance between them to decrease. Therefore, it is more common in clinical practice to see objects become smaller than to see objects become larger. The patients complained of distortion of objects, wavy changes in straight lines, unequal vision of objects in both eyes, and changes in refraction during eye examination.

2) Photophobia and night blindness. It is another symptom of retinopathy (including macular degeneration). Compared with the central dark spots and patchy occlusions of the visual field caused by optic neuropathy, patients often complain of excessively bright areas in the visual field, or that objects are clearer in the dark than in the bright. Night blindness is often the main complaint of patients with primary or secondary retinitis pigmentosa. 2 Physical examination

Diagnosis of retinal neuropathy

1) Relative afferent pupillary defect (RAPD). It is not limited by the patient's subjective consciousness and examination conditions. In patients with monocular visual impairment, if a clear RAPD is detected, the lesion can be located with greater certainty in the optic nerve rather than in the macula or retinal localized lesions. However, it should be noted that if the optic neuropathy is bilateral and of comparable severity, RAPD will not occur. In contrast, RAPD also only occurs in cases of extensive retinal disease, especially central/branch retinal artery occlusion, central retinal vein occlusion, and large retinal detachment. Refractive errors, corneal lesions, lens opacities, vitreous hemorrhage, etc. will not lead to RAPD. If a patient has decreased vision and RAPD, and fundus examination also reveals mild cystoid edema of the macula, drusen, or old choroidal lesions, a high level of vigilance is still required for the possibility of optic neuropathy, because mild retinal lesions should not lead to obvious RAPD.

2) Color vision test. As mentioned earlier, color vision impairment is more prominent in optic neuropathy. Color vision impairment is not obvious in patients with mesoplasmosis, choroidal lesions, and epiretinal membranes. However, in patients with cone dystrophy, impaired color vision may be the primary symptom for medical consultation. Simple Ishihara pseudochromatic plates, Farnsworth-Munsell-100 color spectra, and simple D-15 hue plates can be used for inspection. Color vision loss in patients with retinopathy can be generalized or blue-yellow color vision impairment. The diagnosis must rely on further retinal structure and function examinations, fundus fluorescein angiography (FFA) and visual electrophysiological examinations.