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Optic nerve
Congenital optic nerve defects
Disc defects
Coloboma of optic nerve
- Strong correlation to retinal detachment
- No sports
Crescents
- Malinsertion syndrome
- Nasal raised O.U.
- Scleral crescents O.U
Tilted disc
- Horizontal and vertical tilt one eye
- Inferior nasal crescent one eye
Megalopapilla
Morning glory disc
- Unilateral enlarged funnel disc
- Overlying pigmentary disturbance
- Strong correlation to retinal detachment
- No sports
Myelinated nerve fibers
Optic nerve aplasia
Optic nerve hypoplasia
- Bilateral
- Nystagmus
- Unilateral
- Strabismus
Optic nerve pits
- 70% have arcuate scotomas
- 50% develop retinal detachment towards macula
- 75% develop serous maculopathy
Vessel defects
Cilioretinal vessels
- 20% of eyes
- Most often artery
Macrovessels
- Large vessels encroach on macula
Racemose Angioma
- Artery malforming to vein and back to disc
- Unilateral
Persistent hyaloid system
Bergmeisters papilla
Prepapillary vascular loops
- 5% have them
- 95% arterial
- Rule out acquired loops from occlusive disease
- 75% also have cilio central artery
Other defects
Circumpapillary atrophy
Circumpapillary choroiditis
Drusen of optic nerve
- Progressive optic atrophy
- Hemorrhages
- 70% bilateral
- Primarily whites
- Retinitis pigmentosa associated drusen of disc margin
Optic atrophy
Congenital optic atrophy
- Dominate form
- Recessive form
- Red-green defects
- Nystagmus
Juvenile optic atrophy
- 6-12 Yr’s old
- Dominate form 20/20 - 20/60
- Recessive form severe acuity loss
- Blue - yellow defects
- No nystagmus
Behrs optic atrophy
- Recessive
- 1-9 Yr’s old
- Ataxia
- Mental debilitation
Lebers hereditary optic atrophy
- Bilateral
- Acute loss of visual acuity in 10 - 40 yr. old males
10/100
- Genetic ? factor
Aquired optic nerve disease
- Neuropathy
- Afferent defect
- Right to left comparison
- Doughnut rim changes
- Marcus Gunn pupil
- Afferent pupillary defect
- Optic nerve disease or severe macular disease
- Observe with burton lamp
- Color saturation comparison
- Mydryacil bottle
- Light brightness comparison
- "This light is worth $1.00" "What is this one worth?"
- Amsler grid
Demyelininizing neuropathy (Retrobulbar neuritis)
- Sudden unilateral loss of visual acuity
- Usually age 20-40
- Opthalmoscopy negative
- Poor balance, eye pain on movement
- Re-occurances of attacks
- Multiple sclerosis
- Plaques on nerves
- Increased frequency of urination
- Blurred vision in a warm bath
- Uthoffs sign
Neuromyelitis optica (Devic’s disease)
- Rapid onset bilateral loss of visual acuity
- Demyelinizing disease in children and young adults
- Poor prognosis
Inflammatory neuropathy
- Disc edema
- Hemorrhage
- Vitritis
- Most often age 1-10
- Toxoplasmosis
- Measles
- Chickenpox
- Tuberculosis
- Histoplasmosis
- Rapid decrease in visual acuity 2-3 days
- Stabilization for 7-10 days
- Slight improvement in visual acuity
- Optic atrophy 4-8 weeks later
Ischemic optic neuropathy
- Loss of CVRP
- Edema
- Hemorrhages
- Cotton wool
- Prodromal of 5-30 sec transient loss of visual acuity
Arteriosclerotic-hypertensive ION
- Age 50+ males and females
- Anterior ischemic optic neuropathy AHION
- Disc edema
- Atrophy
- Hemorrhages
- Rapid decrease in visual acuity and field over a few days one
eye
- Prodromal of transient blurring, flashing
- Visual acuity stabilizes at 20/60 - 20/200
- 25% chance other eye will do the same
Diabetic ION
- Disc edema
- Circumpapillary hemorrhage
- Mild vision loss
- Occurs in young type I diabetics
- Usually resolves without damage may be optic atrophy
Papilledema
- Disc edema secondary to increased intrcranial pressure
- Mass lesion
- Hypervitaminosis A
- Toxicity to tetracycline or nalidixic acid
- Idiopathic pseudotumor cerebri (Benign intracranial hypertension)
- 10-50 yrs old female
- Not life threatening but threatens vision with optic atrophy
- Secondary to ottis media, head injury, hypervitaminosis A, tetracycline
Temporal arteritic ION
- Age 65+
- More often females
- 75% Prodomal of flickering visual acuity, headache, neckpain,
sore scalp, jaw aches on chewing
- 33% bilateral
- Cupping
- Acute loss of visual acuity
- Shoulder, neck, hips and thighs pain and stiffness
- Morning stiffness
- 20% fatality
- Diagnose with ESR test
Papillophlebitis optic neuropathy
- Disc edema due to inflammatory occlusion of the CRA
- Unilateral
- Health 20-40 males and females
- 20/30 visual acuity and scotomas
- Resolves untreated in 6 - 18 months
- Toxic optic retinopathy
- Disc edema
- Splinter hemorrhage
- Optic arophy
- Gradual decrease visual acuity and scotomas
- Reversible
Venous stasis neuropathy
Tumors
Astrocytic hamartoma
Choroidal melanoma of optic nerve
- 75% mortality in 5 years
- Sub-retinal yellowish - brown
Leukemic nerve infiltration
Melanoctyoma of optic nerve
- Elevated black lesion with flayed margins
- May become malignant
Metastatic carcinoma
Retinoblastoma
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