Optic disc swelling/atrophy

Question 1

What causes papilloedema?

Answer 1

Raised ICP
May be due to:
Tumour
Hydrocephalus (not draining)
CSF absorption blocked
Diffuse cerebral oedema
Hypersecretion of CSF

Question 2

What are the signs of early papilloedema?

Answer 2

Blurred disc margins
Bilateral
Disc hyperaemia
Normal VA
Engorged blood vessels

Question 3

What is a sign of severe papilloedema?

Answer 3

Unable to see small blood vessels on disc

Question 4

What are the signs of late papilloedema?

Answer 4

Disc pallor
No cup
Haem
CWS
Macular star
Enlarged blind spot

Question 5

What are the symptoms of papilloedema?

Answer 5

Severe headache - worse on posture changes or coughing
Throbbing - worse in am
Transient vision loss

Question 6

What causes typical optic neuritis?

Answer 6

Demyelination of the optic nerve behind the disc

Question 7

What causes atypical optic neuritis?

Answer 7

Inflammation or infection of the optic nerve

Question 8

What are the signs of optic neuritis?

Answer 8

Reduced VA
Reduced colour vision
RAPD
Unilateral

Question 9

What are the symptoms of optic neuritis?

Answer 9

Headache
Pain on eye movement

Question 10

What does AION stand for?

Answer 10

Anterior Ischaemic Optic Neuropathy

Question 11

What does NAION stand for?

Answer 11

Non-Arteritic Anterior Ischaemic Optic Neuropathy

Question 12

What does AAION stand for?

Answer 12

Arteritic Anterior Ischaemic Optic Neuropathy

Question 13

What causes NAION?

Answer 13

Sectoral loss of blood supply to the optic nerve

Question 14

What are the acute signs of NAION?

Answer 14

Diffuse or sectoral disc oedema
Small splinter haemorrhages
Altitudinal field defect
Contralateral disc may be crowded
>45 yo

Question 15

What are the late signs of NAION?

Answer 15

No oedema or haem
Optic atrophy
Variable vision loss

Question 16

What causes AAION?

Answer 16

Complete blockage of vessels by giant cells, causing vessel inflammation in and around the eye

Question 17

What is the treatment for NAION?

Answer 17

Treat underlying cardiovascular RFs
Prevent it becoming bilateral

Question 18

What is AAION also known as?

Answer 18

Giant Cell Arteritis (GCA)

Question 18

What are the signs of AAION?

Answer 18

Severe acute vision loss
Transient diplopia
Diffuse disc oedema
Small splinter haemorrhages
Older (65-80)

Question 19

What are the symptoms of AAION?

Answer 19

Temporal headache/tenderness
Jaw claudication
Intermittent vision loss
Loss of appetite
Fatigue

Question 20

What is the treatment for AAION?

Answer 20

Emergency referral for high dose steroids

Question 20

What clinical tests would you perform to differentiate between different optic nerve pathologies?

Answer 20

VA
OCT
Colour vision
Red desaturation
Pupils
Fields
Volk

Question 21

What are the types of compressive optic nerve lesions?

Answer 21

Glioma
Meningioma
Sphenoidal ridge meningioma

Question 22

What is a glioma?

Answer 22

Tumour in the glial tissue (nerve itself)

Question 23

What is a meningioma?

Answer 23

Tumour in the meninges of the optic nerve

Question 24

What is a sphenoidal ridge meningioma?

Answer 24

Meningioma on the bone around the eye - presses on the optic nerve

Question 25

What are the signs of a compressive lesion?

Answer 25

Proptosis Gradual VA reduction

Question 26

What is a sign of an optic nerve glioma?

Answer 26

Optic atrophy

Question 27

What is a sign of an optic nerve meningioma?

Answer 27

Optociliary shunts (30% of pxs) Thickened meninges on CT scan

Question 28

What are some other acquired causes of optic disc swelling?

Answer 28

Papillitis Juxtapapillary choroiditis Optic disc inflammation Lymphoma/metastasis/granuloma

Question 29

What are some congenital optic nerve anomalies which don't have systemic associations?

Answer 29

Tilted disc Disc drusen Optic disc pit Myelinated nerve fibres

Question 30

What are some congenital optic nerve anomalies which do have systemic associations?

Answer 30

Coloboma Hypoplasia Megalopapilla Peripapillary staphyloma Dysplasia

Question 30

What is a consequence of optic disc coloboma?

Answer 30

Reduced VA

Question 31

What are some systemic associations of optic disc coloboma?

Answer 31

CNS malformations Chromosomal abnormalities (e.g. trisomy 13) CHARGE: coloboma, heart defects, atresia choanae (nasal blockage), retarded development, genital and ear abnormalities

Question 32

What is a consequence of optic disc morning glory?

Answer 32

Reduced VA Serous RD (30%)

Question 33

What is a consequence of optic nerve hypoplasia?

Answer 33

Reduced VA

Question 34

What is an association of optic nerve hypoplasia and what should be done?

Answer 34

Brain abnormalities Should be referred to neurology

Question 35

What is megalopapilla?

Answer 35

DD over 2mm (H or V)

Question 36

What is peripapillary staphyloma?

Answer 36

Normal disc with peripapillary excavation

Question 37

What are the hereditary optic neuropathies?

Answer 37

Dominant optic atrophy Leber's hereditary optic neuropathy

Question 38

What causes Leber's hereditary optic neuropathy?

Answer 38

Mitochondrial mutation - inherited maternally Causes loss of RGCs

Question 39

When and how does Leber's hereditary optic neuropathy present?

Answer 39

Usually male 15-25 yo Initially unilateral but fellow eye affected within 2 months

Question 40

What are the acute signs of Leber's hereditary optic neuropathy?

Answer 40

Disc swelling Disc hyperaemia Dilated capillaries Tortuous large vessels Swelling of peripapillary NFL

Question 41

What is a late sign of Leber's hereditary optic neuropathy?

Answer 41

Bilateral featureless optic atrophy

Question 42

What is the management for Leber's hereditary optic neuropathy?

Answer 42

No cure or treatment Refer for diagnosis, genetic counselling, visual rehabilitation, register as SSI

Question 43

What causes dominant optic atrophy?

Answer 43

AD inheritance RGC loss

Question 44

When does dominant optic atrophy onset?

Answer 44

Congenital or 6-12 yo

Question 45

What are the signs of dominant optic atrophy?

Answer 45

Gradual, variable VA reduction Optic disc atrophy - temporal pallor Centroceacal or paracentral VF defect

Question 46

What is the management for dominant optic atrophy?

Answer 46

No cure or treatment Refer for diagnosis, genetic counselling, visual rehabilitation, register as SI