optic atrophy
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Optic atrophy
Angel Das
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Optic Atrophy
Condition of optic disc following degeneration of optic nerve Occurs as result of any injury to nerve fibres involving in anterior visual system – retina to lateral geniculate body
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Classification Ophthalmoscopic Classification -Primary Optic Atrophy - Secondary/Post-neuritic Optic Atrophy -Consecutive Optic Atrophy -Glaucomatous Optic Atrophy -Ischaemic Optic Atrophy Another classification -Ascending/Anterograde optic atrophy -Descending/retrograde optic atrophy
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Primary optic atrophy
Disease proximal to the disc so there is no evidence of local inflammation.
CAUSES: Multiple sclerosis Space occupying lesions Leber’s disease Tabes dorsalis
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o Disc is chalky whiteo Margins well definedo Lamina cribrosa seeno Cupping is shallowo Retina looks normal
Ophthalmoscopic appearance
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Secondary/Post neuritic Optic Atrophy
Break in continuity of fibres in optic disc Occurs in longstanding papilloedema, papillitis or neuroretinitis
Ophthalmoscopic Appearance
-Disc- dirty white
-Edges blurred due to gliosis(proliferation of astrocytes & glial tissue)
-Cup obliterated
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Consecutive Optic Atrophy
Occurs following destruction of ganglion cell- secondary to lesions in choroid /retina
Causes -Diffuse chorioretinitis
-Retinitis pigmentosa
-Pathological myopia
-Occlusion of central retinal artery
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Ophthalmoscopic Appearence -Disc – yellow waxy -Edges – not well defined -Retinal vessels attenuated
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Glaucomatous Atrophy Results from long-standing raised IOP
Ophthalmoscopic Appearence
-Deep & wide cupping of optic disc
-Nasal shift of blood vessels
-Lamina cribrosa pores seen (lamellar dot sign)
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Conditions producing disc ischaemia Causes -Giant cell arteritis -Severe haemorrhage -Severe anaemia -Quinine poisoning
Vascular / Ischaemic Optic Atrophy
Ophthalmoscopic Appearence -pallor of disc -marked attenuation of vessels
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Clinical Features
Loss of vision -partial /total Pupil -semi-dilated -direct light reflex –sluggish /absent -Marcus Gunn pupil/RAPD Visual field loss -Peripheral, Central /Eccentric
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Ophthalmoscopic Appearence
-pallor of disc
-decrease in no: of small blood vessels (kastenbaum index)
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Treatment
Partial optic atrophy – treat underlying cause If complete atrophy – vision cannot be recovered
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