Disorder of the Optic Nerve Head Flashcards
Name and Signs/Symptoms of this conditions
Pseudopapilodema - commonly caused by drusen - there is no ONH swelling.
Signs/Symptoms: abnormal blood vessel configuration, sharp peripapillary RNFL, peripapillary retina not elevated (only disc), , spontaneous venous pulsations and no exudates
What are the differentials for Pseudopapilloedema?
Buried disc drusen
Tilted disc
Small, crowded disc
Name and signs/symptoms of this condition
Papilloedema
Swelling (bilateral) ONH due to raised intracranial pressure - usually bilateral but can be asymmetric
Early: Mild disc hyperaemia with preservation of the physiological cup. Indistinct disc margins & RNFL striations. Spontaneous Venous pulsation is absent (may not be significant because it is also absent in about 20% of the population). DDx: hyperopia + buried drusen.
Established (acute): Normal or reduced VA. Severe disc hyperaemia, moderate disc elevation, indistinct margins, absence of physiological cup. Venous engorgement, peripapillary flame haemorrhages, cotton wool spots. Circumferential retinal folds (Paton lines) develop, especially temporally (Enlarged blind spot
Chronic: Disc elevation without haemorrhages or CWS Telangiectasia, optico-ciliary shunts and drusen-like crystalline deposits may be present A macular star is common.
Atrophic: Secondary optic atrophy: VA severely impaired; optic discs are white, slightly elevated, few blood vessels, indistinct margin
Name, description and sign/symptoms of this condition
Drusen - Common, often familial. They are benign but can cause visual field defects and may need monitoring for driving purposes.
Signs / Symptoms: Occasionally associated with ocular and systemic disorders (e.g., disc haemorrhages or Alagille syndrome) Superficial drusen can be found with FAF
What are the differential diagnoses for Papilloedema?
Established acute: malignant hypertension
What are the differential diagnosises for drusen?
Buried disc drusen
Name description and sign/symptoms of this condition
Name: small crowded disc
Description: anatomical variation caused by a normal amount of axons coursing through a small scleral foramen (disc).
Signs/Symptoms: Asymptomatic. Indistinct disc margins and no or minimal apparent cup. OCT: Pseudo ‘lumpy - bumpy’ contour of the subretinal hypo reflective space due to blood vessel shadowing artefact (*). Intact adjacent retinal architecture (arrows). No Visible cup.
What are the differential diagnoses for small crowded disc?
Pseudopapilloedema
Name, description and signs/symptoms of this condition
Name: tilted disc
Description: Characterised by a disparity between the maximum and minimum elevations of the surface of the disc. Can be congenital or acquired usually associated with myopic and astigmatic refractive error
Signs/Symptoms: Asymptomatic except when associated with myopic maculopathy. Blurred, elevated disc margins temporal/inferonasal peripapillary atrophy. OCT: elevation would be more pronounced
Name, Description and Signs/Symptoms of this condition (top images only)
Name: Buried Disc Drusen
Description: Similar to Drusen - ONH drusen are calcified deposits which may appear at the surface or buried within the disc. They may be caused by a combination of disturbance of metabolism in the axons, abnormal vasculature, and a small scleral canal.
Signs/Symptoms:
Usually asymptomatic but can cause chronic peripheral vision loss. Rarely transient visual obscuration. Clinical appearance: elevated disc with irregular margins. Superficial drusen are yellow and reflective.
FAF/B - scan: hyper - autoflurescent areas of FAF. Hyper - echoic on B - scan (arrow)
OCT: “Lumpy bumpy” subretinal hypo reflective space which may correspond with the contour of drusenoid deposits (*). Cysts with hyper - reflective walls (arrow).
What are the differentials for Buried Disc Drusen?
Psuedopapilloedema
Name this condition?
Central Retinal Vein Occlusion
Signs and Symptoms of CRVO
Mild hyperaemic disc swelling. Venous engorgement (dilated and tortuous) widespread retinal haemorrhages (flame, dot, intraretinal), hard exudates and variable CWS (cotton wool spot). Peripheral VFD or potentially central loss due to macular oedema from ischaemia. OCT and FA useful in diagnosis
What is GCA?
Giant Cell Arteritis - GCA is a granulomatous necrotizing arteritis with a prediction for the major aortic branches and the superficial temporal (STA), ophthalmic, posterior ciliary and proximal vertebral arteries
Signs and Symptoms of GCA?
Scalp tenderness, jaw claudication, optic neuropathy (AAION), temporal arteritis (Thickened, tender, inflamed nodular arteries), arterial pulsation, ocular motor palsies. Investigation: Biopsy (Gold standard)
Description of this condition
Non - artertic Anterior Ischaemic Optic Neuropathy - Infarction of the optic nerve head not associated with GCA (caused by lack of optic nerve perfusion or embolic disease. Caused by occlusion of short posterior ciliary arteries resulting in partial or total infarction of optic nerve head.
Name and Describe this condition
AAION - Artertic Anterior Ischaemic Optic Neuropathy
Infarction of the optic nerve head caused by giant-cell arteritis. Painless and profound vision loss (permanent)
What are the signs and symptoms of NAION?
Signs: diffuse or sectoral hyperaemic disc swelling often associated with small peripapillary splinter haemorrhages RAPD, unilateral visual field defect