Fall 2014: Week 10: Compressive Optic Neuropathy

Question 1

Non-Neoplastic Causes (5)

• I OATS
• Rest are Neoplastic (ON sheath Meningioma; ON Glioma; Pituitary Adenoma; Angioma; Craniopharyngioma; Melanocytoma; Metastasis)

Answer 1

Idiopathic Orbital Inflammatory Dz (Orbital Pseudotumor)

Orbital Hemorrhage

Aneurysms

TED

Sarcoidosis

Question 2

• OMAS
  1. Glioma = Tumor arising from what?
  2. Meningioma = Tumor arising from what?
  3. Angioma (Hemangioma) = Benign Tumor made up of what?
  4. Melanocytoma = Benign tumor arising from what?
  5. Adenoma = Epithelial Tumor arising from what Tissue?
  6. Lymphoma: usually a Malignant Tumor of what tissue?

Answer 2

1. Glial Cells
2. Meninges
3. BVs
4. Melanocytes
5. from Glandular Tissue
6. Lymphoid tissue

Question 3

Characteristics

1. Typically what kind of VISION LOSS?
2. Color vision?
3. Transient Vision loss due to what?
4. What do the eyes do?
5. What other 3 things could be seen?

Answer 3

1. SLOWLY PROGRESSIVE VISION LOSS
2. Decreased
3. Gaze Evoked Transient Vision Loss
4. Proptosis
5. Pain on eye movement; Eyelid involvement possible; Diplopia

Question 4

Ophthalmic Signs

1. Optic nerve Appearance (3 things)
2. What kind of vessels can be seen?
3. What can be seen if U/L or Asymmetric?
4. VF Defects?

Answer 4

1. Cupped, Pallor, Swollen
2. Collateral (Optociliary Shunt) Vessels
3. • APD
4. Enlarged Blind Spot; Generalized Constriction

Question 5

Non-Glaucomatous Cupping

Answer 5

1. Horizontal cupping
2. Pallor in excess of cupping
3. VF that obeys VERTICAL MIDLINE
4. <50 yrs old
5. No FHx of Glaucoma
6. Reduced VA
7. • Symptoms (systemic)
8. VF is worse than EXPECTED by ON Appearance

Question 6

Dx

1. Neuroimaging
2. ON Bx Performed?

Answer 6

1. MRI of Brain and Orbits: Thin slices w/Contrast and FAT SUPPRESSION
2. NO due to risk of permanent vision loss

Question 7

ON Sheath Meningioma

1. Who is affected more?
2. U/L or B/L?
3. ASSOCIATED with WHAT?
4. Tx?
5. 2 Enhancing areas of tumor separated from each other by the NON ENHANCING AREA of the ON is called what…?

Answer 7

1. Middle-Aged WOMEN (2:1 men)
2. U/L
3. NFMB 2 (Acoustic Neuroma (90%) –> Hearing Loss)
4. Radiation
5. TRAM TRACK SIGN

Question 8

Optic Nerve Glioma

1. Most cases present when?
   a. They RARELY EXTEND OUTSIDE what?
2. Tx?
3. ASSOCIATED With WHAT?
   a. Signs?
4. Most common signs?

Answer 8

1. Childhood
   a. Outside the Orbit
2. Observe; Chemotherapy; Surgical Removal
3. NFMB 1
   a. Cafe au lait spots (body) and Lisch Nodules (Iris)
4. Proptosis (94%); Vision loss (87.5%) and Optic Disc Pallor (59%)

Question 9

Capillary Angioma

1. What is it?
2. Associated with what SYNDROME?
3. Uni or Bi?
4. Tx?

Answer 9

1. Benign Vascular Lesions
2. Von Hippel-Lindau Syndrome
3. B/L in up to 50% of peeps
4. Photocoagulation, Cryotherapy, ANTI-VEGF

Question 10

Melanocytoma

1. What is it?
2. Symptomatic?
3. Malignant transformation common?

Answer 10

1. Benign pigmented tumors composed of melanocytes
2. usually asymptomatic and static
3. is uncommon

Question 11

Metastasis

1. Common or rare to the ON?
2. CAs in young pts?
3. Older Pts?
4. Prognosis?

Answer 11

1. RARE (5% of all intraocular metastases)
2. Leukemia, Lymphoma
3. Breast, Lung
4. POOR

Question 12

Pituitary Adenoma

1. MOST COMMON CAUSE OF WHAT?
2. VF Loss?
3. Optic Neuropathy?
4. Diplopia?
5. Prevalence?
6. Size
   a. Microadenoma
7. 2 major groups…

Answer 12

1. COMPRESSIVE OPTIC NEUROPATHY
2. Bitemporal or Junctional Scotoma
3. ON Pallor/Cupping; Papilledema if increased ICP
4. If extension into the Cavernous Sinus
5. 16.7%!!!
6. a. s Macroadenoma
7. Nonfunctional and
   Functional (hormone secreting)

Question 13

Functional Adenomas

1. Prolactinoma (Prolactin)
   a. Men
   b. Women
2. Somatotrophic Adenoma (Growth Hormone)
   a. What is seen in Children
   b. Adults?
3. ACTH (Corticotrophic Adenoma)
   a. Dz?
4. Gonadotrophic Adenoma (LH, FSH)
   a. Men?
5. Incidence
6. Tx?

Answer 13

1. a. Infertility, Galactorrhea, Impotence
   b. Amenorrhea, Galactorrhea, Infertility
2. a. Gigantism
   b. Acromegaly
3. a. Cushing’s Dz
4. a. Decreased libido, Impotence
5. Men, in their 70s, Blacks
6. Medicaiton, Observe, Radiation Therapy, Endoscopic Transsphenoidal Sx

Question 14

Non-Neoplastic Compressive Optic Neuropathy

TED

1. % that get COMPRESSIVE OPTIC NEUROPATHY?

Answer 14

1. 6%
   * U/L or B/L Retraction

Int/Constant Diplopia

Dysthyroid

Orbital CT w/o Contrast

Tx: Monitor; Systemic Condition

Consider radiation therapy or orbital decompression if severe

or Oral or IV steroids