Lecture 8

Question 1

Choroidal nevus

• What is it?
• __% have surface drusen
• Internal reflectivity?
• How many covert
• Size?

Answer 1

Benign choroidal melanoma- focal accumulation of melanocytes in the choroid. 
80% with surface drusen 
Low internal reflectivity 
1/4000 convert 
Less than 6DD in size.

Question 2

Choroidal Osteoma

• What is it and where is the location
• Appearance
• When does it arise

Answer 2

Acquired, slow growing intrachoroidal, bone like tumor.

Yellow-white-orange because boney and near ON.

Arises late in childhood and changes size throughout life.

Question 3

Melanocytoma

• What is it
• Appearance
• Complications/evolution

Answer 3

Benign, primary tumor of the ON that arises from melanocytes.

Elevated, black lesion on the disc with flayed edges that follow the NFL. Small! Less than 2mm.

Slow growth, but may cause vit seeding, exudate, fluid, and edema.

Question 4

Another name for optic nerve glioma

Answer 4

Juvenile Pilocytic Granuloma

Question 5

Most common primary neoplasm of the ON

Answer 5

Optic nerve glioma

Question 6

Optic nerve glioma

• Originates from what tissue
• Location
• Management

Answer 6

• Glial tissue
• Usually retrobulbar and causes proptosis, strab, limited EOMs.
• Image the orbit and send to neuro to check for ON compression!

Question 7

How does age of dx of optic nerve glioma affect the outcome?

Answer 7

Dx young at age 4-8? common and benign.

Dx older? More malignant form- glioblastoma. Pt passes shortly after.

Question 8

Complications of optic nerve glioma

Answer 8

If dx older, death.

Optic atrophy, blindness.

Question 9

If you see an optociliary shunt, what is the next step? (collateral vessels of the ON that connect choroidal and retinal circulature)

Answer 9

Rule out retrobulbar mass unless it’s due to POAG

Question 10

How does age of dx of ON meningioma change outcome?

Answer 10

Dx younger than 20? More aggressive.

Dx older than 30? Less aggressive.

Question 11

ON Meningioma

• What is it
• Location and appearance
• Risk
• Symptoms
• Complications
• Management

Answer 11

Benign neoplasm of the ON sheath

Retrobulbar –> Proptosis, ONH edema, optociliary shunt, APD, ON atrophy.

Women, ionizing radiation, NF2

Reduced VA, field defect, decreased color VA, HA

May erode into the bony orbit

Usually radiation- can’t excise or will likely cause blindness. Tx is especially important in pt’s under 20- more aggressive.

Question 12

Glioblastoma is dx in adults. Called ___ when dx in kids?

Answer 12

ON glioma

Question 13

Choroidal osteoma is at high risk of developing what

Answer 13

CNV! –> VA loss

Question 14

Melanocytoma presentation with IVFA compared to malignant tumors

Answer 14

Appears hypo, whereas malignant tumors are hyper bc high vascularization.

Question 15

Astrocytic Harmatoma is associated with

Answer 15

Tuberous Sclerosis and NF

Question 16

Signs of optic nerve meningioma

Answer 16

Tram track sign

Donus sign

Question 17

TOC for optic nerve meningioma

Answer 17

Radiation therapy. Surgical excision likely will result in vision loss bc so close to the ONH.