Neuro-ophthalmology Flashcards
What 3 things should one comment on when describeing an optic disk?
The three C’s:
The colour
The contour
The cup-disk ratio
What are the sings of optic disk swelling
The colour: pink
The contour: Blurred with haemorrhages at the contour
The cup-disk ratio: not enlarged but hard to see anyway
What are some DDx’s of optic disk swelling
optic neuritis
papilloedema (has to be bilateral)
malignant hypertension
arteritic anterior ischaemic optic neuropathy (aion)
non-arteritic aion
What is seen on fundoscopy in pt’s with optic neuritis?
a swollen disc with a blurred margin
If the inflammation of the optic nerve is further back then the optic disc may not be swollen (retrobulbar neuritis)
with a pink colour and normal cup
What symptoms will a patient with optic neuritis complain of (and what is the typical age demographic)?
Complain of:
1) Blurred vision
2) Dull ache esp. on eye movement
(normally young to middle aged)
What examinations are indicated in optic neuritis and what would the findings be?
Fundoscopy findings (blurred disk margin showing swollen disk or not) and
Visual fields –> reduced centrally due to para-central scotoma or enlarged blind spot.
Swinging flashlight test –> RAPD
What investigations should be done in recurrent optic neuritis?
MRI to check for MS
What does papilloedema mean?
swelling of the optic discs
due to increased intracranial pressure
(therefore must be bilateral)
When is the only occasion that papilloedema can be unilateral?
If the patient has developed optic atrophy in one eye previously
What will a patient with papilloedema complain of?
transient blurring of vision
headaches
What are the early signs of papilloedema?
Fundoscopy:
1) haemorrhages at disk margin
2) exudates (lipid break-down products that are left behind after localized edema resolves, they are around the macula)
3) cotton wool spots (debris from dead nerve cells)
4) retinal folds
Bilateral enlarged blind spots (early)
What are the long term signs of papilloedema?
Irreversible atrophic changes of the optic disk
with
Gradual field loss (late) due to generalised constriction of the optic nerve
What is arteritic anterior ischemic optic neuropathy (AION)?
inflammation of the arteries to the optic disc
which causes infarction
Explain the detailed pathophysiology of arteritic AION.
giant cell (aka temporal) arteritis
where inflammation of the temporal arteries causes occlusion of the
posterior ciliary artery supply to the optic nerve
it hence gets infarcted.
What are the early signs of arteritic AION?
temporal headache and jaw claudication (due to jaw ischemia).
This happens before the optic infarction
Raised CRP and ESR