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OP3104- AOC- YR 3 > Optic Nerve > Flashcards

Optic Nerve Flashcards

1
Q

Pressure in subarachnoid space affects?

A

Affects pressure in optic nerve head.

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1
Q

3 common symptoms of patients with optic nerve disease?

A
  1. Complain of poor vision
  2. Transient loss of vision
  3. Rarely pain unless inflammatory condition
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2
Q

Signs of optic nerve dysfunction?

A
  1. Reduced VA- distance & near
  2. Colour vision- night Vision affected
  3. Pupils: RAPD
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3
Q

What 3 changes can be seen at the optic disc?

A
  1. Disc swelling
  2. Optico- ciliary shunts (abnormal blood vessels)
  3. Optic atrophy - end stage
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4
Q

Optico- ciliary shunts associated with which conditions?

A

central retinal vein occlusion, optic nerve sheath meningioma, chronic glaucoma and chronic papilledema and are a nonspecific sign of chronic retinal venous congestion.

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5
Q

Optico- ciliary shunts- how do they look on the disc?

A

appearing as tortuous vascular loops that start and end on the disc

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6
Q

Optico- ciliary shunts needs to be differentiated from neovasc, why?

A

They must be differentiated from neovascularization of the disc because neovascularization requires prompt treatment with laser photocoagulation or anti-VEGF intravitreal injections, while shunt vessels do not and can protect against retinal ischemia.

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7
Q

Optico- ciliary shunts needs to be differentiated from neovasc: physical difference?

A

Optociliary shunt vessels can be differentiated from neovascularization of the disc by their large caliber and lack of leakage on fluorescein angiogram.

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8
Q

What causes papilloedema?

A

Raised Intracranial pressure

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9
Q

Papilloedema - how does it look and what happens if long standing?

A

Bilateral optic disc swelling.
If long-standing = optic atrophy

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10
Q

Features of early papilledema

A
  1. VA normal
  2. Mild disc hyperemia
  3. Nasally indistinct margin
  4. Mild venous engorgement
  5. Normal optic cup
  6. Spontaneous venous pulsation absent
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11
Q

Features of acute papilledema (disc, VA, margins)?

A

VA- normal
Severe disc elevation hyperemia
Very indistinct margin
Obstruction of small vessels on the disc

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12
Q

Features of late papilledema?

A
  1. Marked venous engorgement
  2. Reduced or absent cup
  3. Haemorrhages and cotton wool spot
  4. Macular star
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13
Q

Discs and VA in chronic papilloedema?

A

VA- Variable (Visual obstruction, macular star)
Marked disc elevation (vintage cork look), disc margin indistinct, variable venous engorgement, absent optic cup.

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14
Q

Bilateral disc swelling vs unilateral- what could the condition be?

A

Bilateral- papilledema
Unilateral- CRVO

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15
Q

Do VF need to be done before referring papilloedema?
If yes, what is seen?

A

Yes
Enlarged blind spot

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16
Q

VA and disc in secondary optic atrophy?

A
  1. VA severely decreased
  2. Mild disc elevation
  3. Indistinct disc margin
  4. Disc pallor with few crossing vessels
  5. Absent cup
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17
Q

Causes of secondary optic atrophy?

A

Papilloedema, treated papilloedema, congenital optic atrophy, trauma

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18
Q

What are pseudopapilloedema?

A

Other causes of swollen disc rather than raised ICP
Acquired = papillitis, ischemic papillopathy, juxapapillary choroiditis, optic disc infiltration

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19
Q

Most common tumour assosiated with optio-ciliary shunts?

A

Nerve sheath meningioma

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20
Q

Optio-ciliary shunts- EMERGENCY OR URGENT?

A

Refer, but non- emergency

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21
Q

Optic atrophy causes?

A

Post Optic neuritis
Long standing papilledema
Compressive optic atrophy - due to tumours
Herediatery optic atrophies (Leber’s hereditary optic neuropathy)

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22
Q

Optic atrophy- how does the disc look?

A

Pale

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23
Q

Example of with systemic condition congenital optic nerve anomalies?

A

Morning glory coloboma

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24
Q

4 congenital optic nerve anomalies without systemic conditions?

A
  1. Tilted disc
  2. Disc drusen
  3. Optic disc pit
  4. Myelinated nerve fibres
25
Q

How are:
VA, VF Defects and related factors of tilted disc?
Refered- how urgent?

A

VA normal
Frequent in myopia, astigmats
Nasal defect common common but can have supertemporal defect
Non-urgent referral.

26
Q

Disc drusen associated with what 2 conditions?
How is VA in this condition?

A
  1. RP
  2. Angioid streak
    VA normal unless complication like choroidal neovascularisation.
27
Q

Disc drusen appearance?

A
  1. Absent cup
  2. Pink/ yellow waxy pearl like
  3. Indistinct lumpy margim
28
Q

How does disc drusen look on CT scans?

A

White spots

29
Q

Optic pits is unilateral or bilateral?

A

Uni

30
Q

Optic disc pit- how does it look?

A

Large disc, containing oval or round pit - seen temporal

31
Q

Optic disc pit complication?

A

Can cause macular detachment if pit on maculo-papillar bundle

32
Q

How does myelinated nerve fibres look like?
What is the cause?

A

Grey/ white opaque lesions on the retina with feathery edges that obscure retina details.
Occurs when myelination spreads on the surface of the retina.

33
Q

The following conditions fall under?
-Optic disc hypoplasia
-Megalopapilla
-Peripaillary staphyloma
-Optic disc dysplasia

A

Congenital optic nerve abnormalities with systemic conditions

34
Q

Optic disc coloboma is a result of?

A

Malclosure of foteal cleft

35
Q

Morning gloary disc is a variant of?
How do the vessels look?

A

Coloboma
Spoke-like emerging vessels

36
Q

What is optic nerve hypoplasia disc like?

A

Small , often pink

37
Q

How does megalopilla disc look like?

A

Huge disc- vertical and horizontal diameter over 2mm.

38
Q

How does peripapillary staphyloma look like?

A

Normal disc with peripapillary excavation (outpouching of disc)
Unilateral

39
Q

Papilloedema meaning?

A

Swelling of optic disc secondary to raised ICP

40
Q

Vintage cork appearance cause?

A

Caused by bilateral raised ICP.
Extensive swelling of disc + haemorrages + dialted vessels.

41
Q

Most common optic neuropathy is?

A

Glaucoma

42
Q

Most common cause of retrobulbar neuritis?
How does the disc look?

A

Demyelination
Disc looks pale due to demyelination. Can affect any part of the eye.

43
Q

Severe episodes of demyelination in different parts of the CNS indicate?

A

MS

44
Q

What attacks myelination?

A

Inflammatory factors

45
Q

What is papillitis and how does the optic nerve head look?

A

Optic nerve head swollen

46
Q

Can MS diagnosis be made in one visit?

A

No, need to monitor px before making diagnosis

47
Q

How does neuriretinitis look?

A

Disc swollen, hyperaemic, macular star.
Difficult to see because px has huge uveitis.

48
Q

AION vs glaucoma?

A

AION= Altitudinal defect,
Glaucoma= doesn’t cause altitudinal defect, doesn’t cross mid line.

49
Q

AION uni or bilateral?

A

Uni

50
Q

Acute non-arteritic AION features

A
  1. Pale disc
  2. Diffused oedema of disc or one sector
  3. Splint hemorrhages over disc
51
Q

Late non-arthritic AION?

A
  1. Resolution of oedema and haemorrhages
  2. Optic atrophy
  3. Variable visual loss (Depends on duration)
52
Q

What is AION?

A

Swelling of arteries

53
Q

Signs of arteritic AION?

A
  1. Pale disc
  2. Disc oedema diffused
  3. Few small splinter heaemorrhages
  4. Optic atrophy if longstanding
54
Q

AION refered?

A

Urgently

55
Q

Arteritic AION?

A

Gaint cell arteritis

56
Q

Why are hereditary optic neuropthies refered non-uregntly?

A

No treatment available

57
Q

Lebers hereditary optic neuroptahy (LHON) signs?

A
  1. Disc swelling
  2. Dilated capillaries
  3. Small vessels dialted
  4. Large vessels tortous
58
Q

Why is papilledema bilateral?

A

Due to raised ICP

59
Q

Dominant Optic Atrophy (ADOA) Features?

A

6-12 years onset
Gradual onset- no sudden loss of vision
Pale disc

60
Q

What is optic nerve glioma and how does it present?

A

Tumor of optic nerve glial tissue.
Presents with- gradual visual loss, proptosis, eventually optic atrophy

61
Q

Optic nerve sheath meningioma presentation?

A

Tumour wraps arround optic nerve. Gradual visual loss due to compression of the optic nerve. Proptosis- die to bulk of tumour.
Optociliary shunts

OP3104- AOC- YR 3 (8 decks)

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