Optic Nerve Abnormalities In Kids

Question 1

Morning glory syndrome

Answer 1

• a funnel shaped excavation of the posterior fundus
• surrounded RPE is elevated
• increased number of vessles
• central white glial seen at normal position of the cup
• usually unilateral

Question 2

Complications of morning glory

Answer 2

Serous detahcment

Fluid around the edges

Question 3

Cause of morning glory

Answer 3

Either due to abnormal closure of the embryonic fissure or abnormal development ofthe distal optic stalk

Question 4

Other tests needed with morning glory syndrome

Answer 4

MRI

Question 5

Myelinated retinal nerve fiber layer

Answer 5

• white superficial retinal are with feathered edges
• follow the orientation of the NFL
• myelination starts at LGN and is supposed to end at the lamina cribrosa, but it extends into the retina
• retinal vessels ar eobscured
• most commonly seen at the disc margin
• vision loss if macular involvement
• amblyopia could occur as well
• scotoma seen at the areas of the myelination

Question 6

ON hypoplasia

Answer 6

• a decrease in the optic nerve axons
• smaller than normal
• disc is pale or gray
• can be unilateral or bilateral
• often asymmetric
• double ring sign (white ring around the disc)
• frequently etiology is unknown
• the inner ring is the hypoplastic disc
• too many or too little vessels may be present
• retinal vessels are tortuous
• isolated or related to a syndrome
• VA correlates to the extent of hypoplasia and the integrity of the fibers
• VA ranges from normal to NLP

Question 7

Findings with ONH hypoplasia

Answer 7

• localized field defects and constrictions are possible
• congenital nystagmus likely in bilateral cases
• sensory strabismus and amblyopia likely in unilateral cases
• midline CNS abnormalities are assocaited with unilateral and bialteral hypoplasia so MRI is indicated
• pituitary hormone abnormaliteis-growth hormone and thyroid deficiencies

Question 8

Septo-optic dysplasia

Answer 8

• ONH hypoplasia
• absence of the septum pellucidum and the agenesis of the corpus callosum: sporadic, unknown cause, presentations vary, pituitary hypoplasia,

Question 9

Disc coloboma

Answer 9

• could be assocaited with a chorioretinal coloboma or only the optic nerve
• mild colobomas could look like deep physiological cupping or glaucomatous damage
• if more extensive, could look like an enlargement of the peripapillary area with deep excavation
• could be assocaited with retina lcolobom in the periphery
• RDs can occur
• one eye or both
• VA is unpredictable

Question 10

Optic pit

Answer 10

• unilateral, sporadic
• inferiroly or central
• shallow or deep
• covered with a gray veil with cilioretinal arteries coming from it
• can be associated with serous RD in adulthood

Question 11

Peripapillary staphyloma

Answer 11

• posterior bulging of the sclera
• ONH is surrounded by stretched choroid, exposing the sclera
• unilateral
• VA is poor
• seen in denegenerative myopia

Question 12

Bergmesiter papilla

Answer 12

• benign glial remnant of the hyaloid artery
• ther arery can remain as a cord from the optic disc to the lens capsule (mittendorf dot)
• assocaited with persistent fetal vasculature

Question 13

Tilted disc

Answer 13

• often bilateral
• superior pole of optic nerve appears elevated while inferior part of optic nerve is displaced postierorly; or titled horizontal resulting in an oval shape
• scleral crescent is seen
• seen in myopes
• could cause bitemproal hemianopsia that does not respect the midline like a chiasmal dfect