Optic Nerve Anomalies - Acquired Flashcards
What is papilloedema?
•Papilloedema is a swelling of the ON secondary to raised intra-cranial pressure
Is papilloedema unilateral or bilateral?
•Papilloedema is typically bilateral but may be asymmetric
What is the managment for papilloedema?
•Any patient presenting with papilloedema should be suspected of having an intracranial mass and referred immediately
What are the symptoms associated with papilloedema?
- VA not affected initially but increase in size of blind spot as progresses
- Blurred vision – transient when rising to stand
- Double vision (VIth nerve palsy)
- May have RAPD
- Headaches – worse after lying down - this is a big indication
- Nausea
- Vomiting
What does early papilloedema look like?
- Mild disc swelling and hyperaemia - nasal margins affected first
- Blurring of disc margins
- Venous engorgement (i.e. veins getting bigger is the first sign)
What may established papilloedema present with?
- Disc swelling
- Cotton wool spots
- Retinal folds
- Hard exudates
What is atrophy?
The wasting away or deterioration of something
What are symptoms and signs of optic atrophy?
- Progressive loss of vision
- Colour Vision, VF and VA all affected
- Disc appears pale
What are the two types of optic atrophy- describe each one.
Primary and Secondary
•Primary
- This is optic atrophy that is not associated with another disease
- It is often hereditary - (most common is Leber’s hereditary optic neuropathy – loss of vision in one eye or both in teens or twenties)
•Secondary
- Associated with another disease
- Usually Alcohol/tobacco or Drug induced.
What is the management of Optic Atrophy?
- It is Irreversible
- If not noted previously then referral to HES – speed depends on VA and whether progressive or not (from patient’s symptoms)
What may optic neuritis be caused by?
- Optic neuritis is caused by inflammation, infection or demyelination of the optic nerve
- Para-infectious causes may occur due to a viral infection or immunisation
- Infectious causes may be due to syphilis, lyme disease and cat-scratch fever
- Can be idiopathic
What is the most common cause of optic neuritis?
Demyelination as a result of a disease such as Multiple Sclerosis
What is multiple sclerosis (MS)?
- Multiple Sclerosis (MS) is a disease of the central nervous system where there is demyelination of the nerve fibres
- Demyelination can occur anywhere in the body causing neural and muscular impairments which can be mild or severe
Whom does optic neuritis most commonly affect?
•Patients usually present between the ages of 20 and 40 – majority are female (3:1)
What is optic neuritis often refered to as and why?
•As ON appears normal - condition sometimes referred to as ‘retrobulbar neuritis’
What are the signs of Non-arteritic Anterior Ischaemic Optic Neuropathy?
- Pale swollen disc
- Surrounding haemorrhages
What is Arteritic Anterior Ischaemic Optic Neuropathy caused by?
•Caused by inflammation of the small and medium arteries around the ONH – especially the temporal, ophthalmic and posterior ciliary arteries.
What are symptoms of Artertic Anterior Ischaemic Optic Neuropathy?
- Sudden profound painless unilateral loss of vision
- Age usually between 60 to 80 years
- Jaw claudication
- Scalp tenderness
- Temporal headache
- Tender inflamed nodular arteries – can see in the picture
- Weight loss
- Fever night sweats
- Might experience TIA (Transient Ischaemic Attacks)
