Optic nerve disease

Question 1

Optic disc swelling

Answer 1

Due to nerve oedema from obstruction of axoplasmic flow caused by ischemia, inflammation, compression, metabolic, or toxic disorders

Question 2

Signs of optic disc swelling on fundoscopy

Answer 2

Blurring of disc margins
Obscuration of vessels crossing the optic disc

Question 3

Causes of unilateral optic disc swelling

Answer 3

1. Glaucoma
2. Ischaemic optic neuropathy (AION NAION)
3. Inflammatory: Optic neuritis
4. Compressive: tumours
   Infiltrative
   Radiation

Question 4

Causes of bilateral optic disc swelling

Answer 4

1. Malignant hypertension
2. Raised intracranial pressure
   - Papilloedema
   - SOLs
   - Hydrocephalus
   - Infx/ Inflammation (E.g., meningitis)
   - Hemorrhage: Spontaneous bleed or 2° to trauma
3. Venous Sinus Thrombosis (Young female patients on OCP)

Question 5

Fundoscopy findings of raised ICP

Answer 5

Flame shaped hemorrhages around optic disc
Bilateral optic disc swelling
Obscuration of vessels crossing the optic disc

Question 6

Optic Disc Cupping means

Answer 6

Increased size of the cup
Raised CDR
MUST RULE OUT GLAUCOMA!

Question 7

Optic neuritis 2° to demyelination is typically a/w

Answer 7

Multiple sclerosis

Question 8

Symptoms of raised ICP

Answer 8

• Headache worse on lying down
• N&V usually projectile worse in morning
• Neurological deficits (weakness/ numbness)
• Diplopia (False localizing VI)
• Transient obscuration of vision (TOV)
• Pulsatile Tinnitus (In tune with heartbeat)

Question 9

Physical findings of raised ICP

Answer 9

Pseudo CN6 palsy

Question 10

Optic atrophy

Answer 10

Pale optic disc with blurred margins
Possible causes:
- Old NAAION
- Compressive optic neuropathy
- Cone dystrophy
(CANNOT diagnose cause of optic atrophy by just looking at the optic disc)