optic nerve disorders

Question 1

optic neuritis

Answer 1

Optic neuritis:
§ Acute visual loss
§ Young, usually female
§ Thorough history imperative
§ Ask about bowel/bladder, unilateral weakness or sensory loss
§ Unilateral swollen optic nerve (often not present when inflammation and demyelination
further back)
§ RAPD present
§ Refer to eye clinic
§ Visual field assessment
§ MRI brain and spine

Question 2

GCA

Answer 2

Giant cell arteritis:
§ This is inflammation of medium-calibre vessels
§ Sight threatening
§ Life threatening
§ Symptoms
§ Headaches/temporal tenderness
§ Jaw claudication
§ Girdle pain, low fever, malaise, weight loss
§ Acute visual loss from arteritic anterior ischaemic optic neuropathy (AION)

Question 3

GCA management

Answer 3

Management
§ Prompt high dose oral prednisolone if symptoms present
§ Urgent ESR/CRP – do not wait for blood results to treat if symptoms present!!!
§ Immediate discussion with ophthalmology if visual symptoms present

Question 4

non-arteritic ischaemic optic neuropathy

Answer 4

Non-arteritic ischaemic optic neuropathy (NAION):
§ Sudden onset visual loss
§ Painless
§ Vasculopathic risk factors
§ BP, cholesterol, smoking
§ Important to exclude GCA giving rise to AION
§ Always ask about headaches/temporal tenderness/
§ Urgent bloods: ESR/CRP
§ If raised then treat as GCA

Question 5

mx of NAION

Answer 5

§ Management
§ Refer to eye clinic
§ Optimise vascular risk factors