Other Optic Neuropathies and Optic Disc Anomalies (M1)

Question 1

What is a condition that has agenesis of septum pellucidum and hypothalamus?

Answer 1

septo optic dis dysplasia (De Morsier’s Syndrome)

Question 2

What is a possible ocular sequelae of a Morning Glory Disc?

Answer 2

1. non-rhegmatogenous retinal detachment

2. retinoschisis

Question 3

What are the most common optic neuropathies?

Answer 3

1. glaucoma
2. typical optic neuropathy
3. anterior ischemic optic neuropathy

Question 4

What is a possible ocular sequelae of an optic pit?

Answer 4

1. non-rhegmatogenous retinal detachment

2. propensity for low-tension glaucoma

Question 5

What are the systemic associations with optic nerve hypoplasia?

Answer 5

1. septo optic dis dysplasia (De Morsier’s Syndrome)

2. Growth hormone deficiency

Question 6

What is an outer ring of visible sclera and RPE surrounding a small optic disc called?

Answer 6

Double ring sign

Question 7

What are the possible methods of infiltrative optic neuropathy?

Answer 7

1. tumors metastasized to optic nerve
2. lymphoma
3. leukemia
4. sarcoidosis
5. syphilis, TB, fungal infection

Question 8

What is a possible ocular sequelae of a coloboma?

Answer 8

non-rhegmatogenous retinal detachment

Question 9

What are the possible locations of an aneurysm for vascular compressive optic neuropathy?

Answer 9

1. anterior cerebral artery
2. anterior communicating artery
3. ophthalmic artery
4. supraclinoid portion of internal carotid artery

Question 10

What are the basic assessment aspects needed with the urgent workup for a patient with optic neuropathy?

Answer 10

1. BP
2. Temperature
3. urine analysis
4. full systemic Hx and exam
5. perimetry

Question 11

What are the imaging aspects needed with the urgent workup for a patient with optic neuropathy?

Answer 11

1. MRI of brain, optic nerves, chiasm with contrast
2. MRV in cases of bilateral disc swelling (venous thrombosis)
3. chest CT or x-ray

Question 12

Which eye does a Morning glory disc favor?

Answer 12

right

Question 13

What is the course of Leber’s Optic Neuropahy (LHON)?

Answer 13

1. vision loss progresses over weeks or months
2. recurrence rare
3. vision loss in second eye typically occurs weeks to months later
4. spontaneous improvement in vision can occur

Question 14

What is needed when you cannot safely diagnose glaucoma, typical optic neuropathy, or anterior ischemic optic neuropathy and there is optic neuropathy present?

Answer 14

urgent workup (referral to neuro-ophthalmologist)

Question 15

What are the possible causes of optic nerve hypoplasia?

Answer 15

1. exaggeration of reduction in axons during development

2. compressive lesion inhibiting normal optic nerve development

Question 16

What hormones can be deficient that can be associated with optic nerve hypoplasia?

Answer 16

1. ACTH
2. FSH
3. LH
4. ADH
5. TSH

Question 17

What is an outpouching of the meninges, often containing the optic chiasm and hypothalamus, and protrudes through a defect in the sphenoid bone called?

Answer 17

Transsphenoidal basal encephalocele

Question 18

What are the optic neuropathies that an optometrist can safely make a diagnosis of?

Answer 18

1. glaucoma
2. typical optic neuropathy
3. anterior ischemic optic neuropathy

Question 19

What are the blood work aspects needed with the urgent workup for a patient with optic neuropathy?

Answer 19

1. CBC
2. glucose
3. ESR
4. CRP
5. ANA
6. ACE
7. syphillis serology
8. consider folate, B12, cat scratch, toxoplasma, Lyme, LHON mito testing

Question 20

What are the findings in a patient with malinserted discs?

Answer 20

1. oblique insertion of optic nerve into scleral canal
2. disc generally tilted temporally (appears elevated nasally
3. generally associated crescent
4. right and left eye typically mirror-images