Systemic Disease and Optic Nerve Flashcards
1
Q
Anatomy of Optic Nerve?
- How many fibres? Type of nerve fibres? Origin?
- Where do they synapse?
- Where do fibres subserve in Visual Field?
A
- 1.2 million afferent nerve fibres
Originate in the retinal ganglion cells - Most synapse in the lateral geniculate body (some go to the pre-tectalnuclei in the midbrain)
- About 1/3 of the fibres subserve the central 5°of the visual field
2
Q
Describe the optic disk?
- Shape?
- Colour?
- Diameter?
A
- Circular or oval structure
- Pale pink.
The temporal side being slightly lighter than the nasal - ~1.5mm in diameter
![](https://s3.amazonaws.com/brainscape-prod/system/cm/158/970/712/a_image_thumb.png?1442300008)
3
Q
- What does optic disc contain?
- Describe disc edge?
A
- The centre has a small depression = physiological cup.
- Disc edges are flat and well defined and the temporal edge is more distinct than the nasal
![](https://s3.amazonaws.com/brainscape-prod/system/cm/158/970/729/a_image_thumb.png?1442300130)
4
Q
- What is pigmented arc?
- What does it make up of?
A
- It is formed when retina does not reach the optic disc margin
- Choroidal pigment
![](https://s3.amazonaws.com/brainscape-prod/system/cm/158/970/749/a_image_thumb.png?1442300288)
5
Q
- What artery is in Optic disc?
- What are their branches?
A
- The central retinal artery appears on the surface of the optic disc.
- It divides into two branches: superior & inferior
![](https://s3.amazonaws.com/brainscape-prod/system/cm/158/970/786/a_image_thumb.png?1442300412)
6
Q
- Where do optic nerve fibres become myelinated?
A
- Lamina cribrosa ( where they exit eyeball)
( Image: paler sheathing, fibres are arcuated)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/158/970/799/a_image_thumb.png?1442300499)
7
Q
Anatomical subdivisions
- How long is the optic nerve between globe to chiasm?
- How many segments? How are they subdivided?
A
- 50mm
-
4 segments
Intraocular
Intraorbital
Intracanallicular
Intracranial
8
Q
Signs of Optic nerve problems?
1. VA?
- Pupil?
- Colour vision
- Sensitivity?
- Any visual field defects?
A
- VA decrease
- Afferent pupil defect
- Dyschromatopsia
- Colour vision impairment
- Mainly affects red or green
- Quick assessment: ask patient to compare colour of a red object
- Diminished light brightness sensitivity
- Visual field defects
9
Q
Underlying disease?
- How to find out underlying disease?
- What factors to be considered?
A
- Careful examination & history taking is essential !!!
- Consider:
- Raised ICP
- Intracranial hypertension: associated with prescription & non-prescription drugs
- Ischaemia: Associated with atherosclerosis, diabetes & giant cell arteritis
- Thyroid disease
10
Q
Optic Atrophy Signs?
Primary
- Apperance of ONH?
- What cause (1)?
- Appearance of optic disc? Margin?
- Vessels on disc surface?
- NFL?
A
Primary
- No swelling at ON head
- Caused by lesions of visual pathway
- Pale flat disc with clear margins
- ↓ # of vessels on disc surface (Kestenbaum sign) with attenuation
- Thinning of NFL
Secondary
- Occurs after swelling at ON head
- White or grey slightly raised disc- Blurry margins
- Kestenbaum sign
![](https://s3.amazonaws.com/brainscape-prod/system/cm/158/971/034/a_image_thumb.png?1442301471)
11
Q
Optic Atrophy Causes?
PRIMARY?
A
- Retrobulbar neuritis
-
Compression
Tumour
Aneurysm - Hereditary neuropathies
-
Other neuropathies
Toxic
Nutritional
12
Q
Optic Atrophy Causes
Secondary?
A
- Papilloedema
- Anterior ischaemic optic neuropathy
- Papillitis
13
Q
OPTIC NEURITIS
- What is it?
- How is it classified ?
A
- Inflammation , infection or demyelination of optic nerve
- By appearance or aetiology
14
Q
OPTIC NEURITIS
Classification?
A
- Retrobulbar neuritis
- Papillitis
- Neuroretinitis
15
Q
Charateristics of Optic neuritis ?
Describe ONH, Optic disc, RNFL?
A
- Retrobulbarneuritis
ON head looks normal initially
Associated with MS
-
Papillitis
Affects ON head
Disc becomes oedematous
Associated with peripapillaryflame haemorrhage -
Neuroretinitis
Affects ON head (papillitis)
RNFL inflammation & macular star
Least common type of neuritis
![](https://s3.amazonaws.com/brainscape-prod/system/cm/158/971/405/a_image_thumb.png?1442302070)
16
Q
Differential diagnosis of macular star?
Other disorder causing macular star?
A
Hypertensive retinopathy
- Also have cotton wool spots
- Hard exudate ( due to hypertension)
- Some haemorrhage
![](https://s3.amazonaws.com/brainscape-prod/system/cm/158/971/495/a_image_thumb.png?1442302208)