Topic A3 Flashcards
What are the classifications of Optic Neuropathy
By cause
1) Inflammatory - Optic Neuritis + demylinating, parainfectious,infectious, non-infectious & neuroretinitis
2) Glaucomatous - various types of glaucoma
3) Ischaemic
- Anterior non-arteritic
- Anterior arteritic
- Posterior Ischaemic
- Diabetic Papillopathy
4) Hereditary
- Leber hereditary optic neuropathy
- Other hereditary optic neuropathies
5) Nutritional & Toxic
- Ethamnutol
- Vigabatrin
- Amiodarone
6) Papilloedema - secondary to raised ICP
7) Traumatic - Traumatic optic neuropathy
8) Compressive - including secondary to an orbital lesion
9) Infiltrative
- Inflammatory conditions such as sarcodosis
- Tumours
- Infective agents
ICP - Intra-cranial pressure
State cause & what it is to be differentiated from
What is Papilledema?
OD oedema which is secondary to elevated ICP
** Differentiate the OD oedema from other causes
Papilledema vs pseudo-papilledema
- ^presence of OD drusen
- usually bilateral
What are the symptoms of papilledema?
1) HA early morning + wakes px up from sleep
- more intense w head movement, bending & coughing
2) Transient Vision Loss - due to postural changes
3) No initial vision complaints
4) Sudden nausea & vomiting
What are the symptoms in the EARLY stage of papilledema?
1) Blurred disc margins
2) Swollen hyperaemic disc
3) Paton’s lines/folds
4) Dilation of superficial capillaries
VA+Fundus features
What are the symptoms in the ACUTE stage of papilledema?
1) Normal/Reduced VA
2) Severe disc hyperaemia
3) Moderate elevation w indistinct margins & absence of physiological cup (OD not in a defined shape)
4) Venous Engorgement
5) CWS
6) Flame-shaped haemorrhages
7) ONH appears enlarged as swelling increases
8) Paton lines (circumferential retinal folds)
9) Enlarged blind spot
What are the symptoms in the CHRONIC stage of papilledema?
1) VA is variable
2) Disc elevation w/o CWS or haemorrhages
3) Nerve fibre loss
What are the symptoms in the ATROPHIC stage of papilledema?
1) VA severely impaired
2) Prolonged raised ICP
3) Gross nerve fibre loss
4) Lesser disc swelling
5) Optic disc pallor
6) Optic atrophy (6-8wks)
7) Poor visual function
What is Spontaneous Venous Pulsations (SVP)?
**One of the symptoms for Papilledema
It is the pulsations caused by variations in the pressure gradient along the retinal vein as it travels through the lamina cribrosa.
**Differences in pulse pressure is because
1) Intraocular space
2) Cerebrospinal fluid
Normally occurs to 80% of the population as well.
What is the management for papilledema?
1) Urgent referral to neurologist / neuro-ophthalmologist
- CT scan
- Brain MRI
2) Differentiate from psuedopapilledema
What is Optic Neuritis/Papillae?
Swelling of the OD caused by local inflammation - associated w demyelination of axons = multiple sclerosis
What are the causes of optic neuritis/papillae?
Children:
- Mumps
- Meningitis
- Chicken Pox
- Upper respiratory tract infections
Adults:
- Viral Infection
- Toxoplasmosis
What are the signs & symptoms of Optic Neuritis/Papillae?
1) Mild/severe pain in or behind eye = vision loss in 1-2 days
2) Loss of vision to 6/18-6/60 = lasts 2-4 weeks
3) Usually unilateral
4) Age typically 18-45 years
5) Swollen & hyperemic disc but w lesser haemorrhage & CWS than papilledema
6) May have macular star
7) RAPD
8) Colour desaturation
9) Central Scotoma
10) May have cells in the vitreous
What is the management for Optic Neuritis/papillitis?
1) Urgent referral to a neurologist/neuro-ophthalmologist
2) Intravenous steroids
What is NAION?
Non-arteritic anterior ischemic optic neuropathy
This disease occurs due to occlusion of the short posterior ciliary arteries which leads to
partial/total infarction of ONH.
Infarction = obstruction of blood supply to an organ or a region of tissue
What conditions make it prone for people to get NAION?
1) small physiological cupping
2) Hypertension
3) DM
4) Usually >50 y/o
What are the signs & symptoms of NAION?
1) Sudden painless monocular visual loss, frequently on awakening
2) VA normal OR slightly reduced in about 30% of px
3) Moderate to severe visual impairment in the remaining 70% of px
4) VF defects = usually inferior altitudinal
5) CV defect proportional to the level of visual impairment
6) Diffuse/sectoral hyperemic disc swelling = often comes with splinter haemorrhage
What is the management for NAION?
1) Immediate referral
2) Treatment
- No definitive treatment
- Some advocate short-term systemic steroid treatment
What is AANION?
Arteritic Anterior Ischemic Optic Neuropathy
- It is the ocular manifestion due to Giant Cell Arteritis (GCA).
- Usually occurs in px >55 y/o
- HA
- Jaw claudication = pain with chewing
- Scalp tenderness esp over superficial temporal arteries (tenderness while combing hair)
- Proximal muscle & joint aches
- aneroxia, weight loss
- fever
What are the signs & symptoms of AAION?
1) Sudden painless loss of vision usually to CF (severe loss)
2) Unilateral first & then progresses to bilateral within days
3) Optic disc pallor & oedema w surrounding flame-shaped haemorrhage
4) VF defect
5) RAPD
6) Colour desaturation
7) Optic atrophy within 4-8 weeks
8) Prognosis is poor where vision loss is usually permanent
** What is GCA?
Giant Cell Arteritis
It is the swelling & thickening of the small artery under the skin around temporal artery
- caused by inflammation in the arteries
- affects px >50 y/o
- this causes head pain, jaw pain & vision problems
- closely linked w polymyalgia rheumatica
**polymyalgia rheumatica = causes muscle pain & stiffness esp around the shoulders
What is the management for AAION?
1) Immediate referral
2) Medical emergency in ophthal. in order to prevent further vision loss
- Erythrocyte Sedimentation Rate (ESR) - to test for inflammation & rule out GCA
- Temporal artery biopsy
- Cortiocosteroids
- Treatment done to prevent progression to fellow eye
What is RAPD?
Relative Afferent Pupillary Defect
1) Marcus Gunn Response
2) Determined by “swinging flashlight test”
3) Causes: (Any optic nerve disease)
- Optic Neuritis/Papillitis
- Unilateral optic neuropathies
- Severe glaucoma
- Optic Nerve damage due to trauma, tumour & infections
4) any large/severe retinal lesions
such as;
- large RD
- CRVO
- CRAO
Give a brief explanation on what is done during the swinging flashlight test and what is observed in a px w (+) RAPD
1) Light is shone in the RE first & both eyes CONSTRICT
2) Light is then shone in the LE & both eyes DILATE
3) Light is shone back to the RE & both eyes CONSTRICT
What are the signs & symptoms of Adie’s (tonic) pupil?
1) Unilateral & dilated pupil w low response to light
2) Sluggish near response
3) Dilated pupil becomes miotic over time
4) usually occurs in women b/w the age of 20-40 y/o
5) Photophobia
6) Asthenopia (Eyestrain)
