Unilateral Disc Edema

Question 1

What is a normal RNFL thickness

Answer 1

80-120

Question 2

Ocular signs of GCA

Answer 2

Amaurosis fugax, sudden vision loss in affected eye, an APD, and unilateral disc edema

Question 3

Symptoms of GCA

Answer 3

Temporal HA, jaw claudication, neck pain, anorexia, tender or nodular temporal artery, malaise, scalp tenderness

Question 4

Presence of symptoms in GCA

Answer 4

1 in 5 patietns will not have systemic symptoms, Dx of this cannot be ruled out based on lack of symptoms alone

Safe to run bloodwork on ALL NAION/AAIONs just in case

Question 5

Why is AAION due to GCA an emergency

Answer 5

Risk of sudden visions loss in other eye within 2 weeks

Question 6

Course of optic nerve edema and RNFL thickness

Answer 6

Starts out as edema (axoplasmic flow stasis) at about 150um or more

Then starts to look somewhat normal at about 80um

Then atrophy at about 60um

Question 7

CRVO

Answer 7

Most common in patients >50 with Hx of DM, HTN, cardiovascular disease, and/or POAG. Present with sudden painless vision loss, intraretinal hemorrhages in all 4 quads, and dilated tortuous retinal veins; optic disc edema and macula edema may also occur,

Question 8

Compressive lesion of the optic nerve

Answer 8

Weill present with a gradual loss in vision.

Question 9

GCA

Answer 9

• > 65
• Sudden painful vision loss but can also present as amaurosis fugax, diplopia (CN 6 palsy), or horners
• chalk white edema
• order ESR, CRP, CBC
• temporal artery biopsy gold standard
• refer ASAP for IV steroids
• at risk for CV disease (MI) secondary to vasculitis

Question 10

NAION

Answer 10

Characterized by ischemia of the anterior optic nerve due to an unknown etiology; most commonly occurs in patients >50 with a Hx of HTN, DM, HLD, and a small crowded optic nerve with a small CD (<0.30) (disk at risk)

Question 11

Symptoms of NAION

Answer 11

Sudden, painless vision loss, typically non progressive. Most often occurs upon wakening
Vision rarely improved after inital onset

Question 12

Nocturnal hypotension

Answer 12

Can lead to NAION due to poor perfusion

Question 13

Ocular signs of NAION

Answer 13

Decreased vision, APD, unilateral optic nerve edema, and variable visual field loss (inferior altitudinal defect is most common)
CWS and red, hyperemic nerve

Question 14

Sleep apnea problems

Answer 14

Floppy eye lid syndrome
NTG
NAION

Question 15

NAION causes

Answer 15

Possible association with sleep apnea and viagra

Question 16

Optic neuritis

Answer 16

Primary inflammation of the optic nerve; inflammation of the anterior 1/3 will cause disc edema, causing a sudden loss of vision. Young, female, and 90% have pain on EOMs

Question 17

Treatment for AAION

Answer 17

IV or oral steroids followed by a long taper over at least 3-6 months and then followed by rheumatology

Question 18

Side effects of systemic steroids

Answer 18

HTN
Elevated blood glucose 
Poor wound healing 
Increased risk of secondary infection 
PSC cataracts