Optic atrophy

Angel Das

Optic Atrophy

Condition of optic disc following degeneration of optic nerve Occurs as result of any injury to nerve fibres involving in anterior visual system – retina to lateral geniculate body

Classification Ophthalmoscopic Classification -Primary Optic Atrophy - Secondary/Post-neuritic Optic Atrophy -Consecutive Optic Atrophy -Glaucomatous Optic Atrophy -Ischaemic Optic Atrophy Another classification -Ascending/Anterograde optic atrophy -Descending/retrograde optic atrophy

Primary optic atrophy

Disease proximal to the disc so there is no evidence of local inflammation.

CAUSES: Multiple sclerosis Space occupying lesions Leber’s disease Tabes dorsalis

o Disc is chalky whiteo Margins well definedo Lamina cribrosa seeno Cupping is shallowo Retina looks normal

Ophthalmoscopic appearance

Secondary/Post neuritic Optic Atrophy

Break in continuity of fibres in optic disc Occurs in longstanding papilloedema, papillitis or neuroretinitis

Ophthalmoscopic Appearance

-Disc- dirty white

-Edges blurred due to gliosis(proliferation of astrocytes & glial tissue)

-Cup obliterated

Consecutive Optic Atrophy

Occurs following destruction of ganglion cell- secondary to lesions in choroid /retina

Causes -Diffuse chorioretinitis

-Retinitis pigmentosa

-Pathological myopia

-Occlusion of central retinal artery

Ophthalmoscopic Appearence -Disc – yellow waxy -Edges – not well defined -Retinal vessels attenuated

Glaucomatous Atrophy Results from long-standing raised IOP

Ophthalmoscopic Appearence

-Deep & wide cupping of optic disc

-Nasal shift of blood vessels

-Lamina cribrosa pores seen (lamellar dot sign)

Conditions producing disc ischaemia Causes -Giant cell arteritis -Severe haemorrhage -Severe anaemia -Quinine poisoning

Vascular / Ischaemic Optic Atrophy

Ophthalmoscopic Appearence -pallor of disc -marked attenuation of vessels

Clinical Features

Loss of vision -partial /total Pupil -semi-dilated -direct light reflex –sluggish /absent -Marcus Gunn pupil/RAPD Visual field loss -Peripheral, Central /Eccentric

Ophthalmoscopic Appearence

-pallor of disc

-decrease in no: of small blood vessels (kastenbaum index)

Treatment

Partial optic atrophy – treat underlying cause If complete atrophy – vision cannot be recovered