Optic Disc Evaluation

Question 1

Glaucoma has pseudopallor where? What bundles are affected?

Answer 1

Vertically

Arcuate bundles

Question 2

Optic Tract lesions have pallor where on the OD?

Answer 2

Bowtie/Band pallor

Question 3

Compression of ON can cause what 2 types of pallor?

Answer 3

• diffuse pallor

- temporal pallor

Question 4

Ischemia shows what type of pallor? What bundles are affected?

Answer 4

• wedge pallor (inferiorly or superiorly)

- affects arcuate bundle

Question 5

Pallored discs can be caused by what 5 things?

Answer 5

1. Optic atrophy
2. Myopia
3. Aphakia
4. ON hypoplasia
5. ON drusen

Question 6

Pallor can only occur at lesions where in the tract?

Answer 6

Anterior to the LGN

Question 7

Ascending Optic atrophy (w/in eye) is caused by what 5 things?

Answer 7

1. Papillitis
2. Chronic Atrophic Papilledema
3. Periarteritis
4. CRAO
5. AION

Question 8

Descending Optic atrophy (behind eye) is caused by what 5 things?

Answer 8

1. Retrobulbar disease
2. Optic Neuritis
3. Toxic
4. Trauma
5. Compression

Question 9

Optochoroidal shunts dilate in response to ? What do they connect?

Answer 9

• Chronic obstruction of CRV

- Connect choroid & retinal circulation

Question 10

What 5 things can cause optochoroidal shunt vessels?

Answer 10

1. Chronic Atrophic Pap.
2. ON -omas
3. CRVO
4. Glaucoma
5. Sphenoid wing meningioma

Question 11

Retinal vascular shunts go from __ to __ while retinal collaterals go from __ to __, vice versa:

Answer 11

shunts = A-V
Collaterals = A-A, V,V

Question 12

What is the work-up for non-glaucomatous optic neuropathy?

Answer 12

1. Lab testing
2. NeuroImaging
3. Carotid Doppler

Question 13

What lab tests are used for inflammation?

Answer 13

ESR and CRP

Question 14

What lab test is used for autoimmune testing?

Answer 14

ANA w/ reflex titer

Question 15

What lab test is used for Sarcoid?

Answer 15

ACE

Question 16

What lab tests are used for syphillis ?

Answer 16

RPR, FTA-ABS

Question 17

What lab tests are used for nutritional evaluation?

Answer 17

1. Vitamin B12
2. Folic Acid
3. Methylmalonic Acid
4. Homocysteine

Question 18

What test is used for malignancy?

Answer 18

SPEP (Serum Protein Electophoresis)

Question 19

What are the normals for vitamin B12?

Answer 19

> 5.4

Question 20

What is the normal for folic acid?

Answer 20

200-1100

Question 21

What is the normal for homocysteine?

Answer 21

<= 13.9

Question 22

If MMA and homocysteine are elevated, what type of deficiency?

Answer 22

Vit B12 Def

Question 23

If MMA normal and Homocysteine elevated, what type of deficiency?

Answer 23

Folate def.

Question 24

In papilledema, one must have an ICP greater than ?

Answer 24

200-250 mmH20

Question 25

What are the causes of hypoplastic optic discs?

Answer 25

1. Idiopathic 2. Toxemia of Pregnancy 3. Fetal Alcohol Syndrome 4. CMV 5. Drugs

Question 26

Hypoplastic discs are aassociated with what 3 hormonal issues?

Answer 26

1. GH deficiency 2. Hypothyroidism 3. Hyperprolactinemia

Question 27

What are the 5 sxs of papilledema?

Answer 27

1. HA 2. Nausea 3. Pulsatile Tinnitus 4. Horizontal diplopia 5. Vomiting

Question 28

This type of papilledema results in segmental swelling of the disc that will progress

Answer 28

Incipient papilledema | - follows ISNT rule

Question 29

What is the main distinguishing feature of hypoplastic disc?

Answer 29

Double ring

Question 30

If a patient has a bilateral hypoplastic disc, what needs to be done?

Answer 30

Immediate work up

Question 31

De Morsier Syndrome is associated with what 3 things?

Answer 31

1. Bilateral hypoplastic discs 2. Absence of Septum Pellucidum 3. Agenesis of Corpus Callosum