OP3104- AOC- YR 3 > Optic Nerve > Flashcards

Optic Nerve Flashcards

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1
Q

Pressure in subarachnoid space affects?

A

Affects pressure in optic nerve head.

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1
Q

3 common symptoms of patients with optic nerve disease?

A
  1. Complain of poor vision
  2. Transient loss of vision
  3. Rarely pain unless inflammatory condition
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2
Q

Signs of optic nerve dysfunction?

A
  1. Reduced VA- distance & near
  2. Colour vision- night Vision affected
  3. Pupils: RAPD
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3
Q

What 3 changes can be seen at the optic disc?

A
  1. Disc swelling
  2. Optico- ciliary shunts (abnormal blood vessels)
  3. Optic atrophy - end stage
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4
Q

Optico- ciliary shunts associated with which conditions?

A

central retinal vein occlusion, optic nerve sheath meningioma, chronic glaucoma and chronic papilledema and are a nonspecific sign of chronic retinal venous congestion.

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5
Q

Optico- ciliary shunts- how do they look on the disc?

A

appearing as tortuous vascular loops that start and end on the disc

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6
Q

Optico- ciliary shunts needs to be differentiated from neovasc, why?

A

They must be differentiated from neovascularization of the disc because neovascularization requires prompt treatment with laser photocoagulation or anti-VEGF intravitreal injections, while shunt vessels do not and can protect against retinal ischemia.

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7
Q

Optico- ciliary shunts needs to be differentiated from neovasc: physical difference?

A

Optociliary shunt vessels can be differentiated from neovascularization of the disc by their large caliber and lack of leakage on fluorescein angiogram.

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8
Q

What causes papilloedema?

A

Raised Intracranial pressure

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9
Q

Papilloedema - how does it look and what happens if long standing?

A

Bilateral optic disc swelling.
If long-standing = optic atrophy

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10
Q

Features of early papilledema

A
  1. VA normal
  2. Mild disc hyperemia
  3. Nasally indistinct margin
  4. Mild venous engorgement
  5. Normal optic cup
  6. Spontaneous venous pulsation absent
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11
Q

Features of acute papilledema (disc, VA, margins)?

A

VA- normal
Severe disc elevation hyperemia
Very indistinct margin
Obstruction of small vessels on the disc

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12
Q

Features of late papilledema?

A
  1. Marked venous engorgement
  2. Reduced or absent cup
  3. Haemorrhages and cotton wool spot
  4. Macular star
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13
Q

Discs and VA in chronic papilloedema?

A

VA- Variable (Visual obstruction, macular star)
Marked disc elevation (vintage cork look), disc margin indistinct, variable venous engorgement, absent optic cup.

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14
Q

Bilateral disc swelling vs unilateral- what could the condition be?

A

Bilateral- papilledema
Unilateral- CRVO

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15
Q

Do VF need to be done before referring papilloedema?
If yes, what is seen?

A

Yes
Enlarged blind spot

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16
Q

VA and disc in secondary optic atrophy?

A
  1. VA severely decreased
  2. Mild disc elevation
  3. Indistinct disc margin
  4. Disc pallor with few crossing vessels
  5. Absent cup
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17
Q

Causes of secondary optic atrophy?

A

Papilloedema, treated papilloedema, congenital optic atrophy, trauma

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18
Q

What are pseudopapilloedema?

A

Other causes of swollen disc rather than raised ICP
Acquired = papillitis, ischemic papillopathy, juxapapillary choroiditis, optic disc infiltration

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19
Q

Most common tumour assosiated with optio-ciliary shunts?

A

Nerve sheath meningioma

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20
Q

Optio-ciliary shunts- EMERGENCY OR URGENT?

A

Refer, but non- emergency

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21
Q

Optic atrophy causes?

A

Post Optic neuritis
Long standing papilledema
Compressive optic atrophy - due to tumours
Herediatery optic atrophies (Leber’s hereditary optic neuropathy)

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22
Q

Optic atrophy- how does the disc look?

A

Pale

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23
Q

Example of with systemic condition congenital optic nerve anomalies?

A

Morning glory coloboma

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24
4 congenital optic nerve anomalies without systemic conditions?
1. Tilted disc 2. Disc drusen 3. Optic disc pit 4. Myelinated nerve fibres
25
How are: VA, VF Defects and related factors of tilted disc? Refered- how urgent?
VA normal Frequent in myopia, astigmats Nasal defect common common but can have supertemporal defect Non-urgent referral.
26
Disc drusen associated with what 2 conditions? How is VA in this condition?
1. RP 2. Angioid streak VA normal unless complication like choroidal neovascularisation.
27
Disc drusen appearance?
1. Absent cup 2. Pink/ yellow waxy pearl like 3. Indistinct lumpy margim
28
How does disc drusen look on CT scans?
White spots
29
Optic pits is unilateral or bilateral?
Uni
30
Optic disc pit- how does it look?
Large disc, containing oval or round pit - seen temporal
31
Optic disc pit complication?
Can cause macular detachment if pit on maculo-papillar bundle
32
How does myelinated nerve fibres look like? What is the cause?
Grey/ white opaque lesions on the retina with feathery edges that obscure retina details. Occurs when myelination spreads on the surface of the retina.
33
The following conditions fall under? -Optic disc hypoplasia -Megalopapilla -Peripaillary staphyloma -Optic disc dysplasia
Congenital optic nerve abnormalities with systemic conditions
34
Optic disc coloboma is a result of?
Malclosure of foteal cleft
35
Morning gloary disc is a variant of? How do the vessels look?
Coloboma Spoke-like emerging vessels
36
What is optic nerve hypoplasia disc like?
Small , often pink
37
How does megalopilla disc look like?
Huge disc- vertical and horizontal diameter over 2mm.
38
How does peripapillary staphyloma look like?
Normal disc with peripapillary excavation (outpouching of disc) Unilateral
39
Papilloedema meaning?
Swelling of optic disc secondary to raised ICP
40
Vintage cork appearance cause?
Caused by bilateral raised ICP. Extensive swelling of disc + haemorrages + dialted vessels.
41
Most common optic neuropathy is?
Glaucoma
42
Most common cause of retrobulbar neuritis? How does the disc look?
Demyelination Disc looks pale due to demyelination. Can affect any part of the eye.
43
Severe episodes of demyelination in different parts of the CNS indicate?
MS
44
What attacks myelination?
Inflammatory factors
45
What is papillitis and how does the optic nerve head look?
Optic nerve head swollen
46
Can MS diagnosis be made in one visit?
No, need to monitor px before making diagnosis
47
How does neuriretinitis look?
Disc swollen, hyperaemic, macular star. Difficult to see because px has huge uveitis.
48
AION vs glaucoma?
AION= Altitudinal defect, Glaucoma= doesn't cause altitudinal defect, doesn't cross mid line.
49
AION uni or bilateral?
Uni
50
Acute non-arteritic AION features
1. Pale disc 2. Diffused oedema of disc or one sector 3. Splint hemorrhages over disc
51
Late non-arthritic AION?
1. Resolution of oedema and haemorrhages 2. Optic atrophy 3. Variable visual loss (Depends on duration)
52
What is AION?
Swelling of arteries
53
Signs of arteritic AION?
1. Pale disc 2. Disc oedema diffused 3. Few small splinter heaemorrhages 4. Optic atrophy if longstanding
54
AION refered?
Urgently
55
Arteritic AION?
Gaint cell arteritis
56
Why are hereditary optic neuropthies refered non-uregntly?
No treatment available
57
Lebers hereditary optic neuroptahy (LHON) signs?
1. Disc swelling 2. Dilated capillaries 3. Small vessels dialted 4. Large vessels tortous
58
Why is papilledema bilateral?
Due to raised ICP
59
Dominant Optic Atrophy (ADOA) Features?
6-12 years onset Gradual onset- no sudden loss of vision Pale disc
60
What is optic nerve glioma and how does it present?
Tumor of optic nerve glial tissue. Presents with- gradual visual loss, proptosis, eventually optic atrophy
61
Optic nerve sheath meningioma presentation?
Tumour wraps arround optic nerve. Gradual visual loss due to compression of the optic nerve. Proptosis- die to bulk of tumour. Optociliary shunts
OP3104- AOC- YR 3
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