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Anatomy
Afferent fibres. The optic nerve
Surrounding sheaths
a The innermost sheath is
the delicate vascular pia mater.
b The outer sheath comprises
the arachnoid mater and the
tougher dura mater which is
continuous with the sclera; optic
nerve fenestration involves
incision of this outer sheath.
The subarachnoid space is
continuous with the cerebral
subarachnoid space and contains
DEFINITION:
It refers to degeneration of
CLASSIFICATION:
Primary versus secondary
optic atrophy
Ophthalmoscopic
classification
Ascending versus
descending optic atrophy
- it refers to simple
degeneration of the nerve
fibres without any complicating
process within the eye eg:
syplilitic optic atrophy of tabes
dorsalis.
Tabetic optic
atrophy:
Tabes degeneration was due to
OPHTHALMOSCOPIC
CLASSIFICATION
Classified based on
ophthalmoscopic appearance as
follows
1. Primary (simple) optic atrophy
2. Consecutive optic atrophy
3. Glaucomatous optic atrophy
4. Post - neuritic optic atrophy
5. Vascular (ischaemic) optic
atrophy
ASCENDING VERSUS
DESCENDING OPTIC
ATROPHY
Ascending atrophy follows damage to
ETIOLOGICAL CLASSIFICATION:
CONSECUTIVE ATROPHY:
-secondary to retinal
disease and destruction of
ganglion cells
post inflammatory: diffuse
chorioretinitis
degenerative: primary pigmentary
and systemic degeneration
- glaucomatous
- postpapilledema, due to swelling and
pressure at disc
-arterial, sclerosed and frequently calcified
artery pressing
upon nerve
- aneurysms of internal carotid
- bony pressure at optic foramen (osteitis
deformans,oxycepaly)
- tumors (optic nerve sheaths, orbit,
cranium)
- imflammatory adhesions (basal
arachnoiditis)
-swelling in nerve (neurofibromatous
degeneration of
v.recklinghausn disease)
CIRCULATORY ATROPHY:
Optic neuritis,
perineuritis
disseminated sclerosis
neuromyelitis optica
herpes zoster
tabes
TOXIC ATROPHY:
PATHOLOGICAL FEATURES:
ACUTE NECROSIS:
SECONDARY DEGENERATION:
Following three
situations may occur:
1) Degeneration of the nerve fibres may
fibres may be
associated with negligible gliosis
- occurs due to progressive
decrease in blood
supply
- such pathological changes are
known as cavernous optic
atrophy
- occurs in glaucomatous and
ischaemic (vascular) optic atrophy
ETIOLOGY:
PRIMARY (SIMPLE) OPTIC
ATROPHY:
-occurs due to lesions
proximal to the optic disc
without antecedent
papilloedema.
-It may be caused by lesions
affecting the visual pathways
from the retrolaminar portion of
CLINICAL FEATURES:
LOSS OF VISION : -sudden or
gradual(depend on cause)
- partial or total (depending on degree
of atrophy)
-ophthalmic signs cannot be correlated
with amount of vision
PUPIL:
semidilated and direct light
reflex is very sluggish
or absent
marcus gunn pupil on swinging
flash light test
CONSECUTIVE OPTIC
ATROPHY:
-disc appears yellow waxy
-edges are not so sharply
defined as in optic
atrophy
-retinal vessels are
attenuated
GLAUCOMATOUS OPTIC
ATROPHY:
-deep and wide cupping of
the optic disc and nasal
shift of the blood vessels
ISCHAEMIC OPTIC ATROPHY:
- pallor of optic disc
associated with marked
attenuation of the vessels
DIFFERENTIAL DIAGNOSIS:
Pallor of the optic disc does not signify
hypoplasia
congenital pit
coloboma
NON-PATHOLOGICAL PALLOR OF
OPTIC DISC:
axial myopia
infants
elderly people with sclerotic
changes
temporal pallor associated with
large physiological cup
PROGNOSTIC FACTORS:
Atrophic cupping:
abscess, arachnoiditis:
- pallor of disc and visual field defects
does not indicate poor prognosis
- in such cases if there is absence of
atrophic cupping and if retinal vessels are
not narrowed, operative treatment results in
good improvement
demyelinizing diseases :
-occurs in disseminated
sclerosis, encephalomyelitides
and neuromyelitis optica
- prognosis is good in these
conditions
Parenchymatous optic atrophy :
TREATMENT:
In case of partial optic
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