02 - Optic Nerve

0.0(0)
learnLearn
examPractice Test
spaced repetitionSpaced Repetition
heart puzzleMatch
flashcardsFlashcards
Card Sorting

1/81

encourage image

There's no tags or description

Looks like no tags are added yet.

Study Analytics
Name
Mastery
Learn
Test
Matching
Spaced

No study sessions yet.

82 Terms

1
New cards

ischemia = e.g. ischemic optic neuropathy

compression = e.g. a tumor pushing on the chiasm

inflam = e.g. demyelinating disease

trauma = e.g. traumatic optic neuropathy after getting hit in the eye

What are 4 potential causes of non-glaucomatous ON cupping?

<p>What are 4 potential causes of <span style="text-decoration:underline">non-glaucomatous</span> <strong>ON cupping</strong>?</p>
2
New cards

no = rim pallor is most likely neuro disease

Is cupping of the ONH glaucoma if the ONH rim is pale?

<p>Is cupping of the ONH glaucoma if the <strong>ONH rim is pale</strong>?</p>
3
New cards

yes = rim thinning is glaucoma

Is cupping of the ONH glaucoma if the ONH rim is gone/thin?

<p>Is cupping of the ONH glaucoma if the <strong>ONH rim is gone/thin</strong>?</p>
4
New cards

yes = BV bayonetting

Is cupping of the ONH glaucoma if the ONH rim is sharpened?

<p>Is cupping of the ONH glaucoma if the <strong>ONH rim is sharpened</strong>?</p>
5
New cards

ONH hypoplasia
myopia
aphakia
optic atrophy
infants

What are some causes of a pale ONH?

<p>What are some causes of a <strong>pale ONH</strong>?</p>
6
New cards

pale nerve head

reduced VA

APD

dyschromatopsia

VF defect

RNFL dropout

electrodiagnostic dropout

What 3 findings will we always see in true optic atrophy?

<p>What 3 findings will we always see in true <strong>optic atrophy</strong>?</p>
7
New cards

hypoplastic ONH = part of sclera is filling optic canal around the ONH

What is the cause of this pale ONH?

<p>What is the cause of this <strong>pale ONH</strong>?</p>
8
New cards

reddish

Through NS CATs, a pale ONH may look ___________.

<p>Through <strong>NS CATs</strong>, a pale ONH may look ___________.</p>
9
New cards

pink

Through dim illumination or an undilated pupil, a pale ONH may look __________, which is why it's important to assess the ONH on bright illumination.

<p>Through <strong>dim illumination</strong> or an undilated pupil, a pale ONH may look __________, which is why it's important to assess the ONH on bright illumination.</p>
10
New cards

AKA secondary optic atrophy = lesion in the gangiion cells or ONH or due to RP = BLURRY disc margins, artery attenuation or absence, sheathed BV

What is ascending optic atrophy?

<p>What is <strong>ascending optic atrophy</strong>?</p>
11
New cards

papillitis
chronic papilledema
periarteritis
CRAO
AAION
POAG

What are some causes of ascending optic atrophy?

<p>What are some causes of <strong>ascending optic atrophy</strong>?</p>
12
New cards

AAION

What cause of ascending optic atrophy is shown here?

<p>What cause of <strong>ascending optic atrophy</strong> is shown here?</p>
13
New cards

RP

What cause of ascending optic atrophy is shown here?

<p>What cause of <strong>ascending optic atrophy</strong> is shown here?</p>
14
New cards

chronic atrophic papilledema

What cause of ascending optic atrophy is shown here?

<p>What cause of <strong>ascending optic atrophy</strong> is shown here?</p>
15
New cards

AKA primary optic atrophy = lesion in the LGN to the ONH = SHARP disc margins, normal BV

What is descending optic atrophy?

<p>What is <strong>descending optic atrophy</strong>?</p>
16
New cards

retrobulbar optic neuritis
toxic neuropathy
trauma
neoplasms in the orbit, canal, cranium (compression

What are some causes of descending optic atrophy?

<p>What are some causes of <strong>descending optic atrophy</strong>?</p>
17
New cards

neoplasm in cranium (craniopharyngioma) causing compression

What cause of descending optic atrophy is seen here?

<p>What cause of <strong>descending optic atrophy</strong> is seen here?</p>
18
New cards

intracranial injury to ON

What cause of descending optic atrophy is seen here?

<p>What cause of <strong>descending optic atrophy</strong> is seen here?</p>
19
New cards

difficult to ascertain cause = could be due to CRAO, canalicular meningioma, hypotensive events, etc.

What is the challenge with diffuse ONH pallor?

<p>What is the challenge with <strong>diffuse</strong> ONH pallor?</p>
20
New cards

toxic disease = alcohol, malnutrition

hereditary degeneration = Leber's optic atrophy, autosomal dominant optic atrophy, etc.

acute demyelinating disease

compressive disease

What typically causes temporal segmental ONH pallor?

<p>What typically causes <strong>temporal segmental</strong> ONH pallor?</p>
21
New cards

papillomacular bundle is involved = cecocentral VF defect from blindspot to fixation

What retinal and VF area is associated with temporal segmental ONH pallor?

<p>What retinal and VF area is associated with <strong>temporal segmental</strong> ONH pallor?</p>
22
New cards

glaucoma

What typically causes inferior wedge-shaped segmental ONH pallor?

<p>What typically causes <span style="text-decoration:underline">inferior</span> <strong>wedge-shaped segmental</strong> ONH pallor?</p>
23
New cards

ischemic optic neuropathy

What typically causes superior wedge-shaped segmental ONH pallor?

<p>What typically causes <span style="text-decoration:underline">superior</span> <strong>wedge-shaped segmental</strong> ONH pallor?</p>
24
New cards

optic tract lesions = carry ipsilateral temporal fibers and contralateral nasal fibers

optic chaism lesions = bilateral bow tiee

What typically causes "bow tie" segmental ONH pallor?

<p>What typically causes <strong>"bow tie" segmental</strong> ONH pallor?</p>
25
New cards

fibers from temporal retina entering OS ONH
fibers from nasal retina entering OD ONH
papillomacular bundles of the OD ONH

Ex) if you lesion the left optic tract, which retinal fibers are affected?

<p>Ex) if you lesion the left optic tract, which retinal fibers are affected?</p>
26
New cards

bow tie pallor in OD ONH
temporal pallor in OS ONH

Ex) if you lesion the left optic tract, which ONH areas are affected?

<p>Ex) if you lesion the left optic tract, which ONH areas are affected?</p>
27
New cards

NAAION or AAION = ischemic event like a local infarction of the post ciliary arteries

What typically causes altitudinal segmental ONH pallor?

<p>What typically causes <strong>altitudinal segmental</strong> ONH pallor?</p>
28
New cards

acquired optociliary shunt BV on a pale ONH with slow progression vision loss

What is the Hoyt-Spencer sign?

<p>What is the <strong>Hoyt-Spencer sign</strong>?</p>
29
New cards

sphenoid wing meningiomas
ON gliomas
ON arachnoid cysts
chronic OAG
ON drusen
CRAO
chronic papilledema
DM

What are some possible causes of acquired optociliary shunt BV?

<p>What are some possible causes of <strong>acquired optociliary shunt BV</strong>?</p>
30
New cards

glial veil

What finding shown here is a cause of pseudo disc edema?

<p>What finding shown here is a cause of <strong><span style="text-decoration:underline">pseudo</span> disc edema</strong>?</p>
31
New cards

myelinated nerve fibers

What finding shown here is a cause of pseudo disc edema?

<p>What finding shown here is a cause of <strong><span style="text-decoration:underline">pseudo</span> disc edema</strong>?</p>
32
New cards

CWS near the ONH

What finding shown here is a cause of pseudo disc edema?

<p>What finding shown here is a cause of <strong><span style="text-decoration:underline">pseudo</span> disc edema</strong>?</p>
33
New cards

flame-shaped hemorrhages near the ONH with CWS

What finding shown here is a cause of pseudo disc edema?

<p>What finding shown here is a cause of <strong><span style="text-decoration:underline">pseudo</span> disc edema</strong>?</p>
34
New cards

drusen of the ONH

What finding shown here is a cause of pseudo disc edema?

<p>What finding shown here is a cause of <strong><span style="text-decoration:underline">pseudo</span> disc edema</strong>?</p>
35
New cards

giant hamartoma of the ONH

What finding shown here is a cause of pseudo disc edema?

<p>What finding shown here is a cause of <strong><span style="text-decoration:underline">pseudo</span> disc edema</strong>?</p>
36
New cards

hypoplastic ONH – vessels seem out of proportion to the size of the ONH

What finding shown here is a cause of pseudo disc edema?

<p>What finding shown here is a cause of <strong><span style="text-decoration:underline">pseudo</span> disc edema</strong>?</p>
37
New cards

papilledema due to IIH

NOTE: papilledema is just 1 cause of disc edema

What finding shown here is a cause of true disc edema?

<p>What finding shown here is a cause of <strong><span style="text-decoration:underline">true</span> disc edema</strong>?</p>
38
New cards

papillitis with disc edema and good vision

What finding shown here is a cause of true disc edema?

<p>What finding shown here is a cause of <strong><span style="text-decoration:underline">true</span> disc edema</strong>?</p>
39
New cards

idiopathic scarring of ONH

What finding shown here is a cause of true disc edema?

<p>What finding shown here is a cause of <strong><span style="text-decoration:underline">true</span> disc edema</strong>?</p>
40
New cards

BRVO = venous stasis retinopathy with edema, hemes

What finding shown here is a cause of true disc edema?

<p>What finding shown here is a cause of <strong><span style="text-decoration:underline">true</span> disc edema</strong>?</p>
41
New cards

grade 4 HTN retinopathy causing disc edema

What finding shown here is a cause of true disc edema?

<p>What finding shown here is a cause of <strong><span style="text-decoration:underline">true</span> disc edema</strong>?</p>
42
New cards

AAION causing disc edema, flame hemes

What finding shown here is a cause of true disc edema?

<p>What finding shown here is a cause of <strong><span style="text-decoration:underline">true</span> disc edema</strong>?</p>
43
New cards

mineralized hamartoma, closely related to ON astrocytic hamartoma, often found in tuberous sclerosis pt's

What is a giant hamartoma of the ONH?

<p>What is a <strong>giant hamartoma</strong> of the ONH?</p>
44
New cards

hyaline, acellular, calcium phosphate byproducts of disc astrocytes (may or may not be calcified)

What are disc drusen?

<p>What are <strong>disc drusen</strong>?</p>
45
New cards

papilledema = present

drusen = absent

How can we differentiate papilledema from drusen based on the cup?

<p>How can we differentiate papilledema from drusen based on the <strong>cup</strong>?</p>
46
New cards

papilledema = blurred sup and inf

drusen = symmetric, scalloped blur

How can we differentiate papilledema from drusen based on the disc margins?

<p>How can we differentiate papilledema from drusen based on the <strong>disc margins</strong>?</p>
47
New cards

papilledema = hyperemic

drusen = normal

How can we differentiate papilledema from drusen based on the colour?

<p>How can we differentiate papilledema from drusen based on the <strong>colour</strong>?</p>
48
New cards

papilledema = elevated rim that extends into RNFL

drusen = central elevation, bumpy

How can we differentiate papilledema from drusen based on the NRR?

<p>How can we differentiate papilledema from drusen based on the <strong>NRR</strong>?</p>
49
New cards

papilledema = edema sup and inf, muddy peripapillary reflex

drusen = focal atrophy, normal linear light reflexes

How can we differentiate papilledema from drusen based on the RNFL?

<p>How can we differentiate papilledema from drusen based on the <strong>RNFL</strong>?</p>
50
New cards

papilledema = optociliary shunts develop, venous dilation, absent SVP

drusen = central origin, trifurcation and other anomalous patterns, present SVP

How can we differentiate papilledema from drusen based on the BV?

<p>How can we differentiate papilledema from drusen based on the <strong>BV</strong>?</p>
51
New cards

elevated ICP > 200mmH2O

NOTE: pt may not have had an SVP to begin with, so this isn't always the best rule of thumb!

Why MIGHT there no SVP in disc edema?

<p>Why MIGHT there no SVP in disc edema?</p>
52
New cards

retroilluminate the ONH by putting the beam right beside it

red-free filter

How can we better visualize disc drusen on fundoscopy?

<p>How can we better visualize disc <strong>drusen</strong> on fundoscopy?</p>
53
New cards

true

True or False: drusen of the ONH are the most common congenital/inherited optic neuropathy.

<p>True or False: <strong>drusen</strong> of the ONH are the most common congenital/inherited optic neuropathy.</p>
54
New cards

hyperAF drusen within the hypoAF nerve head

How do disc drusen appear on FAF?

<p>How do disc <strong>drusen</strong> appear on FAF?</p>
55
New cards

papilledema = rounded, regular elevation +/- lazy V sign

drusen = irregular elevation

How can we differentiate papilledema from drusen with OCT?

<p>How can we differentiate papilledema from drusen with OCT?</p>
56
New cards

hyper-reflective if calcified

How do disc drusen appear on B scan?

<p>How do disc <strong>drusen</strong> appear on B scan?</p>
57
New cards

hyper-reflective if calcified

How do disc drusen appear on a CT scan?

<p>How do disc <strong>drusen</strong> appear on a CT scan?</p>
58
New cards

buried drusen may migrate to the surface of the ONH

How can drusen progress anatomically over time?

<p>How can <strong>drusen</strong> progress <span style="text-decoration:underline">anatomically</span> over time?</p>
59
New cards

VF defects may develop, including an enlarged blindspot and arcuate defect

How can drusen progress functionally over time?

<p>How can <strong>drusen</strong> progress <span style="text-decoration:underline">functionally</span> over time?</p>
60
New cards

false

True or False: drusen and papilledema will not coexist at the same time in a pt.

61
New cards

blockage

How do surface drusen appear on early IVFA?

<p>How do <strong>surface drusen </strong>appear on <span style="text-decoration:underline">early</span> IVFA?</p>
62
New cards

nodular staining

How do surface drusen appear on late IVFA?

<p>How do <strong>surface drusen </strong>appear on <span style="text-decoration:underline">late</span> IVFA?</p>
63
New cards

no staining or nodular staining

How do buried drusen appear on early IVFA?

<p>How do <strong>buried drusen </strong>appear on <span style="text-decoration:underline">early</span> IVFA?</p>
64
New cards

late peripapillary staining (noduler, circumferential)

How do buried drusen appear on late IVFA?

<p>How do <strong>buried drusen </strong>appear on <span style="text-decoration:underline">late</span> IVFA?</p>
65
New cards

early and late diffuse leakage

How does disc edema appear on IVFA?

<p>How does <strong>disc edema </strong>appear on IVFA?</p>
66
New cards

early = edema leaks, drusen stain
late = edema leaks, drusen stain

How does co-existent drusen and edema appear on IVFA?

<p>How does <strong>co-existent drusen and edema</strong> appear on IVFA?</p>
67
New cards

double ring sign = outer yellow sclera, inner pigmented ring around ONH

margins may be blurred due to too many crowded axons

NOTE: these findings are not that common

What are 2 features of the disc margin that suggests it may be a hypoplastic ONH?

<p>What are 2 features of the <span style="text-decoration:underline">disc margin</span> that suggests it may be a <strong>hypoplastic ONH</strong>?</p>
68
New cards

overestimating

Double ring sign may result in you _______________________ the nerve size.

<p><strong>Double ring sign</strong> may result in you _______________________ the nerve size.</p>
69
New cards

subnormal axons

normal mesodermal glial elements

A hypoplastic disc actually has a subnormal number of _________, but it has a normal number of ____________________________________________.

<p>A hypoplastic disc actually has a <strong>subnormal</strong> number of _________, but it has a <strong>normal</strong> number of ____________________________________________.</p>
70
New cards

RNFL is often thin/absent due to either axon atrophy or RGCs failing to develop

What feature of the NRR and RNFL suggests it may be a hypoplastic ONH?

<p>What feature of the <span style="text-decoration:underline">NRR and RNFL</span> suggests it may be a <strong>hypoplastic ONH</strong>?</p>
71
New cards

pale colour bc the sclera is showing through

red colour bc the small disc is in high contrast to the surround

What feature of the disc colour suggests it may be a hypoplastic ONH?

<p>What feature of the disc <span style="text-decoration:underline">colour</span> suggests it may be a <strong>hypoplastic ONH</strong>?</p>
72
New cards

tortuous, large in comparison to the nerve itself

What feature of the disc colour suggests it may be a hypoplastic ONH?

<p>What feature of the disc <span style="text-decoration:underline">colour</span> suggests it may be a <strong>hypoplastic ONH</strong>?</p>
73
New cards

yes

Can VF defects result from hypoplastic ONH?

<p>Can VF defects result from <strong>hypoplastic ONH</strong>?</p>
74
New cards

most often as bitemporal hemianopsias but can be other defects anywhere in the VF, including binasal or ST defects

What is the most common VF defect we see in hypoplastic ONH?

<p>What is the most common VF defect we see in <strong>hypoplastic ONH</strong>?</p>
75
New cards

true

True or False: hypoplastic discs may cause a VF defect that does NOT respect the vertical midline.

<p>True or False: <strong>hypoplastic discs</strong> may cause a VF defect that does NOT respect the vertical midline.</p>
76
New cards

developmental abnormalities like GH deficiency, hypothyroidism

forebrain anomalies such as lacking a septum pelucidum between the 2 lateral ventricle halves

What are some associations seen in pt's with bilateral hypoplasia of their ONH and poor VA?

<p>What are some associations seen in pt's with <strong>bilateral hypoplasia</strong> of their ONH and <strong>poor VA</strong>?</p>
77
New cards

refer to pediatrician to assess:

GH levels

thyroid function

endocrine function

CT/MRI to look for basal encephalocoele = abnormal communication of bone that allows brain tissue to herniate into orbit, nasal pharynx, etc

How should we manage pt's with bilateral hypoplasia of their ONH and poor VA?

<p>How should we manage pt's with <strong>bilateral hypoplasia</strong> of their ONH and <strong>poor VA</strong>?</p>
78
New cards

no management necessary other than routine following with an OD/OMD and pediatrician to monitor for endocrine issues

How do we manage pt's with bilateral hypoplasia of their ONH and good VA?

<p>How do we manage pt's with <strong>bilateral hypoplasia</strong> of their ONH and <strong>good VA</strong>?</p>
79
New cards

no management necessary other than routine following with an OD/OMD and pediatrician to monitor for endocrine/neuro issues

How do we manage pt's with unilateral hypoplasia of their ONH and good OR poor VA?

<p>How do we manage pt's with <strong>unilateral hypoplasia</strong> of their ONH and <strong>good OR poor VA</strong>?</p>
80
New cards

septo-optic dysplasia with...

bilateral ONH dyplasia

absence of septum pellucidum

agenesis of corpus callosum

dysplasia of 3rd ventricle

hypopitutitarism

What is De Morsier's syndrome?

<p>What is <strong>De Morsier's syndrome</strong>?</p>
81
New cards

ON aplasia/dysplasia

ONH pit

sup segmental hypoplasia

ONH coloboma

What are 4 other congenital nerve disorders than may be associated with forebrain anomalies?

<p>What are 4 other congenital nerve disorders than may be associated with <strong>forebrain anomalies</strong>?</p>
82
New cards

hypoplastic ONH

anosmia

forebrain anomalies

gonadotropin deficiency = delayed puberty, amenorrhea

What is Kallman's syndrome?

<p>What is <strong>Kallman's syndrome</strong>?</p>