Optic atrophy

1. Optic atrophy
Angel Das

2. 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

3. 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

4. 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

5. o Disc is chalky white
o Margins well defined
o Lamina cribrosa seen
o Cupping is shallow
o Retina looks normal
 Ophthalmoscopic appearance

6. 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

7. 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

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

9. 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)

10.  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

11. 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

12.  Ophthalmoscopic Appearence
-pallor of disc
-decrease in no: of small blood vessels
(kastenbaum index)

13. Treatment
 Partial optic atrophy – treat underlying cause
 If complete atrophy – vision cannot be recovered