Optic neuropathy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

Optic neuropathy refers to damage to the optic nerve due to any cause.

Pathophysiology

The primary change occurring in optic neuropathy is nerve cell damage. The optic nerve comprises axons that emerge from the retina of the eye and carry visual information to the primary visual nuclei, most of which is relayed to the occipital cortex of the brain to be processed into vision. Neurons from retina leave the eye at the optic disc, and go to the visual cortex via the optic nervce, optic chiasm, optic tract and optic radiations. Damage and death of these neurons leads to characteristic features of optic neuropathy.

Causes

Common Causes

Causes by Organ System

Cardiovascular Acute hypotension , Allergic vasculitis, Arteriosclerosis, Buerger disease, Carotid occlusive disease, Cavernous hemangiomas, Central retinal artery occlusion, Central retinal vein occlusion, Cholesterol granuloma, Hypertension, Optic nerve vascular lesions, Polyarteritis nodosa, Postviral vasculitis, Takayasu disease, Temporal arteritis, Vascular occlusions of the optic nerve, Vasculitis
Chemical/Poisoning Bee stings, Lead poisoning, Methanol, Methyl alcohol consumption
Dental No underlying causes
Dermatologic Dermoid cysts, Orbital cellulitis
Drug Side Effect Ak-chlor, Cetina, Chloramphenicol, Clorafen, Diochloram, Ethambutol, Isoniazid, Oprelvekin, Paraxin, Pentamycetin, Quemicetina, Quinine, Sopamycetin, Streptomycin, Thallium
Ear Nose Throat Mucoceles, Sinusitis
Endocrine Glucose-6-phosphate dehydrogenase deficiency , Hyperthyroidism, Thyroid opthalmopathy
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic Wagener syndrome 
Hematologic Buerger disease, Cavernous hemangiomas, Cranial blood suppy disorders , Diabetes mellitus, Giant cell arteritis, Glucose-6-phosphate dehydrogenase deficiency , Pernicious anaemia, Polycythemia vera, Sickle cell disease
Iatrogenic Postimmunization, Radiation necrosis
Infectious Disease Borrelia burgdorferi, Brucellosis, Cat scratch fever, Conjunctival orbital cysts, Cytomegalovirus, Dermoid cysts, Herpes zoster, Hiv-1 disease, Infectious mononucleosis, Influenza, Lyme disease, Measles, Meningitis, Mumps, Onchocerciasis, Orbital abscess, Orbital cellulitis, Posterior uveitis, Postviral vasculitis, River blindness , Sinusitis, Syphillis, Treponema pallidum, Tuberculosis, Varicella, Viral encephalitis
Musculoskeletal/Orthopedic Encephalomyelitis, Neuromyelitis optica
Neurologic Acute disseminated encephalomyelitis , Anterior ischemic optic neuropathy, Benign multiple sclerosis , Cranial blood suppy disorders , Demyelinating disorders, Diffuse sclerosis of schilder, Encephalomyelitis, Guillain-barre syndrome, Leber's optic neuropathy, Low tension migrane, Meningioma, Meningitis, Migraine, Multiple sclerosis, Nerve damage, Neurofibromatosis, Neuromyelitis optica, Optic nerve glioma, Optic nerve tumors, Orbital abscess, Schilder’s disease, Sudanophilic cerebral sclerosis, Viral encephalitis
Nutritional/Metabolic Diabetes mellitus
Obstetric/Gynecologic No underlying causes
Oncologic Meningioma, Metastases, Optic nerve tumors, Polycythemia vera, Primary malignancies, Solid orbital tumors
Ophthalmologic Anterior ischemic optic neuropathy, Central retinal artery occlusion, Central retinal vein occlusion, Chloroptic, Conjunctival orbital cysts, Intraocular hypertension, Leber's optic neuropathy, Low-tension glaucoma, Ophthochlor, Optic nerve glioma, Optic nerve vascular lesions, Papillitis, Postcataract, Posterior uveitis, Thyroid opthalmopathy, Vascular occlusions of the optic nerve, Wagener syndrome 
Overdose/Toxicity Tobacco
Psychiatric No underlying causes
Pulmonary Churg-strauss syndrome, Sarcoidosis
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Churg-strauss syndrome, Diffuse sclerosis of schilder, Neurofibromatosis, Sarcoidosis, Systemic lupus erythematosus, Takayasu disease
Sexual Hiv-1 disease, Syphillis, Treponema pallidum
Trauma Bee stings, Head trauma
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

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Signs and symptoms

Major symptoms are sudden or gradual loss of vision (partial or complete). There may or may not be pain on movement of the affected eye. Patients may lose some of their color vision in the affected eye, with colours appearing subtly washed out compared to the other eye.

On medical examination the head of the optic nerve can easily be visualised by an ophthalmoscope. A pale disc is characteristic of optic neuropathy. Primary and secondary optic neuropathy may have different morphological presentation. The nerve head in optic neuritis may be swollen in some patients. In many cases, only one eye is affected and patients may not be aware of the loss of color vision until the doctor asks them to close or cover the healthy eye.

Differential Diagnosis

  • Acute angle closure glaucoma
  • Anterior ischemic optic neuropathy
  • Branch retinal artery occlusion
  • Central retinal artery occlusion
  • Compressive optic neuropathy
  • Meningioma
  • Multiple Sclerosis
  • Optic Neuritis
  • Sarcoidosis
  • Sudden visual loss
  • Syphillis
  • Thyroid opthalmopathy [1] [2]

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

See also

Optic neuritis



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