Internal Medicine

P1: SBT

0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18

76 Adult Optic Neuropathies

Nutritional associations to look for

■Tobacco usage

■Alcoholism

■Folate deficiency

■Vitamin B12 deficiency

■Toxins that affect optic nerve

■Methyl alcohol Toluene

■Cisplatin

■BCNU

■Interferon alpha

Signs & Symptoms

■Perception of whiteness of the disc (our best parameter for atrophy)

is influenced by disc’s cup size – the larger the cup size, the more

“white” the disc appears

■Ophthalmoscopic features of disc change

➣Is the disc swollen? – if so must rule out papilledema (disc swelling

from raised intracranial pressure)–amedical emergency

➣Are venous pulsations present spontaneously? if so, intracranial

pressure < 200 mm H20 and swollen disc is not likely papilled-

erna

➣Is there a pressure related optic neuropathy – anything to suggest

glaucoma?

Glaucoma is the most prevalent optic neuropathy of adults

Glaucomatous optic atrophy is characterized by

➣undermining of neuroretinal rim

vertical bias to cup configuration

asymmetry of disc excavation

■Decreased vision

■Decreased color perception

■Dimness of vision

➣Constriction of peripheral field

Trouble with tasks requiring fine steropsis

■Trouble with reading – can be declaration of homonymous hemi-

anopia

■Pain on eye movement – characteristic of optic neuritis

➣Transient obscurations of vision – sudden visual loss with valsalva

maneuver – characteristic of the swollen disc

■Loss of central vision

■Loss of color vision

■Constriction of visual field