Internal Medicine

P1: SBT

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

Adult Optic Neuropathies 75

Onset of visual symptoms:

■Acute

➣over minutes and hours

➣Ischemic

➣Inflammatory

➣Traumatic

■Sub-acute

➣over a few days

■Chronic

➣over weeks and months

➣Compressive

➣Heredofamilial and Degenerative

➣Indolent inflammation Toxic/nutritional

➣Infiltration of the nerve

Systemic history of import:

■Headache – R/O Temporal Arteritis

■Weight loss- R/O Temporal Arteritis

■Obesity – R/O raised ICP

■Jaw claudication- R/O Temporal Arteritis

■Temporal tenderness- R/O Temporal Arteritis

■Systemic malignancy – metastatic process can cause compression;

paraneoplastic syndromes can cause visual loss

■Diabetes – can produce diabetic papillopathy

■Hypertension – associated with AION

Systemic medications that affect optic nerve

■Isoniazid

■Ethambutol

■Hydroxyquinolones

■Chloramphenicol

■D-Penicillamine

■5-Fluorouracil

■Hexachlorophene

■Cyclosporine

Systemic medications associated with papillederma and raised

intracranial pressure:

■Steroids

■Vitamin A

■Heavy metals

■Tetracyclines

■C02 retention – chronic lung disease

■Uremia