Optic atrophy

What?
Atrophy. Disuse?
Common morphologic endpoint on any disease
causing axon degeneration
Affects optic nerve anywhere along retinogeniculate
pathway

Clinical features

Loss of vision

Sudden or gradual? depends upon

cause of atrophy

Partial or total? depends upon degree

of atrophy

Pupil

Semidilated

Sluggish or absent direct light reflex

Marcus Gunn pupil on swinging

flashlight test

Visual field loss

Varies with distribution of damaged
fibers

Swinging flashlight
test

Histopathologic changes
Loss of axons
Shrinkage of
myelin layer

Gliosis

Widening
optic cup

Scarring in CNS due to

production of dense fibrous
network of neuroglia in
areas of damage

Pallor why?

Healthy disc

Reflection theory
Light -> total internal reflection through axonal fibers ->
reflection from capillaries on disc surface -> yellow-pink
appearance of healthy optic disc
Degenerated axons -> loss of internal reflection -> pale
optic disc

Kestenbaum capillary theory

Optic disc supplied by autoregulating pial capillaries from
circle of Zinn-Haller
Kestenbaum index number of capillaries on optic disc
Normal: 10
Optic atrophy: 6
Hyperemic disc: 12
Atrophic disc

Hyperemic disc

Ophthalmic classification
Primary optic atrophy
Secondary optic atrophy
Consecutive optic atrophy
Cavernous optic atrophy

Primary optic atrophy

Causes

Pathophysiolo
gy

Fundoscopy

Pituitary tumour
Traumatic optic neuropathy

Nerve fibers degenerate and are

replaced by columns of glial cells
No alteration in optic nerve head
architecture

Disc is chalky white and sharply

demarcated
Retinal vessels are normal

Secondary optic atrophy

Causes

Pathophysiolo
gy

Fundoscopy

Papilledema
Papillitis
Atrophy is secondary to prior
disc swelling
Excessive proliferation of glial
tissue
Disc is dirty grey with poorly
defined margins

Consecutive optic atrophy

Causes

Retinitis pigmentosa
Occlusion of central retinal artery

Pathophysiolo
gy

Destruction of ganglion cells

secondary to degenerative or
inflammatory lesions of choroid
and/or retina

Fundoscopy

Waxy pale disc

Marked attenuation of arteries
Normal physiologic cup and disc
margin

Cavernous optic atrophy

Causes

Glaucoma

Pathophysiolo
gy

Elevated IOP causes ischemia to anterior

part of optic nerve

Fundoscopy

Marked cupping and vertical enlargement

of cup
Laminar dot sign
Bayoneting and nasal shifting of retinal
vessels
Peripapillary halo and atrophy

Which is which?
Disc colour?

Chalky white

Disc margin?

Sharply
demarcated

Retinal
vessels?
Other
abnormalities
?

Retinal
vessels are
normal

Primary optic
atrophy

Which is which?
Disc colour?

Pale

Disc margin?

Vertical
enlargement of
cup

Retinal
vessels?
Other
abnormalities
?

Bayoneting and
nasal shifting of
retinal vessels

Cavernous optic
atrophy

Which is which?
Disc colour?

Dirty grey

Disc margin?

Poorly defined
margins

Retinal
vessels?
Other
abnormalities
?

Secondary optic
atrophy

Which is which?
Waxy pale disc

Disc colour?
Disc margin?

Marked
attenuation of
arteries

Retinal
vessels?
Other
abnormalities
?

Consecutive optic
atrophy

Differential diagnosis
Physiological causes of pale optic disc

Infants

Elderly people with sclerotic changes

Pathological causes of pale optic disc

Hypoplasia

Congenital pit

Treatment
Treating underlying cause may preserve some vision in
partial optic atrophy
Vision cannot be recovered once complete atrophy has set
in