Optic atrophy

204 Optic atrophy

Instruction

Examine this patient’s eyes.

Examine this patient’s fundus.

Salient features

History

• Visual loss: onset of symptoms depends on underlying aetiology

• History of multiple sclerosis

• History of glaucoma

• Optic nerve tumour

• Vitamin B12 deficiency

• Paget’s disease

• Exposure to toxins: lead, methanol, arsenic.

Examination

• Pale disc with sharp margins (Fig. 204.1)

• Intact consensual light reflex but impaired direct light reflex: Marcus Gunn pupillary response (seen in asymmetrical involvement of the two eyes)

• Central scotoma on testing of visual fields.

image

Fig. 204.1 Optic atrophy.

Proceed as follows:

• Tell the examiner that you would like to look for cerebellar signs (remember that multiple sclerosis is the commonest cause of optic atrophy).

Diagnosis

This patient has primary optic atrophy (lesion) caused by multiple sclerosis (aetiology). I would like to check the visual fields for central scotoma (functional status).

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Optic atrophy

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