Compressive Optic Neuropathy
- Results from mechanical mass effect secondary to:
- Tumors (Intracranial, Chiasmal, or Optic Nerve tumors)
- non-neoplastic lesions:
- Retrobulbar hemorrhage.
- Aneurysm.
- Mucocele.
- Orbital apex syndrome (thyroid eye disease).
Symptomatology:
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Slowly progressive process with changes or fluctuations in visual acuity or missing visual field that occur over several months to years.
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Changes in color vision.
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Diplopia (double vision), results from interruption of any of the cranial nerves innervating the extraocular muscles (CN III, IV, VI).
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The optic disc’s appearance may vary greatly depending on the lesion’s location.
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Early in the compressive disease process, the optic disc may appear normal.
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Optic disc edema.
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Atrophic changes (most often due to chronic compression).
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Presence of optocilliary shunt vessels.
Management:
- Early and accurate diagnosis with prompt treatment of the underlying cause of the compression is vital to preserve the patient’s vision.
- Surgical and medical treatments directed at managing the underlying etiology may result in recovery of acuity, fields, and symptoms.