Paraneoplastic Optic Neuropathy

    • Subacute optic neuropathy indirectly related to an underlying cancer
    • Clinical manifestations are caused by an autoimmune cross-reaction to tumor antigens (“molecular mimicry”)
    • Much less common than infiltrative (neoplastic) optic neuropathy and less common than paraneoplastic retinopathy
    • Source of cancer may be known or occult
    • Core clinical features
      • Subacute typically binocular visual loss
      • Optic discs typically appear elevated
      • Tip: the vitreous is always inflamed!
    • Possible accompanying clinical features
      • Altered mental state
      • Ataxia
      • Tremor
    • Imaging features
      • Brain imaging is usually normal
      • Body imaging or blood tests may show cancer
    • Paraneoplastic CRMP-5 antibody may be found, but the paraneoplastic screen is often negative
    • Infiltrative (neoplastic) optic neuropathy
    • Optic neuritis
    • Ischemic optic neuropathy
    • Tip: reject this diagnosis if there is no vitreous inflammation!
    • Exclude alternative causes of vitritis
    • Order a blood panel for paraneoplastic antibodies
    • Search for cancer if not already known
    • Treat the optic neuropathy with high-dose corticosteroids, plasmapheresis, or intravenous immunoglobulin if a cancer is found
    • Treat the underlying cancer
    • Tip: treatment of the underlying cancer is more effective in restoring vision than is anti-inflammatory treatment
    • Treatment is rarely effective in restoring vision

    Optic Nerve And Chiasm Disorders

    Drusen Optic Neuropathy Colobomatous Optic Neuropathy Optic Pit Neuropathy Morning Glory Optic Neuropathy Hypoplastic Optic Neuropathy Typical Optic Neuritis Atypical Optic Neuritis Papillitis (Neuroretinitis) Non-arteritic Ischemic Optic Neuropathy Arteritic Ischemic Optic Neuropathy Posterior Ischemic Optic Neuropathy Hypotensive Ischemic Optic Neuropathy Radiation-induced Optic Neuropathy Diabetic Papillopathy Hypertensive Optic Disc Edema Papilledema Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) Compressive Optic Neuropathy: Overview Optic Neuropathy of Graves Disease Optic Nerve Sheath Meningioma Sphenoid Meningioma Craniopharyngioma Pituitary Adenoma Pilocytic Astrocytoma (Optic Glioma) Carotid Aneurysm Suprasellar Germinoma Infiltrative (Neoplastic) Optic Neuropathy Paraneoplastic Optic Neuropathy Traumatic Optic Neuropathy Toxic Optic Neuropathy Nutritional Deficiency Optic Neuropathy Dominantly-Inherited Optic Neuropathy Leber Hereditary Optic Neuropathy Primary Open Angle Glaucoma