Primary Open Angle Glaucoma

    • Optic neuropathy associated with acquired excavation of the optic disc
    • Elevated intraocular pressure may be present and may contribute to optic nerve damage
    • Treated by reducing intraocular pressure with medication or surgery
    • Slowly progressive nerve fiber bundle visual field loss—usually binocular but may be asymmetric
    • Excavation of the optic discs—usually binocular but may be asymmetric
    • Excavation first extends vertically, beginning inferiorly
    • Tip: marked optic disc excavation always precedes visual field loss
    • Visual acuity is normal until the optic disc is fully excavated (“cupped out”)
    • Optic disc coloboma
    • Myopia
    • Large physiologic cup
    • Compressive optic neuropathy
    • Ischemic optic neuropathy
    • Dominantly-inherited optic neuropathy
    • Diagnose primary open angle glaucoma if visual field loss can be explained by optic disc excavation
    • Trap: beware of imitators of glaucomatous excavation
    • Tip: compressive, atrophic ischemic optic neuropathy, and even nutritional-deficiency, toxic, and hereditary optic neuropathies may display excavation of the optic disc if the patient had large physiologic cups to begin with
    • Medical and surgical measures that lower intraocular pressure may attenuate or halt progression of visual field defects and optic disc excavation, but…
    • Visual field defects may worsen despite effective lowering of intraocular pressure because other factors contribute to disease progression

    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