Optic atrophy, common symptoms and signs

Optic atrophy can be primary, secondary or ascending. This disease does not occur alone but is often caused by some lesions of the optic nerve. It is necessary to diagnose the patient's condition in time and choose appropriate treatment methods.

1. Primary optic atrophy

Primary optic atrophy is caused by damage to the intraorbital, intracanalicular, and intracranial segments of the optic nerve behind the cribriform plate, as well as the optic chiasm, optic tract, and lateral geniculate body. It is therefore also called descending optic atrophy.

The fundus changes of descending optic atrophy are limited to the optic disc, which is grayish white in color and has very neat borders. Due to the atrophy of optic nerve fibers and the loss of their myelin sheath, the physiological depression appears slightly larger and deeper, in the shape of a shallow dish, and small gray-blue dot-like cribriform plates can be seen. The retina and retinal vessels were normal.

A careful visual field analysis must be performed on every patient with primary optic atrophy. Clinically, it is common to see patients with pituitary tumors who first visit the ophthalmology department due to decreased vision. However, because ophthalmologists ignore visual field examinations, they misdiagnose or miss the diagnosis, causing the patients to miss the opportunity for treatment.

2. Secondary optic atrophy

Secondary optic atrophy is optic nerve atrophy caused by long-term optic disc edema or severe optic disc inflammation. The lesions are mostly limited to the optic disc and its adjacent areas, so the fundus changes are also limited to the optic disc and its adjacent retina. The optic disc appears white due to glial hyperplasia, the border of the optic disc is unclear, and the physiological depression is filled with glial cells, so the physiological depression disappears and the cribriform plate cannot be seen. The retinal arteries near the optic disc may become thinner or have white sheaths, and the retinal veins may be slightly thicker and more tortuous. Some unabsorbed hemorrhages and hard exudates may remain in the posterior pole of the retina.

In patients with secondary optic atrophy, most have completely lost their vision. For the few who still have some vision, their visual field also shows a significant centripetal reduction.

3. Ascending optic atrophy

Ascending optic atrophy is caused by extensive lesions of the retina or choroid, which causes damage to retinal ganglion cells and leads to optic nerve atrophy. Therefore, it is also called retinitic optic atrophy or consecutive optic atrophy. Almost all extensive retinochoroidal lesions can cause ascending optic atrophy. For example: central retinal artery occlusion, retinitis pigmentosa, severe retinal choroidal inflammation and degeneration, and advanced glaucoma.

The fundus of ascending optic atrophy is characterized by a waxy yellow optic disc with clear borders; the retinal blood vessels are mostly thin, and some pigmentation can be seen in the fundus. In addition, patients may also have primary lesions of the retina, choroid, or retinal blood vessels.