Optic atrophy is the degeneration of the optic nerve fibers leading to pallor of the optic disc. It can be classified as primary, secondary, consecutive, glaucomatous, or ischemic based on the underlying cause and appearance of the optic disc. Primary optic atrophy results from diseases proximal to the disc with a chalky white appearance. Secondary optic atrophy occurs after inflammation of the optic disc with a dirty white, blurred disc. Consecutive optic atrophy follows retinal lesions and shows a yellow waxy disc. Treatment focuses on the underlying cause when possible, but once complete atrophy occurs, vision cannot be recovered.

1. Optic atrophy
Angel Das

2. Optic Atrophy
 Condition of optic disc following degeneration of
optic nerve
 Occurs as result of any injury to nerve fibres involving in
anterior visual system – retina to lateral geniculate body

3. Classification
 Ophthalmoscopic Classification
-Primary Optic Atrophy
- Secondary/Post-neuritic Optic Atrophy
-Consecutive Optic Atrophy
-Glaucomatous Optic Atrophy
-Ischaemic Optic Atrophy
 Another classification
-Ascending/Anterograde optic atrophy
-Descending/retrograde optic atrophy

4. Primary optic atrophy
 Disease proximal to the disc so there is no evidence
of local inflammation.
 CAUSES: Multiple sclerosis
Space occupying lesions
Leber’s disease
Tabes dorsalis

5. o Disc is chalky white
o Margins well defined
o Lamina cribrosa seen
o Cupping is shallow
o Retina looks normal
 Ophthalmoscopic appearance

6. Secondary/Post neuritic Optic Atrophy
 Break in continuity of fibres in optic disc
 Occurs in longstanding papilloedema, papillitis or neuroretinitis
Ophthalmoscopic Appearance
-Disc- dirty white
-Edges blurred due to gliosis(proliferation
of astrocytes & glial tissue)
-Cup obliterated

7. Consecutive Optic Atrophy
 Occurs following destruction of ganglion cell-
secondary to lesions in choroid /retina
 Causes
-Diffuse chorioretinitis
-Retinitis pigmentosa
-Pathological myopia
-Occlusion of central retinal artery

8.  Ophthalmoscopic Appearence
-Disc – yellow waxy
-Edges – not well defined
-Retinal vessels attenuated

9. Glaucomatous Atrophy
 Results from long-standing raised IOP
Ophthalmoscopic Appearence
-Deep & wide cupping of optic disc
-Nasal shift of blood vessels
-Lamina cribrosa pores seen
(lamellar dot sign)

10.  Conditions producing disc ischaemia
 Causes
-Giant cell arteritis
-Severe haemorrhage
-Severe anaemia
-Quinine poisoning
Vascular / Ischaemic Optic Atrophy
 Ophthalmoscopic Appearence
-pallor of disc
-marked attenuation of vessels

11. Clinical Features
 Loss of vision
-partial /total
 Pupil
-semi-dilated
-direct light reflex –sluggish /absent
-Marcus Gunn pupil/RAPD
 Visual field loss
-Peripheral, Central /Eccentric

12.  Ophthalmoscopic Appearence
-pallor of disc
-decrease in no: of small blood vessels
(kastenbaum index)

13. Treatment
 Partial optic atrophy – treat underlying cause
 If complete atrophy – vision cannot be recovered