Optic nerve atrophy refers to degeneration of the optic nerve fibers leading to loss of vision. It can be primary, resulting from conditions like glaucoma, or secondary to disorders that first affect the retina or optic nerve like papilledema. Primary atrophy presents with a pale white disc with clear margins, while secondary atrophy shows a dense white disc with blurred margins and proliferation of fibrous tissue on the disc and vessels. Symptoms include progressive vision loss depending on degree of nerve fiber loss, and examination finds reduced acuity and visual field defects reflecting the extent of optic nerve damage. Treatment targets the underlying cause when possible.

1. Dr. Atul Kumar Anand
Senior Resident
AIIMS Patna

2. Optic nerve shrinkage from any process
that produce degeneration of axons in the
ant.visual (Retinogeniculate) pathway
It is a term usually applied to the
condition of the optic disc when the optic
nerve is degenerated.

3. The Kestenbaum count is the number of
capillaries observed on the optic disc.
The normal count is approximately 10.
In optic atrophy, the number of these
capillaries reduces to less than 6; in a
hyperemic disc, the count is more than 12

5. 1-Syphilis – Tabes dorsalis,
2-Pressure – pituitary tumour, glioma of
optic nerve
3-Tuberculous meningitis.
4-Glaucomatous optic atrophy
5-Circulatory optic atrophy – due to
occlusion of central retinal artery, arterio-
sclerosis.
6-Consecutive optic atrophy – due to
destruction of ganglion cells in retina as in
retinitis pigmentosa, choroiditis.

6. consecutive optic nerve atrophy : seen in
retinitis pigmentosa, choroiditis.
Disc: Yellow, waxy appearance, edge are
well defined.
Retina: vessels, show marked attenuation,
particularly in case of retinitis pigmentosa.
Surrounding retina shows evidence of retinitis
pigmentosa, choroditis (pigmentary
disturbance).

7. 7-Traumatic optic atrophy: Avulsion of optic
nerve. fracture of skull, heamorrhage into
optic nerve sheath.
8-Toxic optic atrophy : exogenous toxins,
tobacco, alcohol,
9-Metabolic diabetes mellitus
10- Demyelinating disease – disseminated
sclerosis ,
11-Hereditary – Leber's disease.

8. PRIMARY-
SECONDARY –
 Post- papilloedemic optic atrophy
 Post-Neuritic optic atrophy
 Glaucomatous optic atrophy
 Consecutive optic atrophy

9.  Optic nerve fibers
degenerate in an orderly
manner and are replaced by
columns of glial cells without
alteration in the architecture
of the optic nerve head
 Pale disc
 Chalky white(full moon
against a dark red sky)
 Clear margin of disc/sharply
demarcated
 Normal cup
 Well seen lamina cribrosa
 Normal retinal vessels

10.  Optic nerve fibers exhibit marked degeneration, with
excessive proliferation of glial tissue
 The architecture is lost, resulting in indistinct margins.
The disc is grey or dirty grey , looks pale with a
greenish tinge
 The margins are poorly defined,
 The lamina cribrosa is obscured due to proliferating
fibroglial tissue.
 Hyaline bodies (corpora amylacea) or drusen may be
observed.
 Peripapillary sheathing of arteries as well as tortuous
veins may be observed.

12. Primary or simple optic
atrophy
Secondary or post neuritic
optic atrophy
• -seen in case of syphilis,
pituitary tumor
•1-disc
•a) colour : white with a bluish tint
•b) edges: sharply defined and
regular.
•c) lamina cribrosa seen
(stippling).
•d) slight atrophic cupping seen
•2-Retina:
•a) vessels normal arteries may
be slightly attenuated .
•b)surrounding retina is normal in
appearance.
• Seen following papilloedema
, papillitis.
• There is proliferation of
fibrous tissue on the disc and
along the retinal vessels.
• Dense white, chalky white or
grayish white .
• Blurred and irregular
• Not seen
• No cupping seen
(physiological cup obscured.
• Arteries are thin, veins are
dilated , both show sheathing
with fibrous tissue
• Surrounding retina shows
pigmentary disturbances
which are most common at
macula.

13. Primary or simple optic
atrophy
Secondary or post neuritic
optic atrophy
• -seen in case of syphilis,
pituitary tumor
•1-disc
•a) colour : white with a bluish tint
•b) edges: sharply defined and
regular.
•c) lamina cribrosa seen
(stippling).
•d) slight atrophic cupping seen
•2-Retina:
•a) vessels normal arteries may
be slightly attenuated .
•b)surrounding retina is normal in
appearance.
• Seen following papilloedema
, papillitis.
• There is proliferation of
fibrous tissue on the disc and
along the retinal vessels.
• Dense white, chalky white or
grayish white .
• Blurred and irregular
• Not seen
• No cupping seen
(physiological cup obscured.
• Arteries are thin, veins are
dilated , both show sheathing
with fibrous tissue
• Surrounding retina shows
pigmentary disturbances
which are most common at
macula.

14. Symptoms
• That of causative condition
• Usually there is progressive diminution of vision .
• Visual loss – Depends on the degree of atrophy
• Partial atrophy – Partial visual loss
• Total atrophy – Total visual loss

15. Normal disc
OPTIC ATROPHY
Central Field Loss

16.  Signs
• Visual acuity –
reduced or lost (NPL)
• Afferent Pupillary
defect – Relative or
absolute
• Field defect –
Reflects the degree of
atrophy
• Optic disc pallor –
Reflects degree &
types of atrophy

17. When atrophy is complete the pupil is dilated
and fixed.
Treatment:
1-Directed at the cause –anti-syphilitic
treatment penicillin in high doses , removal of
pituitary tumour.
2-vasodilators: Tb. nicotinic acid.
3-Injection Vitamins B1, B12 in high doses.