This document provides terminology and descriptions related to evaluation of the optic disc. It describes normal anatomy and features of the optic disc including size, shape, color, zones, and vessels. It also summarizes various congenital and acquired optic disc anomalies including glaucoma, papilledema, optic neuropathies, tumors, and other conditions. Key features are described for different stages and types of each condition.
A systematic approach with practical tips to diagnose and manage optic disc pallor. Disc pallor is often encountered in the routine clinical practice and remains a diagnostic enigma for most ophthalmologist. I illustrate the relevant practical points to be looked out for to deal with disc pallor.
A systematic approach with practical tips to diagnose and manage optic disc pallor. Disc pallor is often encountered in the routine clinical practice and remains a diagnostic enigma for most ophthalmologist. I illustrate the relevant practical points to be looked out for to deal with disc pallor.
Approach to Disc Pallor and Automated Fields in Neuro-ophthalmology Dr. Shah Noor Hassan
Visual field assessment is important in the evaluation of lesions involving the visual pathways and should be performed at baseline and periodically in the follow-up. Standard automated perimetry has been shown to be adequate in neuro-ophthalmic practise and is now the technique of choice for a majority of practitioners.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. TERMINOLOGIES
Optic disc - Intraocular portion of optic nerve. Termination of all retinal layers
except nerve fibres, which pass through lamina cribrosa into the optic nerve.
Optic nerve head - Optic disc along with underlying pre-laminar layer of optic
nerve and region of lamina cribrosa
Optic papilla - Slightly elevated periphery of optic disc.
Physiological cup - Depression seen in optic disc
3. GENERAL FEATURES
Shape
Circular or ovoid
Location
Centre of disc lies 4 mm nasally and 1 mm superiorly to fovea
Colour
• Optic cup is white - due to lamina cribrosa and medullated nerve fibres behind it
and absence of vascular choroid
• Neural rim is yellow-pink - rich capillary network
• Fair-skinned, blond, myopic people with large optic discs have a light coloured
discs, and vice versa
4. Zones of the optic nerve head and peripapillary pigmentation
CUP
NRR
SCLERAL LIP
ZONE β
ZONE α
5. Margin
• Nasal margin - not well defined
• Margins at superior and inferior poles and in small optic discs - obscured due to
crowding of nerve fiber bundles
• Choroidal crescent - gap in RPE revealing underlying choroid because of oblique
insertion of optic nerve and tilting of disc
• Scleral crescent - when both RPE and choroid are deficient
• Both crescents mostly arise on temporal aspect of disc
6. Dimensions
Vertical diameter = 1.8 mm
Horizontal diameter = 1.5 mm
Depth = 1 mm
Cup : Disc ratio - Ratio of vertical diameter of optic cup
to that of optic disc
May vary from 0.1 - 0.9
Correction factors for estimating optic disc diameter:
Volk +78 D = 1.1 x
Volk +90 D = 1.3 x
ISNT rule - Inferior NRR is broadest followed by superior, nasal and temporal
Small and moderate sized optic discs follow the rule, large discs may not
7. • Physiologic cupping - horizontally oval and deeper in nasal quadrant
• Only 2 % of normal population have C:D ratio > 0.7
• Number of optic nerve fibres, and area of neural rim they comprise, is constant.
Thus, small optic discs have small cup because of concentration of nerve fibres
at their point of confluence
• Small discs - 0.35
Large discs - 0.55
• Early glaucomatous changes can be missed in small discs
Cupping over diagnosed in large discs
8. Retinal vessels on and near optic disc
• CRA enters globe through physiological cup - divides dichotomously within cup
and on surface of disc - 4 branches (ST, SN, IT, IN)
• May divide within optic nerve head - 2 or 4 branches emerging separately from
within the physiological cup
• Veins lie temporal to arteries
• Cilioretinal artery - in 40% people and emerge from temporal aspect of optic
disc
9. Spontaneous vascular pulsations
• Venous pulsation - seen at sharp bend in the vein as it turns into lamina cribrosa
• Absent in 20% healthy people
• Can be elicited by elevating IOP by pressing gently on globe
• Indication of normal ICP, if IOP is normal
• Can be seen in presence of elevated ICP if IOP is high
• Arterial pulsation - raised IOP or elevated pulse pressure
10. Other important observations
• Copper-wire appearance - reflection of light at vessel centre
• Relative sizes of arteries and veins (normally - 2:3)
• Thickening of arterioles - ageing, arteriosclerosis, hypertension
• Very narrow, thready arterioles - tapetoretinal degenerations
• Changes at AV crossings
12. NON-PROGRESSIVE CONGENITAL OPTIC DISC ANOMALIES
COLOBOMA
• Enlarged optic disc, partially or almost totally excavated
• Deepest part of coloboma is usually situated inferiorly
• Glistening white, tinged with grey on its surface
• Increased number of blood vessels cross border of coloboma - represent
branches of central retinal vessels which have divided on optic disc surface
before reaching retina
• Peripapillary pigmentary changes (hyper or hypo)
13. TILTED OPTIC DISC / NASAL FUNDUS ECTASIA SYNDROME /
FUCH'S COLOBOMA / DYSVERSION OF THE OPTIC DISC
• Usually inferiorly or inferonasally
• Choroidal or scleral crescent
• Situs inversus - in 80% of eyes with tilted disc. Temporal retinal vessels first turn
nasally before curving temporally towards macula
14. OPTIC DISC PIT
• Round or oval
• Pigmented (usually)
• 1 pit per optic disc, occasionally 2 or 3
• Size = 1/4 - 1/2 DD
• Larger optic disc with distinct physiological cup
• Base of pit may pulsate - underlying blood vessels, or transmission from
subarachnoid space
• Peripapillary chorioretinal atrophy
• Retinal vessels cross the pit - running superficially or dipping below its surface
• 60% cases - cilioretinal artery arises from periphery of pit
• Serous RD develops in 30% cases - resolves spontaneously
15.
16. APLASIA AND HYPOPLASIA
• Abnormally small optic disc with pathologically low number of nerve fibers
• Grey or pale
• Double ring sign - peripapillary halo bordered by ring of increased or
decreased pigmentation
• Deficit visual function
17. ALTITUDINAL HEMIHYPOPLASIA
• Hypoplasia restricted to upper half of disc
• In children of severe diabetic mothers with poor control during pregnancy
• Little or no visual field below horizontal meridian
MICROPAPILLA
• Smaller optic disc
• Blurred margins
• Small or absent cup
• Normal visual function
18. MEGALOPAPILLA / MACROPAPILLA
• Extraordinarily large optic disc
• Very large central cup and narrow but healthy neuroretinal rim
• Bilateral
• Peripapillary pigmentary changes may be present
• Normal optic nerve function
19. MORNING GLORY OPTIC DISC
• Enlarged, nearly circular optic disc containing a deep conical depression with
white to pink glial tissue at its base
• Grey or black halo
• Retinal vessels loop over the edge of optic disc in a radial fashion (origin and
early branching obscured by glial tissue)
• Serous RD - may fluctuate and resolve spontaneously
20. MYELINATED NERVE FIBRES
• 1% of normal population
• Not present at birth; develop post-natally
• White, highly reflective lesion with feathery margins. Dark slits within the
lesion represent normal, unmyelinated fibres
21. CONGENITAL VASCULAR ANOMALIES
PERSISTENT HYALOID ARTERY
• Bloodless, transparent, thread-like remnant extending forwards from optic disc
• Portion near the disc may contain blood
Anteriorly the artery may retain its attachment to posterior lens capsule - Mittendorf's dot
22. BERGMEISTER'S PAPILLA (PERSISTENT HYPERPLASTIC PRIMARY
VITREOUS)
• Faint grey or yellow-white protuberance over the optic disc
• Nasally in 90% cases
• Physiological optic cup is reduced or absent
23. PREPAPILLARY VASCULAR LOOPS
• Short and simple, or may be long with several spiral twists
• Never reach the posterior surface of lens
• Loop usually originates from, and returns to the vessels on the optic disc;
occasionally may arise from an artery on disc and return to a retinal branch
• Arterial loops generally affect inferior central retinal vessels (may pulsate)
• Venous loops usually affect superior retinal veins
24. ACQUIRED VASCULAR ANOMALIES
NEOVASCULARISATION AT DISC
• Fine network of vessels lying flat on disc or protruding into vitreous
• Do not branch dichotomously
Causes -
• Proliferative diabetic retinopathy
• Retinal vein occlusion
• Old retinal artery occlusion
• Ocular ischemic syndrome
• Radiation retinopathy
• Carotid-cavernous fistula
27. PAPILLITIS
• Early phase - disc is moderately swollen and hyperemic
• Indistinct margins
• Splinter haemorrhages on the disc surface
• Later - secondary optic atrophy
NEURORETINITIS
• Early phase - disc may appear swollen; later - consecutive optic atrophy
28. OPTIC NEUROPATHY
RETROBULBAR OPTIC NEUROPATHY
Early phase - disc appears normal; later - primary optic atrophy
ISCHEMIC PAPILLOPATHY
Acute phase - swollen and pale optic disc (usually sectorial), superficial splinter
haemorrhages
Chronic phase - secondary optic atrophy
ARTERITIC PAPILLOPATHY
Features same as in ischemic papillopathy
30. LEBER'S HEREDITARY OPTIC NEUROPATHY
• Swollen and hyperaemic optic disc
• Dilated telangiectatic capillaries mainly on, and extending from, temporal side
of optic disc
• Chronic stage - secondary optic atrophy, marked reduction in vascularity
31. OPTIC ATROPHY
PRIMARY OPTIC ATROPHY
• Chalky white optic disc with clearly defined margins
• Disc pallor, more on temporal side
• Atrophied neural rim - loss of physiological cup and flattening of optic disc
• No gliotic or vascular changes
32. SECONDARY OPTIC ATROPHY
• Grayish white swollen optic disc
• Poorly defined margin
• Partially or completely filled physiological cup
• Gliotic changes may or may not be present
33. CONSECUTIVE OPTIC ATROPHY
• Pale yellow, waxy looking flat optic disc
• Well defined margins
• Minimal gliotic changes
• e.g. Retinitis pigmentosa
CAVERNOUS OPTIC ATROPHY OF SCHNABEL
• Seen in ischemic lesions of optic nerve head
• Diffusely enlargement and bean pot like cupping
34. PERIPAPILLARY ATROPHY
Alpha Zone:
• Hypo and hyper-pigmented areas
• Present in glaucomatous as well as non-glaucomatous eyes
Beta Zone:
• Large choroidal vessels become visible
• Larger beta zone often has thin NRR in the same area
• More common in glaucomatous eyes and progression of beta zone is
associated with glaucoma progression
35. MYOPIA
• Optic disc is sometimes distorted
• Tilting of optic disc, usually temporally
• Retinal vessels appear dragged
• Nasal vessels curve around the elevated nasal sector of disc, temporal vessels
pursue a straightened course
• Myopic crescent
36. HYPERMETROPIA
• Small, pink optic disc, appears elevated and congested, but capillaries are not
dilated
• Central retinal vessels crowd the centre of small optic disc; spontaneous venous
pulsation not affected
• Severe cases - horizontal choroidal folds in peripheral fundus
37. GLAUCOMA
Focal atrophy
• Polar notching - small, discrete neural atrophy, usually in inferotemporal
quadrant
• Selective loss of neural rim tissue in inferotemporal and superotemporal
sectors - vertical or oblique enlargement of cup
• With progression temporal neural rim is involved followed by nasal quadrant
• Bayoneting sign - Retinal vessel bending sharply at the edge of disc
Concentric atrophy
• Less common
• Begins temporally, progresses circumferentially - temporal unfolding
38. LARGE OPTIC DISC WITH LARGE
PHYSIOLOGIC CUPPING
GLAUCOMATOUS CUPPING
Preserved healthy NRR widest at inferior
pole and narrowest in temporal quadrant
(I>S>N>T)
Cup extends to the disc margin
39. Deepening of cup
• Overpass cupping - vessels initially bridge the deepened cup, later collapse into it
• Laminar dot sign - Exposure of underlying lamina cribrosa. Fenestration with
striate appearance has higher association with glaucomatous damage than dot-
like appearance
Pallor/cup discrepancy
• In early stages of glaucomatous optic atrophy - size of cup > area of pallor
• Other causes of optic atrophy - area of pallor > size of cup
• Area of cupping recognized by observing kinking of vessels at cup margin
• Saucerisation - diffuse, shallow cupping extending to disc margins
• Focal saucerisation - localized shallow, sloping cup, usually in inferotemporal
quadrant
• Tinted hollow - normal NRR colour in area of focal saucerisation
• Shadow sign - grayish hue of NRR
40. Advanced glaucomatous cupping
• Total cupping - white disc with loss of all neural rim tissue
• Bending of vessels at disc margin
41. Optic disc haemorrhages
• NTG > COAG
• Most commonly in inferior quadrant
• Resolve spontaneously and reappear at same or different location
• Cross the disc margin - papillary portion often disappears first during
resorption, leaving the appearance of an extrapapillary haemorrhage
• Decline in frequency with advanced damage
• Associated with progressive changes of visual field
Peripapillary pigmentary disturbance
• Scleral lip or peripapillary halo
• Peripapillary atrophy (both zone beta and zone alpha)
42. PAPILLOEDEMA
Early phase
• Swollen optic disc with indistinct margin
• First seen in nasal quadrant and then in superior and inferior sectors (because
of variation in density of nerve fibres in NRR)
• Physiological cup is maintained giving the disc a cylindrical appearance
• Disc is hyperemic due to capillary dilatation
• Retinal veins are congested and non-pulsatile
• Circumpapillary accumulation of fluid - concentric retinal folds (Paton’s lines)
and choroidal folds (best seen with red-free filter)
43. Acute phase
• Optic disc becomes increasingly swollen and elevated
• Physiological cup may still be maintained
• Retinal venous congestion more pronounced.
• Some blood vessels partially obscured at the edge of disc
• Flame-shaped haemorrhages on disc margin
• Macular star - accumulation of fluid and exudates, most prominent on nasal
aspect of macula
44. Long standing phase
• Disc markedly swollen and physiological cup obliterated – Champagne cork
appearance
• Circulatory adjustments lead to resolution of venous congestion and retinal
edema
45. Atrophic stage
• Pale optic disc (Secondary optic atrophy)
• Neuronal degenerative changes - punctate white opacities in superficial nerve
fibre layer
• Attenuated retinal arteries
• Circumpapillary choroidal pallor and RPE atrophy with areas of pigmentary
clumping
46. OPTIC DISC DRUSEN
Children
• Small optic disc
• Drusen hidden within substance of nerve head
• Pseudopapilledema
• Retinal veins not distended, spontaneous retinal pulsation not affected
• Central retinal vessels may show anomalous branching (10% cases)
• Cilioretinal arteries commonly occur
47. Adolescents and adults
• Drusen - single or multiple, glistening, semi-translucent; may coalesce – give
disc a yellow-pink appearance
• Optic disc may become enlarged and its border indistinct or irregular
• Physiological cup is obliterated
• Splinter haemorrhages on disc surface, subretinal haemorrhages in
peripapillary area
48. TUMOURS AND TUMOUR-LIKE CONDITIONS
MELANOCYTOMA
• Grey to jet-black
• Eccentrically placed on optic disc, extending over disc margin
• Optic disc adjacent to the tumour is normal, may be swollen
49. ASTROCYTIC HAMARTOMA
• Early stage - Smooth semi-translucent mass
• Mature stage - Mulberry-like white reflective mass, may become calcified
• Very vascular; blood vessels can be seen coursing through their substance
50. CAPILLARY HAEMANGIOMA
• Localised, round, orange-pink
• Vascular
• Situated eccentrically on disc overlapping the disc margin and extending
forwards into vitreous
51. CAVERNOUS HAEMANGIOMA
• Grape-like saccular aneurysms lying flat on the retina
• Circulation through haemangioma is sluggish and blood tends to stagnate in
each saccule, with red blood cells sedimenting in response to gravity, leaving
a pale layer of plasma above
52. GLIOMA
• Smooth, elevated, white mass partially or completely obscuring the disc
• Compression of disc may cause occlusion of central retinal vessels
• Glioma situated posterior to lamina cribrosa may cause primary optic atrophy
53. MENINGIOMA
Direct involvement of optic nerve
• Elevated, pale mass obscuring the optic disc and displacing the peripapillary
retina
• Splinter haemorrhages may be seen over the surface of the mass
Optic nerve compression
• Pale, swollen optic disc
• Optociliary shunt vessels
54. OPTIC DISC GRANULOMA
Acute stage
• Raised, irregular, hyperaemic lesion affecting the optic disc and extending into
the adjacent retina
• Peripapillary sub-retinal fluid accumulation
Later stage
White mass of scar tissue overlying the disc causing traction retinal folds