eMedicine Specialties > Ophthalmology > Optic Nerve

Optic Neuropathy, Compressive: Follow-up

Author: Talmadge (Ted) Cooper, MD, Adjunct Clinical Associate Professor, Department of Ophthalmology, Stanford Medical School
Contributor Information and Disclosures

Updated: Sep 10, 2007

Follow-up

Complications

  • Surgery to remove orbital tumors compressing the optic nerve is frequently associated with injury to the third, fourth, and/or sixth cranial nerves, which may result in paralytic strabismus and ptosis.
  • Surgery to remove lesions that are intimately involved with the nerve sheath (eg, meningiomas, schwannomas) often results in further loss of vision or blindness.

Prognosis

  • Prognosis depends on the type of lesion causing compression of the optic nerve.
  • Some tumors are relatively easy to excise, while others are likely to result in loss of vision.

Patient Education

  • Adequately inform the patient that vision may deteriorate despite surgery or radiation.

Miscellaneous

Medicolegal Pitfalls

  • Although optic neuritis is much more common than compressive optic neuropathy, avoid confusing the two conditions.
    • Optic neuritis usually presents with acute or subacute visual loss in a patient younger than 50 years and is frequently associated with pain on eye movement. The vision usually improves substantially in optic neuritis with or without steroid treatment.
    • Compressive optic neuropathy presents as gradually progressive visual loss, which may not be painful. Vision may improve with steroid treatment only to deteriorate again when steroids are withdrawn. Compressive optic neuropathy should be considered in the following situations:
      • A patient who is suspected of having acute optic neuritis continues to lose vision after 2 weeks or fails to recover vision in 2-3 months.
      • Disc swelling increases or optic atrophy is not seen within 6-10 weeks in a patient who is suspected of having anterior ischemic optic neuropathy.
      • A diagnosis of posterior ischemic optic neuropathy is being considered in a patient.
    • An MRI of the optic nerves with gadolinium and fat suppression should be obtained promptly in the situations described above. Patients with incidentally discovered optic atrophy require neuroimaging studies to exclude a possible compressive lesion.

Special Concerns

  • Cavernous hemangiomas and meningiomas may enlarge during pregnancy, causing optic nerve compression.
 


More on Optic Neuropathy, Compressive

Overview: Optic Neuropathy, Compressive
Differential Diagnoses & Workup: Optic Neuropathy, Compressive
Treatment & Medication: Optic Neuropathy, Compressive
Follow-up: Optic Neuropathy, Compressive
Multimedia: Optic Neuropathy, Compressive
References
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References

  1. Lee AG, Chau FY, Golnik KC, Kardon RH, Wall M. The diagnostic yield of the evaluation for isolated unexplained optic atrophy. Ophthalmology. May 2005;112(5):757-9. [Medline].

  2. Miller NR, Newman NJ, Biousse V. Walsh and Hoyt's Clinical Neuro-Ophthalmology. 6th ed. Lippincott, Williams & Wilkins; 2004.

  3. Schiefer U, Wilhelm H, Hart, W. Neuro-ophthalmic presentations of orbital disease. In: Clinical Neuro-Ophthalmology: A Practical Guide. Wien & New York: Springer; 2007.

  4. Shields AJ, Shields CL, Scartozzi R. Survey of 1264 patients with orbital tumors and simulating lesions: the 2002 Montgomery Lecture, Part 1. Ophthalmology. 2004;111(5):997-1008. [Medline].

  5. Spoor, TC. Atlas of Oculoplastic and Orbital Surgery. Informa Healthcare; 2007.

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Further Reading

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Keywords

compressive optic neuropathy, optic neuropathies, optic neuritis, optic nerve, optic nerve compression, optic atrophy, vision loss, thyroid ophthalmopathy

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Contributor Information and Disclosures

Author

Talmadge (Ted) Cooper, MD, Adjunct Clinical Associate Professor, Department of Ophthalmology, Stanford Medical School
Talmadge (Ted) Cooper, MD is a member of the following medical societies: American Academy of Ophthalmology and American College of Medical Informatics
Disclosure: Nothing to disclose.

Medical Editor

Edsel Ing, MD, FRCSC, Assistant Professor, Department of Ophthalmology & Vision Sciences, University of Toronto, Sunnybrook and Women's Health Sciences Center, Toronto East General Hospital
Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, Canadian Medical Association, Canadian Ophthalmological Society, and North American Neuro-Ophthalmology Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Brian R Younge, MD, Professor of Ophthalmology, Mayo Clinic School of Medicine
Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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