Optic Atrophy Differential Diagnoses

Updated: Apr 01, 2019
  • Author: Rashmin Gandhi, MBBS, FRCS(Edin), FRCS(Glasg); Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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DDx

Diagnostic Considerations

Table 1. Various Common Groups of Disorders Presenting with Optic Atrophy (Open Table in a new window)

 

 

Postneuritis

Ischemic

Arteritic

Ischemic

Nonarteritic

Compressive

Age

15-50 y

Approximately 70 y

Sixth decade

Varies based on cause

Sex

Multiple sclerosis F>M

F>M

F=M

Varies based on cause

Visual acuity

Varies from mild blurring (34%) and moderate loss of acuity (12%) to severe or total loss of light perception (complete blindness) in 54% of cases, to no light perception. The loss of vision is acute and progressive.--Vision usually recovers within 2 mo

< 20/200 (6/60)

>20/200 (6/60)

Varies from mild blurring to no light perception

Color vision

Color vision > vision loss

Color vision loss = vision loss

Color vision loss = vision loss

Color vision = vision loss

RAPD*

+

+

+

+

Motility

Painful movement in cases of retrobulbar neuritis

Normal

Normal

Depends on the site of compression

Nystagmus

In multiple sclerosis, vertical nystagmus (upbeating or downbeating) may be seen

No

No

See-saw nystagmus in optic chiasm compression

Optic disc

Temporal pallor

Pallid disc edema

Segmental disc edema

Bow-tie pallor seen in optic chiasm compression; varies in other instances

 

Electrophysiologic study

VEP-increased latency < †>

VEP-reduced amplitude

VEP-reduced amplitude

Reduced VEP amplitude

Neuroimaging

(CT, MRI)

In multiple sclerosis, hyperechoic lesions are seen in the brain on MRI

-

-

For exact location of compression

Other associations

 

Headache, scalp tenderness, jaw claudication

 

Hypertension and diabetes

Headache, vomiting, and focal neurologic deficits

*RAPD - Relative afferent pupil defect

< †>VEP - Visual-evoked potential

Differential Diagnoses

  • Axial myopia

  • Brighter-than-normal luminosity

  • Myelinated nerve fibers

  • Optic disc drusen

  • Optic nerve hypoplasia

  • Optic nerve pit

  • Scleral crescent

  • Tilted disc