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    Optic Nerve

    Uploaded by

    Patrick

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Optic Nerve

    Uploaded by

    Patrick
    2 views13 pages

    Original Title

    Optic nerve

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    Copyright:

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    Download as pptx, pdf, or txt
    2 views13 pages

    Optic Nerve

    Uploaded by

    Patrick

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 13

    Definition

    • Optic nerve head (ONH) is the distal


    portion of the optic nerve (ON) →
    extends from the retinal surface to the
    myelinated portion of the ON that begins
    just behind the sclera.
    • Composed of the nerve fibers which
    originate in the ganglion cell layer of the
    retina and converge upon the nerve head.
    Morphology of Normal ONH
    Disc : vertically oval
    Disc divided in 3 groups : (wide variation in size)
    - Small disc : < 1,50 mm
    - Medium disc : 1,50-2,00 mm
    - Large disc : > 2.00 mm
    Cup : horizontally oval, symmetrical in 2 eyes
    Cup represents partial or complete absence of
    axons
    Small Discs with Small Cups & Healthy
    NRR
    Physiologic Cup
    • Symmetrical in both eyes
    • Similar in parents and siblings
    • Genetically determined
    • C/D > 0,7 : smaller percentage of population
    • C/D difference of > 0,2 : 1 % normal population
    Methods for examining the optic disc
    Methods Advantages Disadvantages
    Direct Ophthalmoscopy High magnification Not stereoscopic
    Portable
    Available

    Indirect Ophthalmoscopy Stereoscopic Low magnification


    Diffuse ilumination

    Slitlamp technique:
    1. 90 D and 78 D Convenient Virtual, inverted image
    Good stereopsis Air-cornea interface

    2. Hruby lens Good stereopsis Air-cornea interface


    Requires cooperative
    patient

    Stereoscopic fundus Stereoscopic Subjective


    photograph Dilated pupil

    Imaging: Objective Need clear media


    OCT, HRT, GDxVCC Reproducible
    Five rules for assessment of the
    optic disc in glaucoma (the 5Rs)
    1. Observe the scleral Ring to
    identify the limits and size
    of the optic disc
    2. Identify the size of the Rim
    3. Examine the Retinal nerve
    fibre layer
    4. Examine the Region of
    peripapillary atrophy
    5. Look for Retinal and optic
    disc haemorrhages
    Disc Asymmetry
    This include asymmetry in :
    • Size of the cup
    • Width of NRR
    • Vessel course
    • Peripapillary atrophy
    Vertical Enlargement of Cup
    • Vertical C/D > horizontal C/D
    • Loss of axons occurs >> in sup & inf regions
    • This causes thinning of NRR at vertical poles resulting
    enlargement of the cup in vertical direction.
    The scleral ring

    Rim Width = distance


    between the scleral ring
    and location where the
    vessel is bent (cup
    border)
    The scleral ring

    Rim Width = distance


    between the scleral ring
    and location where the
    vessel is bent (cup
    border)
    Optic disc size
    Optic disc size
    Optic disc size

    Be cautious
    with myopic
    discs

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