Abstract
Optic nerve hypoplasia is the most common congenital optic disc anomaly and is a common cause of congenital blindness. The increased prevalence of this disorder reflects its greater recognition by ophthalmologists and possibly the increased incidence of alcohol and drug abuse. It may be unilateral or bilateral, and may occur with or without any associated neurological or ocular abnormalities.1
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References
Lambert SR, Hoyt CS, Narahara MH. Optic nerve hypoplasia. Surv Ophthalmol 1987;32(l):1–9.
Hotchkiss ML, Green WR. Optic nerve aplasia and hypoplasia. J Pediatr Ophthalmol Strabismus 1979;16(4):225–240.
Mosier MA, Lieberman MF, Green WR, Knox DL. Hypoplasia of the optic nerve. Arch Ophthalmol 1978;96(8):1437–1442.
Spalton DJ, Hitchings RA, Hunter PA, editors; Tan JCH, associate editor; Harry J, pathology advisor. Atlas of clinical ophthalmology. Philadelphia; Edinburgh: Elsevier Mosby; 2005.
Gardner HB, Irvine AR. Optic nerve hypoplasia with good visual acuity. Arch Ophthalmol 1972;88(3):255–258.
Petersen RA, Walton DS. Optic nerve hypoplasia with good visual acuity and visual field defects: a study of children of diabetic mothers. Arch Ophthalmol 1977;95(2):254–258.
Zeki SM. Optic nerve hypoplasia and astigmatism: a new association. Br J Ophthalmol 1990; 74(5):297–299.
Brodsky MC, Glasier CM. Optic nerve hypoplasia. Clinical significance of associated central nervous system abnormalities on magnetic resonance imaging. Arch Ophthalmol 1993;111(1): 66–74.
Hoyt WF, Kaplan SL, Grumbach MM, Glaser JS. Septo-optic dysplasia and pituitary dwarfism. Lancet 1970;1(7652):893–894.
Brodsky MC, Glasier CM, Pollock SC, Angtuago EJ. Optic nerve hypoplasia. Identification by magnetic resonance imaging. Arch Ophthalmol 1990;108(11):1562–1567.
Arslanian SA, Rothfus WE, Foley TP Jr, Becker DJ. Hormonal, metabolic, and neuroradiologic abnormalities associated with septo-optic dysplasia. Acta Endocrinol (Copenh) 1984;107(2): 282–288.
Izenberg N, Rosenblum M, Parks JS. The endocrine spectrum of septo-optic dysplasia. Clin Pediatr (Phila) 1984;23(11):632–636.
Margalith D, Tze WJ, Jan JE. Congenital optic nerve hypoplasia with hypothalamic-pituitary dysplasia. A review of 16 cases. Am J Dis Child 1985;139(4):361–366.
Novakovic P, Taylor DS, Hoyt WF. Localising patterns of optic nerve hypoplasia: retina to occipital lobe. Br J Ophthalmol 1988;72(3): 176–182.
Skarf B, Hoyt CS. Optic nerve hypoplasia in children. Association with anomalies of the endocrine and CNS. Arch Ophthalmol 1984; 102(1):62–67.
Hoyt WF. Congenital occipital hemianopia. Neuro-Ophthalmol Jpn 1985;2:252–259.
Ragge NK, Barkovich AJ, Hoyt WF, Lambert SR. Isolated congenital hemianopia caused by prenatal injury to the optic radiation. Arch Neurol 1991;48(10):1088–1091.
Taylor D. Congenital tumours of the anterior visual system with dysplasia of the optic discs. Br J Ophthalmol 1982;66(7):455–463.
Francheschetti A, Bock RH. Megalopapilla; a new congenital anomaly. Am J Ophthalmol 1950;33(2):227–235.
Jonas JB, Gusek GC, Guggenmoos-Holzmann I, Naumann GO. Size of the optic nerve scierai canal and comparison with intravital determination of optic disc dimensions. Graefes Arch Clin Exp Ophthalmol 1988;226(3):213–215.
Bynke H, Homdahl G. Megalopapilla: a differential diagnosis in suspected optic atrophy. Neuro-Ophthalmology 1971;71:423–425.
Grimson BS, Perry DD. Enlargement of the optic disk in childhood optic nerve tumors. Am J Ophthalmol 1984;97(5):627–631.
Goldhammer Y, Smith JL. Optic nerve anomalies in basal encephalocele. Arch Ophthalmol 1975;93(2):115–118.
Kim RY, Hoyt WF, Lessell S, Narahara MH. Superior segmental optic hypoplasia. A sign of maternal diabetes. Arch Ophthalmol 1989; 107(9):1312–1315.
Nelson M, Lessell S, Sadun AA. Optic nerve hypoplasia and maternal diabetes mellitus. Arch Neurol 1986;43(1):20–25.
Petersen RA, Holmes LB. Optic nerve hypoplasia in infants of diabetic mothers. Arch Ophthalmol 1986;104(11):1587.
Hoyt WF, Rios-Montenegro EN, Behrens MM, Eckelhoff RJ. Homonymous hemioptic hypoplasia. Fundoscopic features in standard and red-free illumination in three patients with congenital hemiplegia. Br J Ophthalmol 1972; 56(7):537–545.
Apple DJ, Rabb MF, Walsh PM. Congenital anomalies of the optic disc. Surv Ophthalmol 1982;27(1):3–41.
Dorrell D. The tilted disc. Br J Ophthalmol 1978;62(1):16–20.
Giuffre G. Chorioretinal degenerative changes in the tilted disc syndrome. Int Ophthalmol 1991;15(1):1–7.
Young SE, Walsh FB, Knox DL. The tilted disk syndrome. Am J Ophthalmol 1976;82(1):16–23.
Larsen WJ. Development of the eyes. In: Larsen WJ, editor. Human embryology, 2nd ed. New York: Churchill Livingstone; 1993.
Giuffre G. Hypothesis on the pathogenesis of the papillary dysversion syndrome. J Fr Ophtalmol 1985;8(8–9):565–572.
Bottoni FG, Eggink CA, Cruysberg JR, Verbeek AM. Dominant inherited tilted disc syndrome and lacquer cracks. Eye 1990;4(pt 3):504–509.
Khairallah M, Chatti T, Messaoud R, Ladjimi A, Chachia N. Peripapillary subretinal neovascularization associated with tilted disk syndrome. Retina 1996;16(5):449–451.
Prost M, De Laey JJ. Choroidal neovascularization in tilted disc syndrome. Int Ophthalmol 1988;12(2):131–135.
Stur M. Congenital tilted disk syndrome associated with parafoveal subretinal neovascularization. Am J Ophthalmol 1988;105(1):98–99.
Manor RS. Temporal field defects due to nasal tilting of discs. Ophthalmologica 1974;168(4): 269–281.
Brazitikos PD, Safran AB, Simona F, Zulauf M. Threshold perimetry in tilted disc syndrome. Arch Ophthalmol 1990;108(12):1698–1700.
Giuffre G. The spectrum of the visual field defects in the tilted disc syndrome: clinical study and review. Neuro-Ophthalmology 1986;6:239–246.
Giuffre G, Anastasi M. Electrofunctional features of the tilted disc syndrome. Doc Ophthalmol 1986;62(3):223–230.
De Rouck A, Kayembe D, De Laey JJ, Lentini F, De Sutter E. Clinical and electrophysiological manifestations of the tilted disk syndrome. Bull Soc Belge Ophtalmol 1981;193:147–159.
Toussaint P, Turut P, Milazzo S, Le Bihan S, Bego B. Aspects of the tilted disk syndrome. Bull Soc Ophtalmol Fr 1989;89(2):267–268, 271-2.
Hatten ME, Mason CA. Mechanisms of glialguided neuronal migration in vitro and in vivo. Experientia (Basel) 1990;46(9):907–916.
Keane JR. Suprasellar tumors and incidental optic disc anomalies. Diagnostic problems in two patients with hemianopic temporal scotomas. Arch Ophthalmol 1977;95(12): 2180–2183.
Pollock S. The morning glory disc anomaly: contractile movement, classification, and embryogenesis. Doc Ophthalmol 1987;65(4):439–460.
Beyer WB, Quencer RM, Osher RH. Morning glory syndrome. A functional analysis including fluorescein angiography, ultrasonography, and computerized tomography. Ophthalmology 1982;89(12):1362–1367.
Haik BG, Greenstein SH, Smith ME, Abramson DH, Ellsworth RM. Retinal detachment in the morning glory anomaly. Ophthalmology 1984; 91(12):1638–1647.
Steinkuller PG. The morning glory disk anomaly: case report and literature review. J Pediatr Ophthalmol Strabismus 1980;17(2):81–87.
Graether JM. Transient amaurosis in one eye with simultaneous dilatation of retinal veins in association with a congenital anomaly. Arch Ophthalmol 1963;70:342–345.
Caprioli J, Lesser RL. Basal encephalocele and morning glory syndrome. Br J Ophthalmol 1983;67(6):349–351.
Hope-Ross M, Johnston SS. The Morning Glory syndrome associated with sphenoethmoidal encephalocele. Ophthalmic Paediatr Genet 1990;11(2):147–153.
Koenig SB, Naidich TP, Lissner G. The morning glory syndrome associated with sphenoidal encephalocele. Ophthalmology 1982;89(12): 1368–1373.
Eustis HS, Sanders MR, Zimmerman T. Morning glory syndrome in children. Association with endocrine and central nervous system anomalies. Arch Ophthalmol 1994;112(2):204–207.
Yokota A, Matsukado Y, Fuwa I, Moroki K, Nagahiro S. Anterior basal encephalocele of the neonatal and infantile period. Neurosurgery 1986;19(3):468–478.
Hansen MR, Price RL, Rothner AD, Tomsak RL. Developmental anomalies of the optic disc and carotid circulation: a new association. J Clin Neuro-Ophthalmol 1985;5:3–8.
Massaro M, Thorarensen O, Liu GT, Maguire AM, Zimmerman RA, Brodsky MC. Morning glory disc anomaly and moyamoya vessels. Arch Ophthalmol 1998;116(2):253–254.
Metry DW, Dowd CF, Barkovich AJ, Frieden IJ. The many faces of PHACE syndrome. J Pediatr 2001;139(1):117–123.
Francois J. Colobomatous malformations of the ocular globe. Int Ophthalmol Clin 1968;8(4): 797–816.
Font RL, Zimmerman LE. Intrascleral smooth muscle in coloboma of the optic disk. Electron microscopic verification. Am J Ophthalmol 1971;72(2):452–457.
Foster JA, Lam S. Contractile optic disc coloboma. Arch Ophthalmol 1991;109(4):472–473.
Willis R, Zimmerman LE, O’ Grady R, et al. Heterotopic adipose tissue and smooth muscle in the optic disc, association with isolated colobomas. Arch Ophthalmol 1972;88:139–146.
Lin CC, Tso MO, Vygantas CM. Coloboma of optic nerve associated with serous maculopathy. A clinicopathologic correlative study. Arch Ophthalmol 1984;102(11):1651–1654.
Schatz H. Central serous chorioretinopathy: the etiology of sequelae. Ophthalmology 1988;95(7):1007–1008.
Chestler RJ, France TD. Ocular findings in CHARGE syndrome. Six case reports and a review. Ophthalmology 1988;95(12):1613–1619.
Russell-Eggitt IM, Blake KD, Taylor DS, Wyse RK. The eye in the CHARGE association. Br J Ophthalmol 1990;74(7):421–426.
Pagon RA. Ocular coloboma. Surv Ophthalmol 1981;25(4):223–236.
Carney SH, Brodsky MC, Good WV, Glasier CM, Greibel ML, Cunniff C. Aicardi syndrome: more than meets the eye. Surv Ophthalmol 1993;37(6):419–424.
Hoyt CS, Billson F, Ouvrier R, Wise G. Ocular features of Aicardi’s syndrome. Arch Ophthalmol 1978;96(2):291–295.
Limaye SR. Coloboma of the iris and choroid and retinal detachment in oculo-auricular dysplasia (Goldenhar syndrome). Eye Ear Nose Throat Mon 1972;51(10):384–386.
Villalonga Gornes PA, Galan Terraza A, Gil-Gibernau JJ. Ophthalmoscopic evolution of papillary colobomatous malformations. J Pediatr Ophthalmol Strabismus 1995;32(1): 20–25.
Jacobs M, Taylor D. The systemic and genetic significance of congenital optic disc anomalies. Eye 1991;5(pt 4):470–475.
Brown G, Tasman W. Congenital anomalies of the optic disc. New York: Grune & Stratton; 1983.
Kranenburg EW. Crater-like holes in the optic disc and central serous retinopathy. Arch Ophthalmol 1960;64:912–924.
Brown GC, Shields JA, Goldberg RE. Congenital pits of the optic nerve head. II. Clinical studies in humans. Ophthalmology 1980;87(1): 51–65.
Sobol WM, Blodi CF, Folk JC, Weingeist TA. Long-term visual outcome in patients with optic nerve pit and serous retinal detachment of the macula. Ophthalmology 1990;97(11): 1539–1542.
Gass JD. Serous detachment of the macula. Secondary to congenital pit of the optic nerve head. Am J Ophthalmol 1969;67(6):821–841.
Theodossiadis GP, Kollia AK, Theodossiadis PG. Cilioretinal arteries in conjunction with a pit of the optic disc. Ophthalmologica 1992; 204(3):115–121.
Parsa CF, Silva ED, Sundin OH, et al. Redefining papillorenal syndrome: an underdiagnosed cause of ocular and renal morbidity. Ophthalmology 2001;108(4):738–749.
Schimmenti LA, Cunliffe HE, McNoe LA, et al. Further delineation of renal-coloboma syndrome in patients with extreme variability of phenotype and identical PAX2 mutations. Am J Hum Genet 1997;60(4):869–878.
Parsa CF, Goldberg MF, Hunter DG. Papillorenal (“renal coloboma”) syndrome. Am J Ophthalmol 2002;134(2):300–301.
Kiegler HR. Comparison of functional findings with results of standardized echography of the optic nerve in optic disk drusen. Wien Klin Wochenschr 1995;107(21):651–653.
Giarelli L, Ravalico G, Saviano S, Grandi A. Optic nerve head drusen: histopathological considerations—clinicalfeatures. Metab Pediatr Syst Ophthalmol 1990;13(2–4):88–91.
Lorentzen SE. Drusen of the optic disk, an irregularly dominant hereditary affection. Acta Ophthalmol (Copenh) 1961;39:626–643.
Boldt HC, Byrne SF, DiBernardo C. Echographic evaluation of optic disc drusen. J Clin Neuro-Ophthalmol 1991;11(2):85–91.
Friedman AH, Gartner S, Modi SS. Drusen of the optic disc. A retrospective study in cadaver eyes. Br J Ophthalmol 1975;59(8):413–421.
Lansche RK, Rucker CW. Progression of defects in visual fields produced by hyaline bodies in optic disks. AMA Arch Ophthalmol 1957;58(1): 115–121.
Spencer WH. XXXIV Edward Jackson Memorial Lecture: Drusen of the optic disc and aberrant axoplasmic transport. Ophthalmology 1978;85(1):21–38.
Tso MO. Pathology and pathogenesis of drusen of the optic nerve head. Ophthalmology 1981; 88(10):1066–1080.
Friedman AH, Henkind P, Gartner S. Drusen of the optic disc. A histopathological study. Trans Ophthalmol Soc U K 1975;95(1):4–9.
Friedman AH, Beckerman B, Gold DH, Walsh JB, Gartner S. Drusen of the optic disc. Surv Ophthalmol 1977;21(5):373–390.
Boyce SW, Platia EV, Green WR. Drusen of the optic nerve head. Ann Ophthalmol 1978;10(6): 695–704.
Seitz R. The intraocular drusen. Klin Monatsbl Augenheilkd 1968;152(2):203–211.
Sarkies NJ, Sanders MD. Optic disc drusen and episodic visualloss. BrJ Ophthalmol 1987;71(7): 537–539.
Beck RW, Corbett JJ, Thompson HS, Sergott RC. Decreased visual acuity from optic disc drusen. Arch Ophthalmol 1985;103(8): 1155–1159.
Knight CL, Hoyt WF. Monocular blindness from drusen of the optic disk. Am J Ophthalmol 1972;73(6):890–892.
Vicary DL, Swann PG. Relative afferent pupil defect associated with optic disc drusen. Aust N Z J Ophthalmol 1991;19(3):245–248.
Pietruschka G, Priess G. Clinical importance and prognosis of drusen of the disc. Klin Monatsbl Augenheilkd 1973;162(3):331–341.
Hoover DL, Robb RM, Petersen RA. Optic disc drusen and primary megalencephaly in children. J Pediatr Ophthalmol Strabismus 1989;26(2):81–85.
Savino PJ, Glaser JS, Rosenberg MA. A clinical analysis of pseudopapilledema. II. Visual field defects. Arch Ophthalmol 1979;97(1):71–75.
Mustonen E. Pseudopapilloedema with and without verified optic disc drusen. A clinical analysis II: visual fields. Acta Ophthalmol (Copenh) 1983;61(6):1057–1066.
Lorentzen SE. Drusen of the optic disk. A clinical and genetic study. Acta Ophthalmol (Copenh) 1966;90(suppl):1–180.
Erkkila H. Optic disc drusen in children. Acta Ophthalmol Suppl 1977;129:3–44.
Okun E. Chronic papilledema simulating hyaline bodies of the optic disc. A case report. Am J Ophthalmol 1962;53:922–927.
Sibony PA, Kennerdell JS, Slamovits TL, Lessell S, Krauss HR. Intrapapillary refractile bodies in optic nerve sheath meningioma. Arch Ophthalmol 1985;103(3):383–385.
Kurz-Levin MM, Landau K. A comparison of imaging techniques for diagnosing drusen of the optic nerve head. Arch Ophthalmol 1999; 117(8):1045–1049.
Roh S, Noecker RJ, Schuman JS, Hedges TR III, Weiter JJ, Mattox C. Effect of optic nerve head drusen on nerve fiber layer thickness. Ophthalmology 1998;105(5):878–885.
Scholl GB, Song HS, Winkler DE, Wray SH. The pattern visual evoked potential and pattern electroretinogram in drusen-associated optic neuropathy. Arch Ophthalmol 1992;110(1): 75–81.
Stevens RA, Newman NM. Abnormal visualevoked potentials from eyes with optic nerve head drusen. Am J Ophthalmol 1981;92(6): 857–862.
Vieregge P, Rosengart A, Mehdorn E, Wessel K, Kompf D. Drusen papilla with vision disorder and pathologic visual evoked potentials. Nervenarzt 1990;61(6):364–368.
Erkkila H. Clinical appearance of optic disc drusen in childhood. Albrecht Von Graefes Arch Klin Exp Ophthalmol 1975;193(1):1–18.
Lorentzen SE. Incidence of cilioretinal arteries. Acta Ophthalmol (Copenh) 1970;48(3): 518–524.
Erkkila H. The central vascular pattern of the eye ground in children with drusen of the optic disk. Albrecht Von Graefes Arch Klin Exp Ophthalmol 1976;199(1):1–10.
Masyama Y, Kodama Y, Matsumara Y, et al. Clinical studies on the occurrence and the pathogenesis of optociliary veins. J Clin NeuroOphthalmol 1990;10:1–8.
Karel I, Otradovec J, Peleska M. Fluorescence angiography in circulatory disturbances in drusen of the optic disk. Ophthalmologica 1972;164(6):449–462.
Frohlich SJ, Ulbig MW, Klauss V. Sudden loss of vision without previous symptoms. 58-yearold patient with sudden and painless loss of vision of the right eye. Ophthalmologe 1999; 96(2):120–121.
Jonas JB, Gusek GC, Guggenmoos-Holzmann I, Naumann GO. Optic nerve head drusen associated with abnormally small optic discs. Int Ophthalmol 1987;11(2):79–82.
Brown GC, Magargal LE, Shields JA, Goldberg RE, Walsh PN. Retinal arterial obstruction in children and young adults. Ophthalmology 1981;88(1):18–25.
Newman NJ, Lessell S, Brandt EM. Bilateral central retinal artery occlusions, disk drusen, and migraine. Am J Ophthalmol 1989;107(3): 236–240.
Newsom RS, Trew DR, Leonard TJ. Bilateral buried optic nerve drusen presenting with central retinal artery occlusion at high altitude. Eye 1995;9(pt 6):806–808.
Saudax E, Martin-Beuzart S, Lesure P, George JL. Submacular neovascular membrane and drusen of the optic disk. J Fr Ophthalmol 1990;13(4):219–222.
Harris MJ, Fine SL, Owens SL. Hemorrhagic complications of optic nerve drusen. Am J Ophthalmol 1981;92(1):70–76.
Brodrick JD. Drusen of the disc and retinal haemorrhages. Br J Ophthalmol 1973;57(5): 299–306.
van den Born LI, van Soest S, van Schooneveld MJ, Riemslag FC, de Jong PT, Bleeker-Wagemakers EM. Autosomal recessive retinitis pigmentosa with preserved para-arteriolar retinal pigment epithelium. Am J Ophthalmol 1994; 118(4):430–439.
Grover S, Fishman GA, Brown J Jr. Frequency of optic disc or parapapillary nerve fiber layer drusen in retinitis pigmentosa. Ophthalmology 1997;104(2):295–298.
Bouchet GC, Chabot J. Fluorographic diagnosis of papillary pseudo-edema related to the presence of hyalin verrucosity of the papilla. Bull Soc Ophtalmol Fr 1970;70(11):1121–1131.
Goodman RM, Smith EW, Paton D, et al. Pseudoxanthoma elasticum: a clinical and histopathological study. Medicine (Baltim) 1963;42: 297–334.
Pierro L, Brancato R, Minicucci M, Pece A. Echographic diagnosis of drusen of the optic nerve head in patients with angioid streaks. Ophthalmologica 1994;208(5):239–242.
Samples JR, van Buskirk M, Shults WT, Van Dyk HJ. Optic nerve head drusen and glaucoma. Arch Ophthalmol 1985;103(11):1678–1680.
Jiraskova N, Rozsival P. Results of 62 optic nerve sheath decompressions. Cesk Slov Oftalmol 1999;55(3):136–144.
Francois J. Pre-papillary cyst developed from remnants of the hyaloid artery. Br J Ophthalmol 1950;34(6):365–368.
Gieser DK, Goldberg MF, Apple DJ, Hamming NA, Kottow MH. Persistent hyperplastic primary vitreous in an adult: case report with fluorescein angiographic findings. J Pediatr Ophthalmol Strabismus 1978;15(4):213–218.
Hamming NA, Apple DJ, Gieser DK, Vygantas CM. Ultrastructure of the hyaloid vasculature in primates. Invest Ophthalmol Vis Sci 1977; 16(5):408–415.
Straatsma BR, Heckenlively JR, Foos RY, Shahinian JK. Myelinated retinal nerve fibers associated with ipsilateral myopia, amblyopia, and strabismus. Am J Ophthalmol 1979;88(3 pt 1): 506–510.
Magoon EH, Robb RM. Development of myelin in human optic nerve and tract. A light and electron microscopic study. Arch Ophthalmol 1981;99(4):655–659.
De Jong PTVM, Bistervels B, Cosgrove J, et al. Medullated nerve fibers: a sign of multiple basal cell nevi (Gorlin’s) syndrome. Arch Ophthalmol 1985;103:1833–1836.
Kronish JW, Tse DT. Basal cell nevus syndrome. In: Gold DH, Weingeist TA, editors. The eye in systemic disease. Philadelphia: Lippincott; 1990.
Traboulsi EI, Lim JI, Pyeritz R, Goldberg HK, Haller JA. A new syndrome of myelinated nerve fibers, vitreoretinopathy, and skeletal malformations. Arch Ophthalmol 1993;111(11):1543–1545.
Brodsky MC, Buckley EG, McConkie-Rosell A. The case of the gray optic disc! Surv Ophthalmol 1989;33(5):367–372.
Taylor D. Optic nerve. In: Pediatrie ophthalmology. Cambridge: Blackwell; 1990.
Halbertsma KTA. Pseudoatrophy of the optic nerve in infant 2 months old. Ned Tijdschr Geneeskd 1937;81:1230–1236.
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Chan, J.W. (2007). Congenital Disc Anomalies. In: Optic Nerve Disorders. Springer, New York, NY. https://doi.org/10.1007/978-0-387-68979-1_8
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