Optic Neuropathy

  • Larissa K. Ghadiali
  • Jeffrey G. OdelEmail author


Optic neuropathy, or damage to the optic nerve, is diagnosed by characteristic visual field loss, color vision deficit, decreased brightness sense, afferent pupillary defect, nerve fiber layer dropout, optic nerve pallor, or optic nerve swelling. Optical coherence tomography (OCT) can demonstrate optic neuropathy by exhibiting decreased nerve fiber layer thickness, ganglion cell layer complex loss, or nerve fiber layer swelling. OCT can also show normal outer retinal structure and thereby aid in localizing the problem to the optic nerve. Visual field loss in optic neuropathy reflects the nerve fiber course thru the retina. Cecocentral visual field loss, as seen in nutritional optic neuropathy, autosomal dominant optic neuropathy, ethambutol toxicity, and optic neuritis, reflects damage to the so-called papillomacular bundle and is accompanied by decreased color vision (as measured by color plates, e.g., AO/HRR color plates) and decreased central acuity. In optic neuropathy accompanied by cecocentral visual field loss, color vision loss is markedly decreased compared to visual acuity.


Optic neuropathy Acute unilateral optic neuropathy Chronic progressive unilateral optic neuropathy Sequential optic neuropathy Optic neuritis Multiple sclerosis and optic neuropathy Non-arteritic ischemic optic neuropathy 

Suggested Reading

  1. Arnold AC. Evolving management of optic neuritis and multiple sclerosis. Am J Ophthalmol. 2005;139(6):1101–8.CrossRefGoogle Scholar
  2. Biousse V, Newman NJ. Ischemic optic neuropathies. N Engl J Med. 2015;372(25):2428–36.CrossRefGoogle Scholar
  3. Chamberlain PD, Sadaka A, Berry S, Lee AG. Ethambutol optic neuropathy. Curr Opin Ophthalmol. 2017;28(6):545–51.CrossRefGoogle Scholar
  4. Eddleman CS, Liu JK. Optic nerve sheath meningioma: current diagnosis and treatment. Neurosurg Focus. 2007;23(5):E4.CrossRefGoogle Scholar
  5. Hayreh SS. Ischemic optic neuropathies. New York: Springer; 2011. 456pCrossRefGoogle Scholar
  6. Hayreh SS, Zimmerman B. Management of giant cell arteritis. Our 27-year clinical study: new light on old controversies. Ophthalmologica. 2003;217(4):239–59.CrossRefGoogle Scholar
  7. Kawasaki A, Purvin V. Giant cell arteritis: an updated review. Acta Ophthalmol. 2009;87(1):13–32.CrossRefGoogle Scholar
  8. Lam BL, Morais CG Jr, Pasol J. Drusen of the optic disc. Curr Neurol Neurosci Rep. 2008;8(5):404–8.CrossRefGoogle Scholar
  9. Lessell S. Nutritional amblyopia. J Neuroophthalmol. 1998;18(2):106–11.CrossRefGoogle Scholar
  10. Miller NR, Arnold AC. Current concepts in the diagnosis, pathogenesis and management of nonarteritic anterior ischaemic optic neuropathy. Eye (Lond). 2015;29(1):65–79.CrossRefGoogle Scholar
  11. Miller NR, Subramanian P, Patel V. Walsh & Hoyt’s clinical neuro-ophthalmology: the essentials. 3rd ed. Philadelphia: Lippincott Williams & Williams; 2015. 600pGoogle Scholar
  12. Purvin V, Kawasaki A. Common neuro-ophthalmic pitfalls: case-based teaching. New York: Cambridge University Press; 2009. 234pCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of OphthalmologyLoyola University Medical CenterMaywoodUSA
  2. 2.Columbia University Irving Medical CenterNew YorkUSA
  3. 3.Department of Ophthalmology, Edward S. Harkness Eye InstituteColumbia University Vagelos College of Physicians and SurgeonsNew YorkUSA

Personalised recommendations