CUPPED OPTIC NERVE

CUPPED OPTIC NERVE

 

Cupped optic nerve is a consequence of many disorders, and rarely may be because of physiological changes that have no unwanted consequence.

Cupping of optic nerve can be seen with many neurological disorders, or even benign tumors, all of which are easily treatable.

Patient history, tests about visual field, and fundoscopic examinations help doctors to diagnose your condition.

In this article we will go through the causes of cupped optic nerve, which are as follows:

 

Ocular hypertension.

Glaucoma.

Optic neuropathy.

Pituitary adenoma.

Physiological cupping.

Other than the causes, we will talk about:

When to see a doctor.

Treatment.

Takeaway.

 

 

OCULAR HYPERTENSION

The pressure which is present inside your eye is known as intraocular pressure.

Ocular hypertension is a term used in cases where this normal intraocular pressure is higher than just normal.

We measure the normal eye pressure in mmHg, which is in between 10-21 mmHg. Whenever intraocular pressure of your eyes goes beyond 21 mmHg, it is known as ocular hypertension.

Even though optic nerve in normal ocular hypertension is normal, but in case this hypertension increases and you have cupped optic nerve, condition will be known as glaucoma. Having ocular hypertension puts you at severe risk of having glaucoma.

 

GLAUCOMA

Glaucoma is a group that consists of different eye diseases that result in the damage of the optic nerve, which is essential for good vision.

This damage is usually caused by abnormally high pressure in your eye.

It is one of the leading causes of irreversible blindness in people ages more than 60 years. Even though it can be seen in any age, but more commonly glaucoma is seen in older people.

There are no warning signs in many of the forms of glaucoma. The effects are so gradual that you may not notice any change in vision until the disease is advanced.

Glaucoma can either be open-angled, or closed-angled. Symptoms of these two types are different from each other, but cupped optic nerve is seen in both of them.

Symptoms of open-angled glaucoma:

  • Blind spots (areas where you cannot see anything; area that appears black) in central or peripheral vision. This can occur in one eye only (unilateral), or in both the eyes (bilateral) which is usually the case.
  • In advanced stages of this type of glaucoma, you may experience tunnel vision.

Symptoms of closed-angle glaucoma:

  • Headache that is often severe.
  • Pain in the eye(s).
  • Vomiting and nausea.
  • Blurred vision.
  • Light halos.
  • Redness of the eyes.

You might be at a risk of suffering from glaucoma if your have a high intraocular pressure (internal eye pressure), if you are above 60 years of age, if you have someone in your family who has glaucoma, if you have some underlying medical conditions (like diabetes, diseases related to heart, sickle cell anemia, or high blood pressure), if you have myopia (near-sightedness) or hypermetropia (far-sightedness) that is severe, if you have had an eye surgery, or if you have been taking steroid medication for a long time (especially in the form of eyedrops).

Never miss the opportunity to check with a doctor in case you see any symptoms, especially if you are at high risk of having glaucoma as it, eventually, will cause blindness if left untreated.

 

OPTIC NEUROPATHY

It is a group of different conditions where optic nerve is damaged and no longer works properly. It happens because of disruption of blood supply to the optic nerve, which might be because of an injury to the nerve in an acute way (condition known as traumatic optic neuropathy).

Ischemic optic neuropathy:

or more commonly seen as anterior ischemic optic neuropathy is a condition where blood supply to optic nerve is blocked. Anterior ischemic optic neuropathy is a symptom of another condition known as giant cell arteritis (where arteries are inflamed to an extend that they no longer let the blood to pass).

Cupped optic nerve is a classic sign of this condition, with a normal intraocular pressure. Those who have this condition suffer from acute vision loss.

There are some other optic neuropathies that cause cupped optic nerve including hereditary optic neuropathy (Leber hereditary optic neuropathy, and dominant optic atrophy). To diagnose this type of optic neuropathy it is seen that people have usually someone in the family who has the same condition, and these people lose their vision gradually (not acutely).

Symptoms of optic neuropathy are:

  • Flickering lights.
  • Less contrasted or less vivid colors (than they normally appear).
  • Vision loss.
  • Pain in eye or around eye, and in the face.

 

PITUITARY ADENOMA

Pituitary adenomas are small, non-malignant (benign), outgrowths present in your pituitary gland. Some tumors among them cause more than normal hormones to be produced, and some cause the opposite of it- too less hormones to be made.

There have been many cases where pituitary adenomas have been found incidentally in imaging tests like CT or MRI performed some completely different cause, where no symptoms are felt by the patient.

But, if the adenomas begin to produce hormone, or cause pituitary to produce too less of it, patient may be symptomatic.

Symptoms of pituitary adenomas causing hormone production depend on what kind of hormone is made, and may include:

  • ACTH (adrenocorticotropic hormone) hormone: upper back and abdominal fattening, round face- known as “moon face”, muscle weakness in arms and legs, and muscles begin to look thinner, high blood pressure, high blood sugar, acne, weak bones, easy bruises, irritability. Too much
  • Growth hormone (GH): enlarged hands, enlarged feet, excessive sweating, high blood sugar, problems related to heart, joint pain, body hair increased.
  • Prolactin: irregular menstrual or monthly cycles, no menstrual periods, discharge from breasts, erectile dysfunction, decreased libido, breast growth.
  • Thyroid stimulating hormone: weight loss, irregular or rapid heartbeat, irritability, bowel movement changes (frequent), excessive sweating.

Symptoms when too less hormones are produced:

  • Nausea and vomiting.
  • Weakness.
  • Cold.
  • No or decreased menstrual periods.
  • Sexual dysfunction.
  • Increased urination.
  • Weight gain or loss with no apparent reason.

Generally, pituitary adenomas may have below mentioned symptoms:

  • Headache.
  • Vision problem.
  • Weight gain.
  • Cupped optic nerve.

 

PHYSIOLOGICAL OPTIC CUPPING

There can also be a chance of having a cupped optic nerve, without any visual field defects, and there is no abnormally high intraocular pressure.

Physiological cupping is a congenital cupping disorder of the eye, which is caused by the optic nerve canal and pronounced glial atrophy of the papilla of Bergmeister.

GODC is a type of ascending atrophy of the optic nerve associated with the loss of cell axons of the retinal ganglion.

 

WHEN TO SEE A DOCTOR

Any symptoms seen related to vision must be checked with doctor.

As cupped optic nerve occurs because of a number of pathologic causes, it may result in irreversible blindness.

Symptoms to be taken seriously:

  • Headache that is often severe.
  • Pain in the eye(s).
  • Vomiting and nausea.
  • Blurred vision.
  • Light halos.
  • Redness of the eyes.
  • Flickering lights.
  • Less contrasted or less vivid colors (than they normally appear).
  • Vision loss.
  • Pain in eye or around eye, and in the face.
  • Nausea and vomiting.
  • Weakness.
  • Cold.
  • No or decreased menstrual periods.
  • Sexual dysfunction.
  • Increased urination.
  • Weight gain or loss with no apparent reason.

If you are at higher risk of getting glaucoma, which is the most common cause of cupped optic nerve, always get your checked even if no symptoms are seen.

Risk factor for glaucoma are:

having a high intraocular pressure (internal eye pressure), if you are above 60 years of age, if you have someone in your family who has glaucoma, if you have some underlying medical conditions (like diabetes, diseases related to heart, sickle cell anemia, or high blood pressure), if you have myopia (near-sightedness) or hypermetropia (far-sightedness) that is severe, if you have had an eye surgery, or if you have been taking steroid medication for a long time (especially in the form of eyedrops).

 

TREATMENT

Treatment is done on the basis of diagnosis.

For glaucoma, things cannot be reversed, but your doctors will give your medicines or ask you to go through surgery to prevent things from further worsening up.

Treatment plans include eyedrops which can be prostaglandins, beta-blockers, alpha adrenergic agonists, carbonic anhydrase inhibitors, cholinergic agents.

Some side effects might be noticed as these drops are absorbed by blood.

If eye drops do not bring your intraocular pressure down, your doctors will prescribe oral medicines, which is carbonic anhydrase inhibitor. Side effects might include tingling, depression, upset stomach, kidney stones, or frequently going to washroom (excessive urination).

To lower the pressure, if eyedrops or oral medicines do not work, surgery or laser therapy may be the only option.

For pituitary adenomas, medications, surgery, or radiation is used. Sometimes, it is important for the doctor to make you undergo all three of them in combination.

 

TAKEWAY

Cupped optic nerve is a serious sign which should never be ignored as it may be cause irreversible blindness.

In case you see any symptom related to your vision, sudden headaches, painful eyes or face, flashing lights, blind spots in vision, you should immediately seek medical help.

Based on your diagnosis, your doctor will start the treatment. Even though treatment doesn’t always cause your vision to come back, but it will ensure your symptoms no longer progress or worsen.

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