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Part V: Optic Atrophy

Atrophy of the optic disk which may be congenital or acquired. This condition indicates a deficiency in the number of nerve fibers which arise in the RETINA and converge to form the OPTIC DISK, OPTIC NERVE, OPTIC CHIASM, and optic tracts. GLAUCOMA, ISCHEMIA, inflammation, a chronic elevation of intracranial pressure, toxins, optic nerve compression, and inherited conditions (see OPTIC ATROPHIES, HEREDITARY) are relatively common causes of this condition.

1. Special Features
   1. Atrophy with optocilliary veins
   2. atrophy with focally narrowed retinal arterioles
      1. Post ischemic (AION) cupless atrophy
      2. Post radiation papillopathy
   3. Atrophy with diffuse narrowed retinal arterioles
   1. Old central retinal artery occlusion with and without additional retinovascolar signs
   2. Retinal pigmentary degeneration (sine pigmentosa)
   3. Quinine toxicity
   4. Atrophy with arteriolar sheathing, gliosis and pseudodrusen
   5. Atrophy with peripapillary microangiopathy
   6. Atrophy with cupping
      1. Low tension glaucoma, and glaucoma with wedge and sector defects in the RNFL
      2. Temporal cupping with dominant hereditary optic atrophy
      3. Post giant cell arteritis ischemic papillopathy (See section on Ischemic Papillopathies - Disc Swelling)
      4. Atrophy with congenital anomalies
2. Retrobulbar causes
   1. Severe atrophy
      1. Diffuse atrophy
      2. Segmental atrophy
         1. Temporal atrophy
         2. Altitudinal atrophy
         3. Hemianopic (band) atrophy; optic tract atrophy
   2. Incipient atrophy
      1. Normal peripapillary nerve fiber layer
      2. M.S. slits and thinning in the peripapillary nerve fiber layer
3. Incipient Optic Atrophy in Ocular Hypertension