22. VASCULAR
SUPPLY TO THE
GLOBE AND DISC
TWO MAJOR SOURCES by
way of the ophthalmic
artery+
•Posterior Ciliary arteries
•Central retinal artery
23. BLOOD SUPPLY TO THE DISC
is from the posterior ciliary arteries
The posterior ciliary
arteries supply the disc,
the choroid and the
retinal pigment epithelium
24. BLOOD SUPPLY TO THE
DISC
The central retinal artery
supplies the retina
25. CILIORETINAL
ARTERY
• Present in about
32% of patients
• Enters separate
from the CRA
• Occlusion with
swollen nerve =
Temporal arteritis
• Spared in CRAO
26. Tasman and Brown, Congenital Anomalies of
The optic disc. 1983; 82
straight
Hook from disc
Hook edge disc margin
Hook from juxtapapillary region
27. DISCS THAT ARE ONLY CILIORETINAL ARTERIES?
Barroso LH, Hoyt WF, Narahara M. Can the arterial supply of the retina in man be exclusively
cilioretinal? J Neuroophthalmol. 1994 Jun;14(2):87-90.
WHAT SYSTEMIC ANOMALY SHOULD YOU LOOK FOR?
A: Renal dysplasia: Papillo-renal syndrome
32. PAPILLEDEMA
FEATURES OF TRUE
SWELLING
• Hyperemia
• Swelling of nerve fibers
• Elevation disc margin
• Maintenance of cup if
present
• Loss of venous pulse
INCIDENTAL FINDINGS
• Hemorrhages
• Retinal folds
• Nerve Fiber Layer infarcts
33. FEATURES DISTINGUISH TRUE PAPILLEDEMA
FROM PSEUDOPAPILLEDMA
PAPILLEDEMA
• Physiologic cup present
• Vessels are normal
• Hyperemia
• Diffuse elevation
• Retinal veins dilated
• Exudates
• No SVP
PSEUDOPAPILLEDEMA
• Absent cup
• Vessels arise from center
• Disc color normal
• Elevation irregular
• Veins not dilated
• No exudates
• SVP
50. OPTIC DISC HYPOPLASIA confused
with optic atrophy
• Very common optic
disc anomaly
• The double ring sign
• Vision is affected
• Usually seen in
children of diabetic
mothers
• Look for pituitary
dysfunction
52. Optic Nerve Hypoplasia:
(not DeMorsiere’s Syndrome)
(optic n hypoplasia, (absent septum pellucidum) and dwarfism)
• Vision variable
• Seen in drug use
alcohol
phenytoin
• Maternal infections
• Diabetes
Think midline
Defects with
hypopituitarism
Agensis of corpus
Collosum; absent septum pellucidum
Thinning/absence of cc
small chiasm
Pituitary may be absent
Look for DI, GH deficiency,
Hypothyroidism,
hypo-corticoidism,
Growth retardation
56. OPTIC DISC COLOBOMA
Usually inferior
Disc may appear enlarged
Pigmentary changes around defect common
Think cardiovascular, CNS defects, nasopharyngeal
64. VIEW THE DISC WITH
CONFIDENCE
• IDENTIFY NORMAL STRUCTURES—
differentiate variants from disc swelling
or atrophy
• Look for disc anomalies
• Know anomalies that have systemic
associations