In every case of optic nerve head (ONH) elevation, there should be an instant checklist in the practitioner's mind in order to effectively determine if the nerve is in fact "swollen" or "elevated."

Organize approach to case Logical approach to differential diagnoses Appropriate diagnosis of clinical findings

Exam Checklist

Everything we're going to do anyway!

Patient demographics (age, gender, race) History, history, history! Very important step and often evolves during exam. Ocular, medical, family history Symptoms/complaints Review of systems, with close attention to neuro system VA (visual acuity): normal vs. abnormal VF (visual fields): normal vs. VF defect and, if so, what type of defect Pupils: normal vs. +APD (afferent pupillary defect) [NOTE: Lights down. Do quick snap with BIO light; instant release picks up APD.] ON (optic nerve) function: conduction defects, bright comp/red-cap desaturation. Just because the nerve is elevated doesn't mean it MUST be swollen, always examine the ON with stereoscopic views. Take baseline stereoscopic photos in the most questionable cases. Neurological exam PRN (as needed) based on clinical findings and symptoms. Optic Nerve Evaluation: Key Characteristics Disc margins--size, blurred vs distinct, hemorrhages Neuroretinal rim--color, pink, swollen, notched, pallor vs. hyperemia Nerve fiber layer--swollen, flame-shaped hemorrhage, CWS (cotton wool spot), dropout, exudates Cup--C/D, shape, asymmetry Vessels--arterial narrowing, tortuosity, anomolous vessel branching at disc [NOTE: when congenital, explode immediately out of ON--like a tree with a short trunk] ?? obscuration of the peripapillary vessels ?? ?? telangiectasia ?? Color vision: normal vs. abnormal EOM (extraocular muscles): noting any restrictions, pain, and/or diplopia SVP (spontaneous venous pulsation): positive/negative [NOTE: SVP is lost with increased intracranial pressure. If you don't see it, try to elicit it. Remember, 20% of the population doesn't have it.] EVP (elicited venous pulsation): positive/negative Stereoscopic exam of ONH: elevation--UNILATERAL or BILATERAL? What is the BP (blood pressure)?

	URL: http://www.opt.indiana.edu/ce/ondx/eyeexam.htm Revised: July 9, 2007
	IU Optometry home page: http://www.opt.indiana.edu/ Comments (content): Dr. Tiffenie Harris at tlarkins@indiana.edu Comments: Web Administrator Page design and coding: Terri Greene Copyright © 2007, The Trustees of Indiana University