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Compressive Optic Neuropathy

By

John J. Chen

, MD, PhD, Mayo Clinic

Medically Reviewed Oct 2022
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Topic Resources

Compressive optic neuropathy is damage that occurs when something (usually a tumor) presses on the optic nerve.

  • Compression of the optic nerve causes slow, painless, progressive loss of vision.

  • Imaging of the optic nerve (usually by magnetic resonance imaging [MRI]) should be done to evaluate for a mass or tumor.

  • Treatment depends on the cause but often involves surgery.

The Retina and Optic Nerve
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Causes of Compressive Optic Neuropathy

There are a number of causes of compressive optic neuropathy that range from those that directly affect the eye socket (such as orbital tumors), those that originate in the brain (such as pituitary tumors), and those that are caused by inflammation (such as orbital pseudotumor) or other diseases (such as thyroid eye disease).

Symptoms of Compressive Optic Neuropathy

Compressive optic neuropathy from a tumor or mass usually causes slow, painless, progressive loss of vision. It usually affects one eye and typically affects central vision, except for tumors in the pituitary gland, which can compress the optic chiasm (where the optic nerves cross in the brain). If this happens, there is loss of peripheral vision in both eyes.

Diagnosis of Compressive Optic Neuropathy

  • A doctor's evaluation

  • Imaging tests

To diagnose compressive optic neuropathy, a doctor evaluates the person for vision loss and damage to the optic nerve. An eye doctor (optometrist or ophthalmologist) is often required to obtain visual fields and pictures of the optic nerve taken with a camera directed into the front of the eye. The optic nerve can be swollen, pale, or appear normal. Neuroimaging (usually magnetic resonance imaging [MRI] of the brain and orbits) is required to find any mass or tumor that is pressing on the optic nerve.

Treatment of Compressive Optic Neuropathy

  • Surgery

  • Sometimes radiation

Treatment depends on the cause of the compressive optic neuropathy. Usually surgery is required to remove the mass or make the mass smaller. Besides surgery, radiation is used for some tumors. Vision improves after surgery in some people.

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