Compressive optic neuropathy is damage that occurs when the optic nerve is compressed, usually by a tumor. The compression causes slow, painless, progressive loss of vision. Imaging of the optic nerve (usually by MRI) should be performed to evaluate for a mass or tumor. Surgery to remove the tumor is usually needed.
Etiology of Compressive Optic Neuropathy
Compressive optic neuropathy is often caused by a tumor, such as an orbital or pituitary tumor (1). Pituitary adenoma and meningioma are the most common tumors that cause compressive optic neuropathy (1). Inflammation (such as from orbital pseudotumor) or other diseases (such as thyroid eye disease) are also possible causes.
Etiology reference
1. Liu A, Craver EC, Bhatti MT, et al. Population-based incidence and outcomes of compressive optic neuropathy. Am J Ophthalmol. 2022;36:130-135. doi: 10.1016/j.ajo.2021.10.018
Symptoms and Signs of Compressive Optic Neuropathy
Compressive optic neuropathy from a tumor or mass usually causes slow, painless, progressive loss of vision (1). It usually affects one eye and typically affects central vision, except for tumors in the pituitary gland, which can compress the optic chiasm. Compression of the optic chiasm causes bilateral loss of peripheral vision (bitemporal hemianopia).
Symptoms and signs reference
1. Biousse V, Newman NJ. Diagnosis and clinical features of common optic neuropathies. Lancet Neurol. 2016;15(13):1355-1367. doi: 10.1016/S1474-4422(16)30237-X
Diagnosis of Compressive Optic Neuropathy
Funduscopy
Imaging tests
Visual fields are evaluated for potential central and peripheral vision loss, which usually slowly worsen in the setting of compressive optic neuropathy. On funduscopy, the optic nerve can be swollen, pale, or appear normal. Optical coherence tomography is performed to evaluate the optic nerve and may show thickening or atrophy of the optic nerve. Neuroimaging (usually MRI of the brain and orbits with contrast) is performed to find any mass or tumor that is pressing on the optic nerve.
This CT scan of the head shows a solid mass behind the left eye (right).
RAJAAISYA/SCIENCE PHOTO LIBRARY
Treatment of Compressive Optic Neuropathy
Surgery
Sometimes radiation
Treatment depends on the cause of the compressive optic neuropathy. Surgery is usually required to remove or debulk the mass. Besides surgery, radiation is used for some tumors. Medical treatment may be indicated for certain causes (eg, thyroid eye disease). Vision improves after surgery in some patients.
