Overview

Optic Nerve Examination is a fundamental diagnostic procedure used to assess the optic nerve head (optic disc). This examination is crucial for diagnosing glaucoma, optic neuropathies, and other optic nerve disorders.

Optic nerve examination is essential for diagnosing and monitoring glaucoma, the leading cause of irreversible blindness worldwide. It also helps identify optic neuropathies, papilledema, and other optic nerve abnormalities that may indicate systemic disease.

Learn more in our comprehensive RxDx Ophthalmology Course

Indications

✓
Glaucoma Screening

Routine screening for optic nerve damage

✓
Glaucoma Monitoring

Regular disc examination in glaucoma patients

✓
Optic Neuropathy

Evaluation of optic nerve disorders

✓
Papilledema

Assessment of elevated intracranial pressure

✓
Optic Atrophy

Evaluation of optic nerve degeneration

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Severe corneal opacity
✗ Active corneal infection

Relative Contraindications

✗ Severe photophobia
✗ Recent eye surgery
✗ Uncooperative patient

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes explaining the procedure to patient, dilating pupils if needed, ensuring proper patient positioning, selecting appropriate examination methods, and preparing for potential complications. All team members should understand their roles.

Step-by-Step Procedure

Step 1: Patient Preparation

Explain procedure to patient. Dilate pupils if needed. Position patient appropriately. Ensure patient comfort and cooperation.

⚠️ Common Mistakes to Avoid:

  • Inadequate explanation
  • Poor positioning
  • Insufficient dilation

💡 Pro Tip:

Explain that pupil dilation may cause temporary blurring.

Step 2: Pupil Dilation

Apply dilating drops. Wait for adequate dilation. Check pupil size.

⚠️ Common Mistakes to Avoid:

  • Insufficient dilation
  • Inadequate wait time
  • Poor drop technique

💡 Pro Tip:

Wait 15-20 minutes for adequate dilation.

Step 3: Disc Visualization

Use ophthalmoscope or slit lamp. Focus on optic disc. Assess disc color and margins.

⚠️ Common Mistakes to Avoid:

  • Poor visualization
  • Inadequate focus
  • Missing disc details

💡 Pro Tip:

Use red-free light to enhance disc margins.

Step 4: Cup-to-Disc Ratio

Measure vertical cup-to-disc ratio. Document findings. Compare with previous examinations.

⚠️ Common Mistakes to Avoid:

  • Inaccurate measurement
  • Poor documentation
  • Missing comparison

💡 Pro Tip:

Measure vertical cup-to-disc ratio for consistency.

Step 5: Disc Assessment

Evaluate disc color, margins, and vessels. Note any abnormalities. Document findings.

⚠️ Common Mistakes to Avoid:

  • Incomplete assessment
  • Missing abnormalities
  • Poor documentation

💡 Pro Tip:

Systematically assess disc color, margins, and vessels.

Step 6: Documentation

Record disc findings. Document cup-to-disc ratio. Compare with previous examinations.

⚠️ Common Mistakes to Avoid:

  • Poor documentation
  • Missing measurements
  • Incomplete records

💡 Pro Tip:

Document cup-to-disc ratio, disc color, and any abnormalities.

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Post-procedure Care

Post-procedure care involves documenting disc findings, comparing with previous examinations, monitoring for complications, and determining if additional testing is needed. Regular optic nerve examination is essential for glaucoma patients.

Complications & Management

Complication Incidence Signs Management Prevention
Pupil dilation side effects Common Blurred vision, photophobia Reassurance, sunglasses Proper explanation, sunglasses
Patient discomfort 10-20% Anxiety, poor cooperation Reassurance, gentle approach Good communication, proper explanation
Incomplete examination 5-10% Missing disc details Repeat examination Adequate dilation, proper technique
Allergic reaction Rare Redness, itching, swelling Antihistamines, follow-up Check allergy history

Clinical Pearls

💡

Explain that pupil dilation may cause temporary blurring.

🎯

Wait 15-20 minutes for adequate dilation.

⚡

Use red-free light to enhance disc margins.

🔍

Measure vertical cup-to-disc ratio for consistency.

📊

Systematically assess disc color, margins, and vessels.

🎨

Document cup-to-disc ratio, disc color, and any abnormalities.

⚠️

Asymmetric cupping suggests glaucoma - always compare both eyes.