Table 1

Presenting features of optic neuropathies

PresentationTypical clinical signsLikely diagnoses
Sudden onset and non-progressive. May be first noticed on awakeningAltitudinal visual field defect. Swollen optic disc acutelyArteritic or non-arteritic anterior ischaemic optic neuropathy
Acute visual loss. Retro-ocular pain. Pain on eye movement (10% painless). Spontaneous recoveryCentral or centro-caecal scotoma. Normal or swollen optic discOptic neuritis. See table 2 for differential diagnosis
Sequential (can be simultaneous) eg, bilateral painless acute visual loss. Maternal inheritanceCentral or centro-caecal scotoma. Swollen optic disc acutely. Disc capillary telangiectasia acutelyLeber's hereditary optic neuropathy
Unilateral or bilateral visual loss. May be acute or chronicOptic atrophyCompression of optic nerve, chiasm or optic tract. Old optic neuritis
Chronic bilateral visual loss. History of alcoholism, poor nutrition or drug/toxin exposureCentral or centro-caecal scotoma. Optic atrophyTobacco–alcohol amblyopia. Nutritional optic neuropathy. Toxic optic neuropathy
Chronic bilateral visual loss. Family historyCentral or centro-caecal scotoma. Optic atrophyAutosomal dominant optic atrophy. Autosomal recessive optic atrophy. Leber's hereditary optic neuropathy