[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Eye](https://durgical.com/en/general-pathology/areas/eye/) › Optic neuropathies

# Optic neuropathies

- Lesion

The optic nerve can be starved of blood, swollen by raised brain pressure, inflamed or poisoned; each pattern points to a different cause.

Updated Nov 12, 2026

## Key points

- Arteritic AION: giant cell arteritis in older adults; sudden severe loss, chalky white swollen disc; urgent steroids protect the other eye.
- Non-arteritic AION: small crowded disc (‘disc at risk’), vascular risk factors, painless loss on waking.
- Papilledema: bilateral disc swelling from raised intracranial pressure, with preserved acuity early; causes include tumours, venous sinus thrombosis and idiopathic intracranial hypertension.
- Optic neuritis: painful eye movements, central loss, recovers over weeks; MS (often unilateral) vs NMO (severe, bilateral, poor recovery).
- Leber hereditary optic neuropathy: mitochondrial DNA mutations, young men, sequential bilateral central loss.
- Toxic and nutritional: methanol, ethambutol, B12 and folate deficiency, tobacco-alcohol amblyopia.

## What it is

The optic nerve is a tract of the CNS, wrapped in meninges and myelinated by oligodendrocytes. It has a limited set of responses: swelling of the disc, then atrophy with a pale disc. Anterior ischemic optic neuropathy is an infarct of the nerve head, arteritic (giant cell arteritis) or non-arteritic. Papilledema is disc swelling from raised intracranial pressure. Optic neuritis is inflammatory demyelination, often the first sign of multiple sclerosis or neuromyelitis optica. Glaucoma causes cupping. Hereditary (Leber) and toxic-nutritional optic neuropathies affect the central fibres.

## Step by step

- Raised CSF pressure is transmitted along the optic nerve sheath.
- Pressure at the lamina cribrosa slows axoplasmic flow.
- Axons swell at the disc and veins congest.
- The disc becomes elevated with blurred margins and hemorrhages.
- Prolonged swelling ends in optic atrophy and field loss.

## Optic neuropathies compared

| Disorder | Mechanism | Disc | Typical patient |
| --- | --- | --- | --- |
| [Arteritic AION](https://durgical.com/en/conditions/giant-cell-arteritis/) | Inflamed short posterior ciliary arteries | Pale, swollen | Over 50, with headache and jaw claudication |
| [Non-arteritic AION](https://durgical.com/en/conditions/non-arteritic-anterior-ischaemic-optic-neuropathy/) | Hypoperfusion of a crowded disc | Swollen, sector | Older adult with vascular risk |
| [Papilledema](https://durgical.com/en/conditions/idiopathic-intracranial-hypertension/) | Raised intracranial pressure blocks axonal flow | Bilateral swelling | Tumour, venous thrombosis, idiopathic intracranial hypertension |
| [Optic neuritis](https://durgical.com/en/conditions/optic-neuritis/) | Inflammatory demyelination | Normal (retrobulbar) or swollen | Young adult woman, MS or NMO |
| [Glaucoma](https://durgical.com/en/conditions/open-angle-glaucoma/) | Pressure-related axon loss | Enlarged cup | Older adult, often silent |
| [Leber hereditary optic neuropathy](https://durgical.com/en/conditions/leber-hereditary-optic-neuropathy/) | Mitochondrial complex I mutations | Swollen then pale | Young man, maternal inheritance |
| [Toxic or nutritional](https://durgical.com/en/conditions/methanol-poisoning/) | Mitochondrial poisoning, deficiency | Pale temporal disc | Methanol, ethambutol, B12 deficiency |

## Clinical notes

- Optic atrophy of any cause shows as a pale disc with loss of nerve fibre layer.
- In an older adult with sudden visual loss and headache, giant cell arteritis is treated before the biopsy result.

## Memory aid

Starved (AION), squeezed (papilledema), stripped (neuritis), cupped (glaucoma) or poisoned (toxic): five ways to lose the optic nerve.

## Test yourself

Think of the answer, then tap the question to see it.

## What is papilledema?

Swelling of the optic disc caused by raised intracranial pressure, usually on both sides.

## Which systemic disease causes arteritic anterior ischemic optic neuropathy?

Giant cell arteritis.

## How is Leber hereditary optic neuropathy inherited?

Through mitochondrial DNA, from the mother; it mostly affects young men.

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## Elsewhere in DurgiPedia

- [The swollen optic disc: papilloedema or not](https://durgical.com/en/ophthalmology/the-swollen-optic-disc-papilloedema-or-not/)
- [Giant cell arteritis and the eye: treat before the biopsy](https://durgical.com/en/ophthalmology/giant-cell-arteritis-and-the-eye-treat-before-the-biopsy/)
- [Ethambutol and the optic nerve](https://durgical.com/en/ophthalmology/ethambutol-and-the-optic-nerve/)
- [The optic disc: cup, rim and colour](https://durgical.com/en/ophthalmology/the-optic-disc-cup-rim-and-colour/)
- [The visual pathway, pupillary reflexes and eye movements](https://durgical.com/en/physiology/the-visual-pathway-pupillary-reflexes-and-eye-movements/)

## Connections

## Related 6

- [Glaucoma and the optic nerve](https://durgical.com/en/general-pathology/glaucoma-and-the-optic-nerve/)
- [Other retinal vascular disease: ROP and occlusions](https://durgical.com/en/general-pathology/other-retinal-vascular-disease-rop-and-occlusions/)
- [Multiple sclerosis: the plaque](https://durgical.com/en/general-pathology/multiple-sclerosis-the-plaque/)
- [Other demyelinating diseases](https://durgical.com/en/general-pathology/other-demyelinating-diseases/)
- [Cerebral edema, hydrocephalus and herniation](https://durgical.com/en/general-pathology/cerebral-edema-hydrocephalus-and-herniation/)
- [Large-vessel vasculitis: giant cell vs Takayasu](https://durgical.com/en/general-pathology/large-vessel-vasculitis-giant-cell-vs-takayasu/)

## Related conditions 9

- [Non-arteritic anterior ischaemic optic neuropathy](https://durgical.com/en/conditions/non-arteritic-anterior-ischaemic-optic-neuropathy/)
- [Giant cell arteritis](https://durgical.com/en/conditions/giant-cell-arteritis/)
- [Optic neuritis](https://durgical.com/en/conditions/optic-neuritis/)
- [Multiple sclerosis](https://durgical.com/en/conditions/multiple-sclerosis/)
- [Neuromyelitis optica spectrum disorder](https://durgical.com/en/conditions/neuromyelitis-optica-spectrum-disorder/)
- [Idiopathic intracranial hypertension](https://durgical.com/en/conditions/idiopathic-intracranial-hypertension/)
- [Leber hereditary optic neuropathy (LHON)](https://durgical.com/en/conditions/leber-hereditary-optic-neuropathy/)
- [Methanol poisoning](https://durgical.com/en/conditions/methanol-poisoning/)
- [Raised intracranial pressure and brain herniation](https://durgical.com/en/conditions/raised-intracranial-pressure-and-brain-herniation/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Optic neuritis: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000741.htm) (MedlinePlus, US National Library of Medicine, 2026); [Leber hereditary optic neuropathy: MedlinePlus Genetics](https://medlineplus.gov/genetics/condition/leber-hereditary-optic-neuropathy/) (MedlinePlus, US National Library of Medicine, 2026).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/optic-neuropathies/