Optic nerve glioma physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Common physical examination findings of optic nerve glioma include nystagmus, strabismus, proptosis, visual impairment, afferent pupillary defect, edema and/or pallor of optic disc, torticollis and deficits of cranial nerve II.

Physical Examination

Eyes

• Nystagmus may be present.
• Strabismus may be present
• Visual impairment may be present
• Proptosis
• Afferent pupillary defect may be present
• Fundoscopic examination may show pallor and/or edema of the optic disc due to atrophy. Initially, optic nerve head is swollen but subsequently it becomes atrophic. Central retinal vein occlusion and optociliary collaterals may occasionally be seen.
• On slit-lamp examination iris hamartomas (Lisch nodules) may be identified in optic nerve glioma patients with associated NF-1.

Head

• Torticollis may be present

Neurological

• Mental status may be altered if obstructive hydrocephalus is present.
• There are deficits in cranial nerves II- Involuntary eyeball movement and loss of peripheral vision in one or both eyes may be present.

Skin

• Lesions may be present:
  • Café-au-lait spots or hyperpigmented macules may be present in patients with optic pathway glioma associated with NF-1.
  • Axillary or inguinal freckles may be present in patients with optic nerve glioma associated with NF-1.