Compressive optic neuropathy refers to optic nerve damage from chronic pressure by a mass or structural abnormality along its course. Common causes include orbital tumours, thyroid eye disease, and intracranial lesions.
Clinical Signs
Patients may develop gradual vision loss, colour desaturation, visual field defects, and sometimes proptosis or motility problems if the lesion is orbital.
- A relative afferent pupillary defect is often present in unilateral or asymmetric cases.
- Optic disc swelling may appear early, followed by pallor as atrophy develops.
- Symptoms can be subtle initially, so careful visual field and colour testing are important.
- Imaging (MRI/CT) is required to locate and characterise the compressive source.
Treatment
Management targets the underlying cause, using surgical decompression, tumour resection, radiotherapy, or medical treatment such as steroids in thyroid eye disease.
- Early relief of compression offers the best chance of visual recovery.
- Persistent pressure leads to irreversible optic atrophy.
- Multidisciplinary care with neurosurgery, ENT, or oncology is often needed.
- Long‑term follow‑up monitors for recurrence or progression.
