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http://www.revoptom.com/content/c/20600/
VOLUME 3, NUMBER 16
OCTOBER 8, 2012

ASYMMETRIC OPTIC NERVES ARE A SIGNIFICANT INDICATOR OF POTENTIAL GLAUCOMA. BUT, WHAT IF THIS ANOMALY IS OBSERVED IN A YOUNG PATIENT?

Click here to view larger image. This patient presented with evidence of Krukenberg's spindle. Photo credit: Ian Ben Gaddie, O.D.
It's important for a primary eye care practitioner to consider a diagnosis of glaucoma if he or she documents one of these findings:
  • A cup-to-disc ratio greater than 0.50.
  • Asymmetry of the cup-to-disc ratio between the two eyes that is greater than 0.20 (i.e., 0.70 O.D. and 0.40 O.S.).
In patients with this level of asymmetry, it simply could be primary open-angle glaucoma. However, certain considerations should come to mind in a young patient with significant optic nerve asymmetry. One, in particular, is a history of trauma and the associated potential for angle-recession glaucoma.

Additionally, be sure to look for other signs, such as Krukenberg's spindle, which is indicative of pigmentary glaucoma. Further, closely inspect the lens through a dilated pupil for signs of pseudoexfoliation.
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