Loss of vision, either central or peripheral, is the only symptom.
The optic disc is pale and white. In severe cases, the pallor is unmistakable but that of less advanced atrophy may be confused with the pallor of a large physiological cup, or scleral exposure adjacent to the optic disc in a myopic eye.
Quite refined testing may be required to demonstrate loss of visual function in even a markedly pale disc and a reduced visual evoked responses may be the only confirmation of optic nerve demyelination.
Specific ophthalmologic features are suggestive of the underlying cause. Hereditary causes are frequently bilateral. Attenuated retinal vessels are indicative of central retinal artery occlusion or quinine poisoning. An enlarged cup is indicative of glaucoma. Prior disc oedema is characteristic of papilloedema or papillitis as is blurring of the disc margins.
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