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Glaucoma (cupping)

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The first sign of disc damage is usually an upper or lower temporal notch, giving rise to a nasal arcuate scotoma.

The extent of cupping is commonly assessed as the vertical cup:disc ratio, expressed as a fraction.

Characteristically, there is:

  • right/left asymmetry
  • cup to disc ratio is usually 0.5 or greater in the vertical plane
  • affected area of disc is atrophic - light grey / white rather than pink
  • the vessels may be angulated or kinked as they come over the rim of the cup - bayonetting
  • vessels shifted to nasal edge of disc
  • splinter haemorrhages at disc edge

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