What steps should you take to pin down the diagnosis. The optic disc edema resolved with corticosteroid treatment but resulted in mild optic atrophy in 2 patients. This chapter is intended to help clarify the nature of the problem when the physician observes that the optic disc is swollen. Optic disc oedema due to various causes can be unilateral or. Table 111 lists the possible conditions that result in optic disc edema. Venous obstruction and dilation, nerve fiber ischemia, and vascular telangiectasias are secondary phenomena. The swollen optic disc in assessing an ele vated optic disc, the e xaminer.
Differentiating between true optic disc swelling and pseudo optic disc swelling is important for avoiding unnecessary testing, dr. Checking the eyes for signs of papilledema should be carried out whenever there is a clinical suspicion of raised intracranial pressure, and is recommended in newly onset headaches. Differential diagnosis of unilateral optic disc oedema openi. Here we report an unusual case of nf 2 presenting optic neuropathy secondary to severe disc edema without typical findings of obstructive hydrocephalus. A 47 year old man sustained a head injury after tripping. Differentiating between true optic disc swelling and pseudooptic disc swelling is important for avoiding unnecessary testing, dr. Patients a 35yearold woman presented with headache, chronic. We report a case of unilateral optic disc edema in a paediatric patient and discuss the concerns involved in diagnosis and management of similar cases. Oct angiography octa is a new technology allowing the visualization of the peripapillary vascular network and optic disc capillaries.
Visual acuity was unaffected and disc edema was bilateral in all cases. Plasmacytoma can cause optic disc edema through elevated icp. Ophthalmoscopy can also be used to distinguish true edema from pseudoedema. Sep 21, 2016 a 25 year old african man presented with reduced vision and headache lasting three hours.
Although assessment of the optic disc is an essential diagnostic skill, nonophthalmologist physicians report a general lack of con. The peripapillary network alterations of glaucoma and chronic nonarteritic anterior ischemic optic neuropathy naion were reported. Definitions papilledema is swelling of optic nerve head secondary to raised intracranial pressure all other causes of disc swelling in absence of raised icp are called optic disc edema pseudo papilledema is not true edema but mimics optic disc edema. Portable fundus photography may overcome this difficulty. Patients with a unilaterally swollen optic nerve and normal visual function most likely have optic nerve head drusen. In contrast to true papilledema, with aion or optic neuritis, there is a startling loss of visual acuity, but clearcut field defects. True optic nerve edema is associated with a change in blood flow to the eye. Patients with abnormal visual function most likely have demyelinating optic neuritis or nonarteritic. Optic disc swelling is a relatively common condition that can present to different physicians and associate with various entities, some potentially life or sight threatening. Grade iii papilledema is characterized by loss of major vessels as they leave the disc arrow grade iv papilledema is characterized by loss of major vessels on the disc. Here, there are no photoreceptors, hence it is known as the blind spot of the eye. Causes of pseudo disc edema optic nerve head drusen. Arcuate scotoma discrete lesions, commonly ischaemic in origin, may affect the arcuate nerve fibres, which remain separate throughout their course in the optic nerve, thereby producing an arcuate loss.
Differential diagnosis of unilateral optic disc oedema. Recognizing arteritic versus nonarteritic ischemic optic neuropathy abstract a case of giant cell arteritis in a 68yearold patient who has sudden unilateral painless vision loss with no additional symptoms. Female aged 10 years was referred to our clinic due to progressive visual loss of the le over a few days. If papilledema is suspected clinically, magnetic resonance imaging mri with gadolinium contrast or computed. Case report in 1993, a 26yearold man with a 5year history of hearing loss and tinnitus visited a hospital of otolaryngology. Papilledema pe is acquired bilateral optic disc swelling attributed to increased intracranial pressure as listed in table 1. Papillophlebitis and the differential diagnosis of. Accuracy and reliability of a handheld, nonmydriatic. And the patients visionor lifemay depend on a timely diagnosis. Optic disc edema, cystoid macular edema, and elevated. Optic disc edema, globe flattening, choroidal folds, and hyperopic shifts observed in astronauts after longduration space flight thomas h. Optic disc swelling can be caused by a number of conditions.
Design and setting case reports from an inpatient neurology service. As a rule, optic nerve function is abnormal in each of these entities. Optic disc edema, globe flattening, choroidal folds, and. However, the casualty doctor found bilateral blurred optic disc margins on ophthalmoscopy. Case studies in disc edema w ith causes ranging from the infectious to the vascular to the malignant, the swollen optic nerve is a crucial, but often mystifying, sign. Optic disc edema ode first appeared at the lower pole, then the upper pole, then the nasal part, and last the temporal part of the disc. Pointofcare ocular ultrasound to detect optic disc swelling. The purpose of this study was to determine the sensitivity and specificity of a handheld, nonmydriatic fundus camera for the detection of optic. Ten patients had optic disc edema and met inclusion criteria.
Optic disc oedema is a descriptive term used to signify oedema of the optic nerve head. Bilateral optic disc swelling for dd optic disc swelling. A small hemorrhage was observed inferior to the optic disc in the right eye. The differential diagnosis of swollen optic nerves differs according to whether the swelling is unilateral or bilateral, or whether visual function is normal or affected. In such cases the cause can be life threatening and long standing edema may lead to permanent visual field or optic nerve damage.
Although his head injury was classed as nonserious, an urgent computed tomography scan. The differential diagnosis of optic disc edema at the acute phase can be challenging. Bilateral disc edema is an indication of raised intracranial pressure. Several disorders can simulate optic disc swelling, and numerous conditions can cause it. Optic disc edema can be an important indicator of serious neurological disease, but is poorly detected using the direct ophthalmoscope. Papilledema indicates increased intracranial pressure. Trobe, jonathan d md journal of neuroophthalmology. However papilloedema is optic disc oedema due to raised intracranial tension, thus it is a specific term indicating intracranial pathology. May 10, 2019 obstipation of intraaxonal fluid results in swelling of the axons and leakage of water, protein, and other cellular contents into the extracellular space of the optic disc giving rise to optic disc edema. Overview and differential diagnosis of papilledema uptodate.
Differentiating papilledema from other causes of a swollen optic disk, such as optic neuritis, ischemic optic neuropathy, hypotony, central retinal vein occlusion, uveitis, or pseudo swollen disks eg, optic nerve drusen, requires a thorough ophthalmologic evaluation. What do you think about these photos of a young male 11years old with va od cf and os pl with good projection of light free anterior segment. He presented to the accident and emergency department next morning where head x ray revealed no fractures. Patients with edema of the optic disc have smooth internal disc contour, compared with the lumpy appearance found in optic disc drusen. Persistent and extensive optic nerve head swelling, or optic disc edema, can lead to loss of these fibers and permanent visual impairment. At 10 days postlanding, an mri of the brain and orbits was normal except for on thickchoroidal folds. This is just the first emc pils patient information leaflet from your search. While this is most commonly associated with intracranial lesions, a 2016 article by grixti et al. The optic disc, also known as the optic nerve head, forms a slightly raised spot on the nasal side of the retina.
Feb 28, 2019 the optic disc, also known as the optic nerve head, forms a slightly raised spot on the nasal side of the retina. While papilledema is disc edema secondary to increased intracranial pressure, pseudopapilledema is a benign condition that is often due to optic disc drusen. A 25 year old african man presented with reduced vision and headache lasting three hours. Optical coherence tomography angiography at the acute. Sep 15, 2015 ophthalmoscopy can also be used to distinguish true edema from pseudoedema. Cerebral venous sinus thrombosis signaled by bilateral optic disc edema and unilateral preretinal hemorrhage. A bilateral macular star and optic disc oedema the bmj. Optic disc swelling including papilloedema patient. Unilateral optic disc oedema walker visual field losses there are four common visual field defects associated with damage to the optic nerve. Fig 8b in addition, optic disc edema demonstrates a vshaped hyporeflective space between the sensory retina and the retinal pigment epithelium rpe that is minimal or absent with. Pdf oct measurements in patients with optic disc edema. Papillophlebitis and the differential diagnosis of unilateral. Optic disc edema, cystoid macular edema, and elevated vascular endothelial growth factor in a patient with poems syndrome chong, deborah y md.
Fundus examination revealed bilateral, asymmetrical disc edema right eye, grade 3. Bilateral papilledema elevated disc with obscuration of blood vessels and pripapillary hge which is long standind not acute. Swelling of the nerve tissue around the vessels as they enter and leave the eye in acute cases of papilledema causes congestion of the blood vessels. Optic disc edema in glial fibrillary acidic protein. True papilledema may be accompanied by symptoms of elevated intracranial pressure, such as. Careful history and examination are needed to distinguish papilloedema from other causes of optic disc swelling such as central retinal artery or vein occlusion, congenital abnormalities and optic neuritis. Patients with abnormal visual function most likely have demyelinating optic neuritis or. Cerebral venous sinus thrombosis signaled by bilateral. After 6 months of space flight, 7 astronauts had ophthalmic findings, consisting of disc edema in 5, globe flattening in 5, choroidal folds in 5, cotton wool spots cws in 3, nerve fiber layer thickening by oct in 6, and decreased near vision in 6 astronauts. Papilledema is defined as optic disc edema caused by elevated intracranial pressure icp and should be distinguished from papillitis.
Grade v papilledema has the criteria of grade iv plus partial or total obscuration of all vessels of the disc. Fluorescein angiograms from 16 patients with acute papillitis, five with papilledema, and one with optic disc edema from orbital cavernous hemangioma were compared with those of agematched controls. It has no age predilection and its presentation may be acute, subacute or chronic. Oct is an excellent imaging test to help differentiate true disc edema from pseudopapilledema. Pseudopapilledma ppe is the appearance and false impression of bilateral disc swelling that is. Although his head injury was classed as nonserious, an urgent computed tomography scan was ordered and an ophthalmic opinion sought. In addition to bilateral hyperemic and swollen optic disks optic nerve heads, patients typically have engorged and tortuous retinal veins, and retinal hemorrhages around the disk but not into the retinal periphery. This swelling is a reaction to a buildup of pressure in or around your brain that may have many causes often, its. The foremost clinical goal is to differentiate congenital causes of disc elevation from acquired disc edema. One study found that the presence of disc edema with associated chorioretinal folds patons lines had 100% sensitivity, and this finding is pathognomonic for true optic disc edema. It may also be due to a variety of systemic pathologies or drugs. Jan 28, 2016 not all optic disc swelling is papilloedema.
Approach to the patient with bilateral optic disc swelling this live lecture covers the differential diagnosis, evaluation, and management of bilateral optic disc swelling. Cerebral venous sinus thrombosis signaled by bilateral optic. In the case of anterior optic neuritis, the optic disc edema and subsequent loss of the rnfl begins around 1 month and continues for 3 to 6 months. Case studies of optic disc edema american academy of.
Bilateral optic nerve head swelling secondary to increased icp swollen, blurred margins with splinter hemorrhages and exudates as well as nerve fiber layer edema. The pathogenesis and treatment of optic disc swelling in. The senior with bilateral disc edema american academy of. Optic disc edema in glial fibrillary acidic protein autoanti. Papilledema is nearly always bilateral, is accompanied by loss of venous pulsations, and varies in appearance from mild to severe fig. Papilledema is swelling of your optic nerve, which connects the eye and brain. Optic disc swelling is distinct from optic disc atrophy which refers to a loss of nerve fibres. Funduscopic abnormalities usually precede visual disturbances. Papilledema eye disorders merck manuals professional edition. Oct 07, 2011 optic disc oedema is a descriptive term used to signify oedema of the optic nerve head. Papilledema eye disorders merck manuals professional.
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