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. Optic nerve head edema os with blurred disc margins 360 degrees, loss of the optic cup, and an intraretinal flame hemorrhage at the inferior edge of the disc. Differentiating between true optic disc swelling and pseudooptic disc swelling is important for avoiding unnecessary testing, dr. Click to enlarge warfarin was kept at 5 mg per day. 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. Thus, combining mrv with these standard imaging modalities would be useful when attempting to diagnose this condition. Differentiation between causes of optic disc swelling using retinal. Fundoscopic ophthalmoscopic exam stanford medicine 25. Optic disc oedema may be a sign of optic nerve inflammation but commonly indicates a rise in the pressure within the skull from any cause, such as a brain tumour. The most common causes of unilateral optic disc edema are nonarteritic anterior ischemic optic neuropathy aion, optic neuritis termed papillitis when disc swelling is present, and orbital compressive lesions see table 151. Optic disc oedema due to various causes can be unilateral or bilateral. Usually it is bilateral and symmetric, but it may be asymmetric or even unilateral.
A study of the causes of bilateral optic disc swelling in japanese. Acutely, some patients develop luxury perfusion of the ischemic optic nerve head, seen as dilated capillaries on the disc edema, or adjacent to the optic nerve pallor fig. Although characteristics of the optic disc appearance may overlap among aion, optic neuritis, and compressive optic neuropathies, certain. Papilledema is swelling of your optic nerve, which connects the eye and brain. Optic disc swelling including papilloedema patient. Comparison of congenital disc blurring and incipient papilledema in redfree lighta photographic study. However, the casualty doctor found bilateral blurred optic disc margins on ophthalmoscopy. Bilateral papilledema elevated disc with obscuration of blood vessels and pripapillary hge which is long standind not acute. While this is most commonly associated with intracranial lesions, a 2016 article by grixti et al. Generally, these processes also incite concomitant optic disc swelling. Optic perineuritis, a form of inflammation of the optic nerve sheath, typically. Eye care professionals may be the first to detect iih, as we perform ophthalmoscopy on a routine basis. It can be observed by a doctor by looking through the iris of the eye using an ophthalmoscope.
Researchers combine attention assessment with eye tracking to create an objective test for adhd. Papilledema is swelling of the optic disk due to increased intracranial pressure. In contrast to true papilledema, with aion or optic neuritis, there is a startling loss of visual acuity, but clearcut field defects. Unilateral optic nerve edema with preserved visual. Accompanying signs rapid expansion of the optic disc from edema can cause damage to the optic disc and peripapillary vasculature. The optic disk is shaped like a doughnut with a pink neuroretinal rim and a central white depression called the physiologic cup. Papilledema is used to denote a swelling of the optic nerve head disc resulting from raised intracranial pressure. Visual loss, which may occur in some cases, is longstanding, painless. Brown definition a heterogeneous group of optic nerve disorders that have secondary pathological effects on the macular retina. Papilloedema is optic disc swelling resulting from raised icp. Check out the color of the neuroretinal rim, which carries the axons of the retinal ganglion cells. The optic nerve sheath is continuous with the subarachnoid space, so that increased icp is transmitted to the subarachnoid space surrounding the optic nerve.
These authors also included subjects with papilledema, ischemic optic neuropathy, and. There are no early symptoms, although vision may be disturbed for a. R a manual and atlas of medical ophthalmoseopy, phila. The optic disc area is not constant among individuals but shows an interindividual variability of about 1. Optic disc oedema due to various causes can be unilateral or. This chapter is intended to help clarify the nature of the problem when the physician observes that the optic disc is swollen. It can present as perineuritis, anterior or retrobulbar optic neuritis, or optic disc edema. Optic disc drusen, important detail in the differential. Note the hyperemic swelling of the optic nerve associated with many. If papilledema is suspected clinically, magnetic resonance imaging mri with gadolinium contrast or computed tomography ct. We investigated the presentation and clinical characteristics of odv and determined the efficacy of systemic corticosteroids in its management. Papilledema differential diagnoses medscape reference.
Conversely, johnson et al argued that oct could be used to differentiate optic disc edema from optic nerve head drusen, but these authors included subjects with disc edema that was mild, moderate, and severe and drusen that were both visible and buried. He presented to the accident and emergency department next morning where head x ray revealed no fractures. Sixmonth followup visit at eye clinic at this visit, the patient reported dramatic improvement in vision and no symptoms. Any edema of optic nerve head arising from causes other than increased intracranial pressure is termed optic disc edema, and not papilledema.
Optic disc swelling is distinct from optic disc atrophy which refers to a loss of nerve fibres. 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. Some anomalous, but otherwise normal, optic discs may be elevated, giving the false appearance of optic disc edema box 42. The disc margins are blurred, but there are no hemorrhages or exudates fig. The most common cause of disc edema is the slowing of conduction along the optic nerve, but the most worrisome cause is. Pdf oct measurements in patients with optic disc edema. Female aged 10 years was referred to our clinic due to progressive visual loss of the le over a few days. From 1973 to 1997, we investigated 32 patients 34 eyes with odv.
Papilledema eye disorders merck manuals professional. Optic disc swelling can represent papilledema from increased intracranial pressure icp, papillitis from optic neuropathy, or infiltration of the disc. 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. However papilloedema is optic disc oedema due to raised intracranial tension, thus it is a specific term indicating intracranial pathology. Unilateral optic disc edema in a paediatric patient.
Approach to the patient with bilateral optic disc swelling this live lecture covers the differential diagnosis, evaluation, and management of bilateral optic disc swelling. Bilateral optic disc swelling for dd optic disc swelling. Although his head injury was classed as nonserious, an urgent computed tomography scan was ordered and an ophthalmic opinion sought. Optic disc oedema is a descriptive term used to signify oedema of the optic nerve head. Kramer university of texas health science center andrew g. Disc edema, more accurately called optic disc edema, is a medical condition in which the small area at the very back of the eyeball, where the optic nerve connects, is swollen. Chapter 2 coexistent optic nerve and macular abnormalities gary c. The appearance of the optic disc in papilledema is indistinguishable from disc edema resulting from other causes.
Optic disc edema, globe flattening, choroidal folds, and. This swelling is a reaction to a buildup of pressure in or around your brain that may have many causes. True optic nerve edema is associated with a change in blood flow to the eye. The differential diagnosis for a swollen disc can be extensive. Thus, combining mrv with these standard imaging modalities would be. Diabetic papillopathy is believed to be an atypical form of aion that usually occurs in. 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. The precise pathophysiology of infectious neuroretinitis is not known, but it likely. Our studies had indicated that optic disc vasculitis odv is a distinct clinical entity. While papilledema is disc edema secondary to increased intracranial pressure, pseudopapilledema is apparent optic disc swelling that simulates some features of papilledema but is secondary to an underlying, usually benign, process. Optic disk swelling resulting from causes that do not involve increased intracranial pressure eg, malignant hypertension, thrombosis of the central retinal vein is not considered papilledema.
The optic disc is elevated and its surface is covered by cotton wool spots damaged axons and flame hemorrhages damaged vessels. 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 disk swelling description, causes and risk factors. Dilated fundal examination revealed diffuse left sided optic disc swelling and swelling of the superior quadrant of the right disc figure 1. To investigate the etiology of bilateral disc swelling in japanese. Pseudopapilledema or pseudodisc edema is the term used to describe optic nerve variants or abnormalities that mimic papilledema ophthalmoscopically, including congenital anomalies, tilting, hypoplasia, crowded hyperopic disc, optic disc hamartoma, myelinated nerve fibers, and optic nerve head drusen figs. Differentiating between true optic disc swelling and pseudo optic disc swelling is important for avoiding unnecessary testing, dr. 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.
The senior with bilateral disc edema american academy of. Optic disc drusen affects 2% of the population, however, those with a family history was found to be 3. Papilledema is the swelling of the optic nerve as it enters the back of the eye due to raised intracranial pressure. There is a lack of inflammation, infiltration or infection of the optic nerve itself. Key features structural changes of the optic nerve.
Naion non arteritic anterior ischemic optic neuropathy. The most important entity to consider in cases of increased intracranial pressure is a space occupying lesion of the brain. Patients with edema of the optic disc have smooth internal disc contour, compared with the lumpy appearance found in optic disc drusen. 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. 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. Papilledema means optic disc elevation due to increased intracranial pressure. 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. The pathogenesis and treatment of optic disc swelling in. Persistent and extensive optic nerve head swelling, or optic disc edema, can lead to loss of these fibers and permanent visual impairment. Optic disc edema, globe flattening, choroidal folds, and hyperopic shifts observed in astronauts after longduration space flight thomas h.
A study of the causes of bilateral optic disc swelling in japanese patients. Optic disk swelling medigoo health medical tests and. Full text a study of the causes of bilateral optic disc swelling in. While papilledema is disc edema secondary to increased intracranial pressure, pseudopapilledema is a benign condition that is often due to optic disc drusen. A 47 year old man sustained a head injury after tripping. Optic disc oedema definition of optic disc oedema by.
This condition has been reported to be usually bilateral, but, in rare instances, it can present unilaterally. The information was obtained by complete medical and ophthalmic history. Several disorders can simulate optic disc swelling, and numerous conditions can cause it. As a rule, optic nerve function is abnormal in each of these entities. Case studies of optic disc edema american academy of. The ddx includes anterior ischemic optic neuropathy aion, optic neuritis, papillitis, neuroretinitis, and other forms of optic neuropathy. 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. Papilledema is an optic disc swelling that is secondary to elevated intracranial pressure. Her visual acuities va were re 1010, le 310, and she had a relative afferent pupillary defect. Bilateral optic disc edema is a true ocular and medical emergency, even in patients without symptoms who are 2020 and have a normal visual field. Cerebral venous sinus thrombosis signaled by bilateral. The patient subsequently went on to have formalized fields, which confirmed the left inferior altitudinal defect and no obvious field defect on the right figure 2. Swelling of the head of the optic nerve, as seen with an ophthalmoscope at the inside of the back of the eye. Most patients with pseudopapilledema lack visual symptoms, not unlike patients with true papilledema.
The most common cause of the bilateral disc swelling was increased. Addressing the limitations of a fully manual process and building on these first. Differential diagnosis of unilateral optic disc oedema. Optic disc photos of a 17 year old girl with bilateral buried optic disc drusen. 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.
The optic disc, also known as the optic nerve head, forms a slightly raised spot on the nasal side of the retina. Swelling of the optic nerve is neither rare nor difficult to diagnose, but as. In contrast to other causes of optic disc swelling, vision usually is well preserved with acute papilledema. Cerebral venous sinus thrombosis signaled by bilateral optic disc edema and unilateral preretinal hemorrhage. Table 111 lists the possible conditions that result in optic disc edema.
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