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