Patients a 35yearold woman presented with headache, chronic. Optic disc drusen odd are acellular deposits located in the optic nerve head of up to 2. 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 swelling is distinct from optic disc atrophy which refers to a loss of nerve fibres. While papilledema is disc edema secondary to increased intracranial pressure, pseudopapilledema is a benign condition that is often due to optic disc drusen. 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. 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. He presented to the accident and emergency department next morning where head x ray revealed no fractures. Optic disc edema refers to the ophthalmoscopic swelling of the optic disc. Because there are no rods or cones overlying the optic disc, it corresponds to a small blind spot in each eye the ganglion cell axons form the optic nerve after they leave the eye. Her visual acuities va were re 1010, le 310, and she had a relative afferent. What can explain drop of vision is consecutive optic atrophy. 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. 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.
Optic disc photos of a 17 year old girl with bilateral buried optic disc drusen. Swelling of the head of the optic nerve, as seen with an ophthalmoscope at the inside of the back of the eye. A 47 year old man sustained a head injury after tripping. Sep 15, 2015 ophthalmoscopy can also be used to distinguish true edema from pseudoedema. Trobe, jonathan d md journal of neuroophthalmology. Optic disc oedema due to various causes can be unilateral or. 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. Request pdf optic disc edema optic disc edema is the end result of many pathological processes, some relatively benign, some with devastating visual and.
Secondary retinal detachment, retinoschisis, or macular edema. Pathogenesis of oedema of the optic disc springerlink. Pdf optic disc edema associated with spinocerebellar. Approach to the patient with bilateral optic disc swelling this live lecture covers the differential diagnosis, evaluation, and management of bilateral optic disc swelling. 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. Differential diagnosis of unilateral optic disc oedema. Optic disc edema associated with spinocerebellar degeneration article pdf available in ophthalmologica 2124. Bilateral optic disc swelling for dd optic disc swelling.
Differentiating between true optic disc swelling and pseudo optic disc swelling is important for avoiding unnecessary testing, dr. Fluorescein angiogram showed an infiltrative process around the optic nerves in both eyes, and extension through the macula in the left eye figure 1, b and d. 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. Pointofcare ocular ultrasound to detect optic disc swelling. The optic disc represents the beginning of the optic nerve and is. Optic disc edema, cystoid macular edema, and elevated. The disc margins are blurred, but there are no hemorrhages or exudates fig. Papilledema is swelling of your optic nerve, which connects the eye and brain.
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. Papilledema eye disorders merck manuals professional edition. Optic disc edema is associated with leakage of disc capillaries with the fluid spreading from the disc through the outer plexiform layer of the retina. 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. In addition to the optic disc edema, there was a slightly creamy appearance to the choroid around the disc, greater in the left than the right eye. If papilledema is suspected clinically, magnetic resonance imaging mri with gadolinium contrast or computed tomography ct. Differentiating optic disc edema from optic nerve head drusen on optical coherence tomography. The foremost clinical goal is to differentiate congenital causes of disc elevation from acquired disc edema. The disc edema tends to resolve over 2 weeks to 2 months, but in some patients optic atrophy ensues. The optic cup is not obscured in stage 1 or 2 papilledema but may be in higher grades of papilledema. This chapter is intended to help clarify the nature of the problem when the physician observes that the optic disc is swollen. Her visual acuities va were re 1010, le 310, and she had a relative afferent pupillary defect.
Optic nerve head edema among patients presenting to the. Optic disk swelling medigoo health medical tests and. Optic disc swelling including papilloedema patient. Optic disc edema ode due to chronic intracranial hypertension was. Optic disc edema, cystoid macular edema, and elevated vascular endothelial growth factor in a patient with poems syndrome chong, deborah y md. Unilateral pallid optic disc swelling and anemia associated. However papilloedema is optic disc oedema due to raised intracranial tension, thus it is a specific term indicating intracranial pathology. Fluorescein angiography in nonischemic optic disc edema. And the patients visionor lifemay depend on a timely diagnosis.
Leber hereditary optic neuropathy, and trauma, and related conditions. Brown definition a heterogeneous group of optic nerve disorders that have secondary pathological effects on the macular retina. Female aged 10 years was referred to our clinic due to progressive visual loss of the le over a few days. Optic disc drusen can cause the optic nerve to be elevated or to have blurred margins simulating papilledema. Although assessment of the optic disc is an essential diagnostic skill, nonophthalmologist physicians report a general lack of con. Optic disc drusen, important detail in the differential. Case report in 1993, a 26yearold man with a 5year history of hearing loss and tinnitus visited a hospital of otolaryngology. Because there are no rods or cones overlying the optic disc, it corresponds to a small blind spot in each eye. Although his head injury was classed as nonserious, an urgent computed tomography scan was ordered and an ophthalmic opinion sought. Ophthalmoscopy can also be used to distinguish true edema from pseudoedema. Design and setting case reports from an inpatient neurology service.
Papilledema indicates increased intracranial pressure. Pseudopapilledema due to disc drusen is common, occurring in 0. Stage 3 papilledema is elevation of the optic disc with partial obscuration of one of more segments of the blood vessels at the disc margin. Papilledema pe is acquired bilateral optic disc swelling attributed to increased intracranial pressure as listed in table 1. What steps should you take to pin down the diagnosis. Grade v papilledema has the criteria of grade iv plus partial or total obscuration of all vessels of the disc. Pseudopapilledma ppe is the appearance and false impression of bilateral disc swelling that is. Fluorescein angiogram showed an infiltrative process around the optic nerves in both eyes, and extension through the macula in the left eye figure 1, b. 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.
This is a pdf file of an unedited manuscript that has been accepted for publication. Jun 04, 2016 several disorders can simulate optic disc swelling, and numerous conditions can cause it. Dec 31, 2010 chapter 2 coexistent optic nerve and macular abnormalities. 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. 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. Stage 2 papilledema is a circumferential halo of edema on the optic disc. Optic disc edema, globe flattening, choroidal folds, and hyperopic shifts observed in astronauts after longduration space flight thomas h. Pathophysiology of the distal portion of the optic nerve. Causes of pseudo disc edema optic nerve head drusen. Snellen visual acuity, visual field testing humphrey visual fields hvfs or goldmann manual perimetry gvf, pupillary examination, and concomitant cranial. 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. 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. Definition a heterogeneous group of optic nerve disorders that have secondary pathological effects on the macular retina.
Optic disc edema is the earliest sign of odems and may be severe. 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. Case studies of optic disc edema american academy of. In contrast to other causes of optic disc swelling, vision usually is well preserved with acute papilledema. Optic disc oedema definition of optic disc oedema by. The differential diagnosis for a swollen disc can be extensive. Jan 28, 2016 not all optic disc swelling is papilloedema. Differentiation of optic nerve head drusen and optic disc edema with spectral domain optical coherence tomography. 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. Optic disc edema with a macular star and neuroretinitis. Bilateral papilledema elevated disc with obscuration of blood vessels and pripapillary hge which is long standind not acute.
Fourteen patients were assessed with disc swelling noted on dilated fundoscopic exam in 11 of 28 39% eyes. Fig 7a photography using redfree light can also help to. Check out the color of the neuroretinal rim, which carries the axons of the retinal ganglion cells. 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. The optic disc represents the beginning of the optic nerve and is the point where the axons of retinal ganglion cells. Optic disc oedema is a descriptive term used to signify oedema of the optic nerve head. Table 111 lists the possible conditions that result in optic disc edema. The optic disc or optic nerve head is the point of exit for ganglion cell axons leaving the eye. True optic nerve edema is associated with a change in blood flow to the eye.
Key features structural changes of the optic nerve. Drusen of the optic nerve are made up of calcified axonal debris on the surface of the disc. Papilledema eye disorders merck manuals professional. Visual loss, which may occur in some cases, is longstanding, painless. Here we report an unusual case of nf 2 presenting optic neuropathy secondary to severe disc edema without typical findings of obstructive hydrocephalus. Optic disk swelling description, causes and risk factors.
Funduscopic abnormalities usually precede visual disturbances. 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. Papilledema differential diagnoses medscape reference. Although his head injury was classed as nonserious, an urgent computed tomography scan was ordered and an ophthalmic opinion. Optic disc definition of optic disc by medical dictionary. Here, there are no photoreceptors, hence it is known as the blind spot of the eye. Diagnosis edit 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. Unilateral optic disc edema in a paediatric patient. The pathogenesis and treatment of optic disc swelling in. The optic disc, also known as the optic nerve head, forms a slightly raised spot on the nasal side of the retina. The precise pathophysiology of infectious neuroretinitis is not known, but it likely. The subject was investigated experimentally in detail in 77 rhesus monkeys and 26 rabbits.
Several disorders can simulate optic disc swelling, and numerous conditions can cause it. The ganglion cell axons form the optic nerve after they leave the eye. Sep 04, 2019 papilledema is an optic disc swelling that is secondary to elevated intracranial pressure. May 03, 2015 bilateral optic disc swelling for dd optic disc swelling.
Differentiating between true optic disc swelling and pseudooptic disc swelling is important for avoiding unnecessary testing, dr. Optic disc edema in raised intracranial pressure was first described in 1853. Papilledema is an optic disc swelling that is secondary to elevated intracranial pressure. Oct 07, 2011 optic disc oedema is a descriptive term used to signify oedema of the optic nerve head. Differential diagnosis of unilateral optic disc oedema openi. However, the casualty doctor found bilateral blurred optic disc margins on ophthalmoscopy. 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. To determine whether nonischemic optic disc edema is associated with significant delay in fluorescein angiographic optic disc filling. Chapter 2 coexistent optic nerve and macular abnormalities gary c. Optic disc drusen affects 2% of the population, however, those with a family history was found to be 3. Comparison of congenital disc blurring and incipient papilledema in redfree light. No oedema of the optic disc could be produced by acute intracranial hypertension in monkeys. This swelling is a reaction to a buildup of pressure in or around your brain that may have many causes often, its. The optic disk is shaped like a doughnut with a pink neuroretinal rim and a central white depression called the physiologic cup.
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