This chapter reviews the distinction between papilledema (disc swelling secondary to increased intracranial pressure), disc swelling associated with optic neuropathy, and disc elevation due to pseudopapilledema. The fundus appearance of papilledema, the associated visual loss and its mechanisms, and the differential diagnosis in and evaluation of patients with papilledema are discussed The exact cause of optic neuritis is unknown. It's believed to develop when the immune system mistakenly targets the substance covering your optic nerve, resulting in inflammation and damage to the myelin. Normally, the myelin helps electrical impulses travel quickly from the eye to the brain, where they're converted into visual information The differential diagnosis for a swollen disc can be extensive. Here are 4 illustrative examples. With causes ranging from the infectious to the vascular to the malignant, the swollen optic nerve is a crucial, but often mystifying, sign. And the patient's vision—or life—may depend on a timely diagnosis Papilledema is the swelling of the optic nerve as it enters the back of the eye due to raised intracranial pressure. Fluid surrounding the brain is constantly produced and reabsorbed, maintaining just enough intracranial pressure to help protect the brain if there is blunt head trauma . Patton's folds may be seen: chorioretinal folds concentric around the disc
Optic disc swelling (ODS) is a characteristic presentation of various diseases, such as intrinsic ocular disease, as well as intracranial lesions and systemic diseases. 1, 2 Although differential diagnosis of ODS includes various diseases, determination of cause is critical because of the many possible vision- or life-threatening diseases When the optic nerve is irritated and inflamed, it doesn't carry messages to the brain as well, and you can't see clearly. Optic neuritis can affect your vision and cause pain. When the nerve fibers become inflamed, the optic nerve can also start to swell. This swelling typically affects one eye, but can affect both at the same time
Disc edema due to inflammatory causes can be treated with corticosteroids or immunosuppressive drugs. Infectious causes should be treated with an appropriate antibiotics. Treating the underlying condition will usually reduce disc edema and prevent progression to optic atrophy and permanent optic nerve damage In general, optic disc swelling alone refers to axonal distension and elevation of the optic disc, and optic disc edema indicates optic disc swelling along with increased fluid surrounding the axons. This is caused by obstruction of slow and fast axoplasmic transport resulting in axoplasmic backflow The brain and optic nerve are surrounded by cerebrospinal fluid (CSF), which helps to keep them stable and protected from damage from sudden movements. Papilledema occurs when increased pressure.. Physical pressure or CSF pressure can cause the optic disc to swell or to appear swollen
Papilledema is a term that is exclusively used when a disc swelling is secondary to increased intracranial pressure (ICP). It must be distinguished from optic disc swelling from other causes which is simply termed optic disc edema. Papilledema must also be distinguished from pseudo-papilledema such as optic disc drusen. Since the root cause of papilledema is increased intracranial pressure. The term papilledemarefers to optic disc swelling due to increased intracranial pressure, and the two conditions most commonly mistaken for it are disc swelling due to optic neuropathy and pseudopapilledema (disc elevation without nerve fiber layer edema) Optic nerve swelling Optic nerve swelling can be secondary due to neurologic conditions, systemic diseases and infections. These are listed below in Table 5. Optic nerve swelling due to neurologic conditions or systemic disease Optic disc infiltration by neoplastic or inflammatory cells, or scleral infiltration, can cause elevation of the optic disc. Peripapillary masses, such as astrocytic hamartomas, have been implicated Papilloedema refers to optic disc swelling as a result of raised intracranial pressure and it is usually bilateral. There may be diminution in vision and other features of raised intracranial pressure such as headache, seizures, nausea and vomiting. Initially there is a swollen disc (papilloedema) followed later by secondary optic atrophy
Other causes of pseudopapilledema include tilted optic disc, myelinated nerve fibers, congenitally crowded discs and optic nerve hypoplasia. Investigators found with OCT that the mean RNFL thickness is significantly greater in patients with true disc edema compared with those with pseudoedema of any type. 15 In fact, in cases of. Optic disc swelling is a pathological condition with a variety of causes. The clinical causes associated with unilateral optic disc swelling are optic neuritis (ON), non-arteritic anterior ischemic optic neuropathy (NA-AION), compressive optic neuropathy, retinal-vein occlusion, diabetic papillopathy etc. Cases with bilateral optic disc swelling are often associated with papilloedema.
Swelling of the optic disc limits vision and can have a significant effect on quality of life. Causes of optic disc swelling Swelling of the optic disc can occur in reaction to a variety of insults 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. Patients with a unilaterally swollen optic nerve and normal visual function most likely have optic nerve head drusen. Patients with abnormal visual function most likely have demyelinating optic neuritis or non-arteritic. Causes. Optic neuritis usually begins when the body's immune system attacks the optic nerve's myelin covering and the result is a swollen optic nerve, at the nerve ending at the eyeball or somewhere along the length of the optic nerve as it continues to the brain. The swollen optic nerve may be caused or triggered by: Multiple sclerosis . The swelling in the optic disc causes problems on the vision and may cause permanent vision loss when not managed. However, acute papilledema may result to preservation of vision. The occurrence of papilledema usually develops over hours to weeks of.
Papilledema is a serious medical condition where the optic nerve at the back of the eye becomes swollen. Symptoms can include visual disturbances, headaches, and nausea. Papilledema occurs when. Sleep apnea syndrome has been implicated as a cause of myocardial infarction, 3,4 stroke, 5,6 chronic headache, 7 and cognitive dysfunction. 7 Neuro-ophthalmic manifestations include visual field defects, 8 ischemic optic neuropathy, 9 glaucoma, 10 and optic disc edema. 11 The mechanism for the optic disc swelling associated with SAS has not. . 1-6 True unilateral papilledema is a rarity among all the potential clinical causes of optic disc swelling. 2 As is the case with typical bilateral papilledema, unilateral papilledema occurs.
The optic disc margin is blurred. There is hyperaemia with or without splinter haemorrhage(s). The venous pulsation is absent. Note: it is safer to state that the patient has optic swelling rather than papilloedema unless you have evidence of raised intracranial pressure 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.If papilledema is suspected clinically, magnetic resonance imaging (MRI) with gadolinium contrast or computed tomography (CT.
. The most common symptom of optic nerve swelling is frequent or bad headaches, which often accompany vision problems. People may develop major or minor issues with their vision, such as seeing black spots or lights Your doctor will also examine your optic nerve to check for pale color or possibly optic disc swelling. Your normal eye will be compared to the affected eye to detect changes. Your doctor will also carefully rule out artertic ION (a serious eye stroke affecting the optic nerve) and ask about symptoms such as fever, headache, scalp tenderness.
The most common causes are frontal-lobe tumors and olfactory groove meningiomas. The unilateral optic atrophy occurs as a direct consequence of the intracranial lesion exerting pressure on the optic nerve. As the lesion increases in size, the intracranial pressure increases, and causes swelling of the contralateral optic disc While the term papilledema is often used broadly to denote a swollen optic nerve head, the term papilledema should be reserved for optic disc swelling that is due to raised intracranial pressure. This topic will provide an overview and differential diagnosis of papilledema. The entity of increased intracranial pressure and specific causes. A suspicious optic nerve is worrisome for possible swelling, which is known as edema. Swollen optic nerves may be caused by high pressure within the brain (known as papilledema). Papilledema is a medical emergency and may require urgent neuroimaging, lumbar puncture, and hospitalization to determine the cause Dd of disc edema 1. Guide: Dr Anupama Karanth Presenter: Dr Madhurima 2. Causes of pseudo disc edema • Optic nerve head drusen : disc elevation • Medullated nerve fibres : blurred margins • Morning glory syndrome: elevated disc • Tilted disc: blurred margins • Small hyperopic disc: hyperemic disc • Optic disc dysplasia • Bergmeister's papill Objective To review the pathogenesis and treatment of optic disc swelling in neurosarcoidosis, including a novel therapeutic response to infliximab.. Design and Setting Case reports from an inpatient neurology service.. Patients A 35-year-old woman presented with headache, chronic visual loss, papilledema, and optic atrophy, characteristic of chronic intracranial hypertension
Diagnosis: Optic neuritis of the right eye with a prior bout of optic neuritis in the left eye. Discussion: Optic neuritis is defined as inflammation of the optic nerve, which can be anterior, in which optic disc swelling is visible, or more commonly retrobulbar, in which inflammation is posterior to the globe without optic disc edema This Live Lecture covers the differential diagnosis, evaluation, and management of bilateral optic disc swelling. Topics include papilledema and its causes (e.g. idiopathic intracranial hypertension, tumor, etc.), optic nerve infiltration, and pseudopapilledema. Lecturer: Dr. Karl Golnik Transcript (To translate please select your language to the right of this page) DR GOLNIK: Well, welcome to.
Introduction . 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. Materials and Methods . Female aged 10 years was referred to our clinic due to progressive visual loss of the LE over a few days. Her visual acuities (VA) were RE 10/10, LE 3/10, and she had a relative afferent pupillary defect. Although optic disc swelling is common in the POEMS syndrome , a reduction of vision is rare . Bolling and Brazis reported eight patients with POEMS and optic disc edema in whom visual reduction was found in only one patient-a constriction of the visual fields and enlargement of the blind spots. Two patients had slightly reduced visual acuities. There are a multitude of causes of true disc swelling and other disorders that may mimic disc swelling, some of which represent a morphologic variant of normal. The optic nerve may be elevated, simply because the optic nerve enters the eye at an extremely oblique angle (tilted disc), giving a portion a more elevated aspect (usually nasally) Papilloedema refers to optic disc swelling in the presence of raised intracranial pressure (ICP).1 In the absence of raised ICP, it is referred to as disc oedema. Unilateral optic disc oedema in the setting of normal ICP as seen in our case is caused by ischaemia (eg, anterior ischaemic optic neuropathy, retinal vein occlusion) and demyelination (eg, multiple sclerosis) of the optic nerve and. In true disc swelling, the frames (A-E) show progressively increased intensity and area of fluorescence at the disc. This shows fluorescein leakage from the oedematous disc. This is required to exclude all other causes of swollen optic nerves and raised intracranial pressure: IIH is a diagnosis of exclusion. Acute management depends on.
Chapter 11 OPTIC DISC EDEMA. Richard E. Appen. Several disorders can simulate optic disc swelling, and numerous conditions can cause it. Table 11-1 lists the possible conditions that result in optic disc edema. This chapter is intended to help clarify the nature of the problem when the physician observes that the optic disc is swollen The axons of the optic nerve are bundled and insert in the back of the eye, and this optic disc is seen in the back of the eye along with blood vessels. In optic nerve degeneration related to glaucoma, the optic disc displays changes that are characteristic of glaucoma, which your doctor may refer to as cupping. Results/Conclusions: Optic disc swelling is a rare complication of inflammatory bowel disease. Previously reported cases have been attributed to peripapillary inflammation, optic disc ischaemia or intracranial hypertension. Postulated causes of optic nerve ischaemia include a local vasculitis or general hypercoagulability
(Right) Optic disk pallor of the superior optic nerve head in the left eye. ary to arterial hypotension was made. One month later, he changes on the right might reflect a toxic neuropathy, the had persistent disk swelling in the right eye, with left disk dense left altitudinal field defect suggests ischemia. pallor (Figure 2) The optic disc can appear to have no optic cup, resulting in the appearance of papilledema, which is a major part of the differential diagnosis (Davis 2003). As patients get older, particularly past the teenage years, the drusen become more visible. The drusen begin to protrude from the edge of the optic disc and cup, especially on the. Optic neuritis. Optic neuritis (ON) is an attack of inflammation (swelling) of the optic nerve. The optic nerve is important in sending information from the eye to the brain about what we are seeing. ON is caused by the body's immune system becoming mis-programmed and activating immune cells to attack the healthy myelin covering the optic nerve The disc is white, the margins are distinct and the retinal blood vessels at the optic nerve head appear normal. Secondary optic atrophy (Figure 2) is a consequence of long-standing swelling of the optic disc, which may be due to inflammation, ischaemia or raised intracranial pressure. The disc is greyish in colour and the margins are blurred
Optic nerve edema is a common neurologic sign, frequently referred to neurology after an ophthalmologic evaluation. Elevated ICP, as was the concern here, is among many causes of optic nerve swelling. 14. The presence of disc swelling in the setting of increased ICP is a relative emergency Optic nerve edema features include blurring of the disc margins, bleeding around the disc, elevation of the nerve head, and a reddish color of the disc. Disc swelling may be a sign of a brain tumor , an orbital tumor, active optic nerve inflammation, or a mini-stroke to the nerve Given the absence of typical symptoms associated with adult optic neuritis and the frequently bilateral nature of pediatric optic neuritis, neuroimaging is key in ruling out the possibility of an underlying intracranial lesion that could cause bilateral optic disc edema, and confirming the presence of optic nerve enhancement (Figure 2)
The important optic disc abnormalities are: papilloedema, papillitis and optic atrophy. Papilloedema - swelling of the optic disc with blurring of the disc margins, hyperaemia and loss of physiologic cupping. Flame-shaped hemorrhages and yellow exudates appear near the disc margins as edema progresses. There is loss of spontaneous venous. Neuromyelitis optica. Neuromyelitis optica (NMO), also known as Devic's disease, is a rare condition where the immune system damages the spinal cord and the nerves of the eyes (optic nerves). NMO can affect anyone at any age, but it's more common in women than men Papilledema is a condition associated with the swelling of the optic disk located within the retina and leading to the cat's brain. This swelling can lead to increased pressure on the brain and may cause other symptoms, such as inflammation of the optic nerves. When inflammation occurs it interferes with the eye's ability to transmit retinal. Optic disc swelling is a pathological condition with a variety of causes. The clinical features associated with unilateral optic disc swelling are demyelinating optic neuritis (ON), non-arteritic anterior ischemic optic neuropathy (NA-AION), compressive optic neuropathy, retinal-vein occlusion, and diabetic papillopathy Swelling of the optic nerves in the absence of raised ICP is termed disc edema (Parsons JH, Miller NR). Causes of disc edema are extensive and include ischemic optic neuropathy, malignant hypertension, diabetic papillopathy, uremia, intracranial hypotension (CSF leak). Papilledema is considered a medical emergency and is investigated by means.
Unilateral optic swelling, with contralateral optic atrophy (pale disc), due to an intracranial tumour such as an olfactory groove meningioma on the side of the pale disc. As the tumour enlarges it begins to cause raised intracranial pressure and thus papilloedema Grade 4 has severe signs of grade 3, along with optic disc swelling called papilledema and macular edema. People with grade 4 retinopathy have a higher risk for stroke and may have kidney or heart. As Dr Melissa explains, Papilloedema is swelling of the optic nerve located at the back of the eye secondary to elevated intracranial pressure in the brain. It requires urgent attention and is considered an emergency! There are many underlying causes which may be infectious or inflammatory. Early detection and identification of the cause may. Optic nerve sheath meningiomas occasionally cause gaze-evoked amaurosis. There can be overlap in symptoms with optic neuritis. Examination may reveal poor visual acuity, loss of colour vision, visual field loss, optic disc swelling or optic atrophy. If the tumour is large, there may be proptosis ± limitation of eye movements The differential diagnosis of an acute papillitis other than NAION should consider other causes of optic disc swelling with or without vision loss. In contrast to NAION, optic neuritis commonly presents with vision loss in younger individuals, an RAPD, a central visual field defect, dyschromatopsia and a normal fundus exam—that is.
Generally, these processes also incite concomitant optic disc swelling. Some anomalous, but otherwise normal, optic discs may be elevated, giving the false appearance of optic disc edema (Box 4-2). ACCOMPANYING SIGNS Rapid expansion of the optic disc from edema can cause damage to the optic disc and peripapillary vasculature 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. There are no early symptoms, although vision may be disturbed for a few seconds. Papilledema requires an immediate search for the cause The characteristics of non-arteritic anterior ischemic optic neuropathy (NA-AION) and optic neuritis (ON), which showed optic disc swelling most commonly, were compared. Results: NA-AION was the most common disorder (34.7%) that presented with optic disc swelling. ON was identified in 15 patients (30.6%) Optic disc swelling can occur due to various reasons. However, in Ophthalmology, the term 'papilloedema' has been reserved for optic disc swelling associated with increased intracranial pressure alone. As discussed above, papilloedema is a noninflammatory edema of the optic disc which occurs secondary to raised intracranial pressure(ICP)
Optic disc swelling is a general term referring to any cause of a swollen optic disc. Causes of optic disc swelling include intracranial space-occupying lesions, optic neuritis (e.g. multiple sclerosis), malignant hypertension and uveitis (e.g. tuberculosis, sarcoidosis). Optic disc margins appear blurred and small haemorrhages may be noted Hypertension may lead to optic neuropathy (Figure 3). Hypertensive optic neuropathy, specifically, presents as optic disk swelling. The signs include flame shaped hemorrhages at the disc margin, blurred disc margins, congested retinal veins, papilledema, and secondary macular exudates
Anterior ischemic optic neuropathy or AION involves diseases that negatively affect optic nerve head as well as cause swelling of optic disc. These conditions frequently cause rapid and sudden visual loss in one eye. Inflammatory disorders of blood vessels, such as polyarteritis nodosa, giant cell arteritis, Wegener's granulomatosis, Churg. Papilledema (or papilloedema) is optic disc swelling that is caused by increased intracranial pressure. The swelling is usually bilateral and can occur over a period of hours to weeks. Unilateral presentation is extremely rare. Papilledema is mostly seen as a symptom resulting from another pathophysiological process Primary/simple optic atrophy: the optic disc is pale or chalky white and sharply demarcated. Secondary/complex optic atrophy: the optic disc is pale or grey, poorly defined, and prominent. Glaucomatous optic atrophy (see glaucoma) Etiology. Most common causes: optic neuritis, glaucoma; Vascular ; Hydrocephalus, orbital/intracranial lesio The Swollen Optic Disc. In assessing an elevated optic disc, the examiner must first make the important distinction between true disc swelling and pseudopapilledema. Disc swelling caused by elevated ICP is referred to as papilledema and may be accompanied by headache, transitory visual obscurations with change in posture, nausea, and vomiting.
Optic disc elevated above retinal surface. These signs may be ophthalmoscopically subtle. In acute phase, may see hemorrhages and cotton wool spots. In chronic phase, optic disc elevation and blurred margins, but no hemorrhages or cotton wool spots. In atrophic phase (optic nerve axons have died), optic disc shows mixture of pallor and swelling After it has been determined that the optic disc is swollen it is important to discover the cause. Patients will have brain imaging to determine if there is a mass or bleeding, which will require. Ischemic optic neuropathy is a major cause of blindness or significantly impaired vision, and there are few definitive answers regarding its cause, clinical features and treatment.. There are two types of ION: anterior (which is characterized by swelling of the optic nerve head) and posterior (in which there is no swelling)
Asymptomatic bilateral optic disc swelling was detected in a 19-year-old man with type 1 diabetes through routine photographic screening for retinopathy. He was found to have significant vitamin B12 deficiency which the authors believe was the cause for the optic neuropathy. After B12 replacement, visual function and optic disc appearances returned to normal US Pharm. 2011;36(4):HS2-HS6.. Optic neuropathies are disorders of the optic nerve involving degeneration of the nerve. 1 Optic neuropathy should not be confused with optic neuritis.Both can lead to vision problems; optic neuritis involves inflammation of the optic nerve while optic neuropathy refers to damage from any cause OPTIC DISC SWELLING WITHOUT VISUAL LOSS. The most common cause of optic disc swelling without visual loss is papilledema. Papilledema is defined as optic disc swelling caused by increased intracranial pressure. 1 It may be produced by an intracranial mass, by blockage of the arachnoid villi by blood or protein (e.g., after a subarachnoid hemorrhage or from a spinal cord tumor), by obstruction. Atrophy = loss of nerve fibres at the optic nerve head, resulting in a pale disc. What are the two types of optic atrophy? Secondary = atrophy is preceded by disc swelling Further, although NAION is the most likely cause of this pattern of visual acuity loss or VF loss, particularly in the setting of a fellow-eye disc at risk, other conditions such as compressive optic neuropathy must be considered if optic disc swelling was not previously observed in the patient
Posterior ischemic optic neuropathy is a syndrome of sudden visual loss with optic neuropathy without initial disc swelling with subsequent development of optic atrophy. This can occur in patients who are predisposed to AAION and NAION as described above as well as those who had cardiac and spine surgery or serious episodes of hypotension Start studying Disorders of the optic nerve 1. Learn vocabulary, terms, and more with flashcards, games, and other study tools Non-arteritic anterior ischemic optic neuropathy (NAION or NA-AION) is caused by decreased blood flow to the front part of the optic nerve. It typically causes optic nerve swelling and sudden vision loss. NAION typically affects one eye, though the other eye sometimes suffers similar loss months or years later It may be either retrobulbar neuritis (where the optic disc appearance is unaltered) or papillitis (where there is swelling of optic disc). Nearly two-thirds have papillitis and are bilateral. Nearly three-fourths of optic neuritis in children is preceded by an episode of fever, often viral The distinction between true papilledema and pseudopapilledema rests on characteristics of the optic disc when examined ophthalmoscopically. Buried disc drusen frequently simulate papilledema and often result in misdirected diagnostic maneuvers in search of a cause for presumed intracranial hypertension