optic nerve head swelling
TRANSCRIPT
![Page 1: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/1.jpg)
Optic nerve swellinghow to deal with ?!
![Page 2: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/2.jpg)
You can notice: Disc hyperemia Blurred margins Nerve fiber layer (NFL) opacification and
swelling Disc elevation Tortous veins
![Page 3: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/3.jpg)
A male pt 15 years old , came to outpatient clinic complaining of persistent headache for the last 2 months .
![Page 4: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/4.jpg)
The headache was mainly at waking, increased by coughing, associated with nausea and vomiting
history
![Page 5: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/5.jpg)
Visual acuity, color vision, and pupillary examination were normal.
examination
![Page 6: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/6.jpg)
Dilated fundus examination showed :
![Page 7: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/7.jpg)
papilledema (d.t increased ICP). space occupying lesion of the optic nerve
head optic neuritis AION malignant hypertension CRVO Diabetic papillopathy others (panuveitis, scleritis, thyroid eye dis,
meningitis, uremia,…..)
Differential diagnosis of optic disc swelling ..
![Page 8: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/8.jpg)
Papilledema Vs pseudopapilledema
![Page 9: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/9.jpg)
![Page 10: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/10.jpg)
Tilted disc
![Page 11: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/11.jpg)
optic head drusen
![Page 12: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/12.jpg)
papilledema (d.t increased ICP). space occupying lesion of the optic nerve
head optic neuritis AION malignant hypertension CRVO Diabetic papillopathy others (panuveitis, scleritis, thyroid eye dis,
meningitis, uremia,…..)
Differential diagnosis of optic disc swelling ..
![Page 13: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/13.jpg)
PRESENTATION : mild diminution of vision, progressive monocular visual loss.
OCULAR FINDINGS: modest decrease in VA (6/12 or better), disc swelling may be unilateral or bilateral, visual field defects (general constriction or scotoma), ± RAPD and dyschromatopsia.
Others : + systemic vasculopathy
1-Diabetic papillopathy
![Page 14: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/14.jpg)
![Page 15: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/15.jpg)
papilledema (d.t increased ICP). space occupying lesion of the optic nerve
head optic neuritis AION malignant hypertension CRVO Diabetic papillopathy others (panuveitis, scleritis, thyroid eye dis,
meningitis, uremia,…..)
Differential diagnosis of optic disc swelling ..
![Page 16: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/16.jpg)
PRESENTATION : painless reduction in VA This is monocular but the fellow eye can be affected in unfortunate patients.
OCULAR FINDINGS: mild-to-severe, sudden or progressive (over weeks) reduction in VA (if severe, RAPD may also be present), dilated, tortuous veins, diffuse retinal haemorrhages and disc oedema. Later on, there may be conjunctival congestion and disc oedema.
OTHERS: evidence of systemic ds (Cardiac, clotting ds,..)
2-CRVO
![Page 17: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/17.jpg)
![Page 18: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/18.jpg)
papilledema (d.t increased ICP). space occupying lesion of the optic nerve
head optic neuritis AION malignant hypertension CRVO Diabetic papillopathy others (panuveitis, scleritis, thyroid eye dis,
meningitis, uremia,…..)
Differential diagnosis of optic disc swelling ..
![Page 19: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/19.jpg)
PRESENTATION: decreased VA and episodes of temporary visual loss. May be asymptomatic.
OCULAR FINDINGS: attenuation of arterioles (copper wiring), arteriovenous nipping (narrowing of the veins as the arteries pass over them) and signs of vascular leakage (haemorrhages and exudates). Disc swelling occurs in the presence of very high blood pressure
OTHERS : systemic HTN , ‘most common cause of disc swelling’
3-Malignant hypertension
![Page 20: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/20.jpg)
![Page 21: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/21.jpg)
papilledema (d.t increased ICP). space occupying lesion of the optic nerve
head optic neuritis AION malignant hypertension CRVO Diabetic papillopathy others (panuveitis, scleritis, thyroid eye dis,
meningitis, uremia,…..)
Differential diagnosis of optic disc swelling ..
![Page 22: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/22.jpg)
(Non arteretic)
NATURE: this is a partial or total infarction of the optic nerve head due to occlusion of the posterior ciliary arteries. Patients tend to be in the 45-65 year-old age group and predisposing factors include hypertension, diabetes, hypercholestrlemia
PRESENTATION: sudden painless monocular visual loss (often discovered on waking)
4-AION
![Page 23: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/23.jpg)
![Page 24: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/24.jpg)
NATURE: Granulomatous inflammation of vessels involving the elastic tissue, There is a predilection for the temporal, ophthalmic, posterior ciliary and vertebral arteries.
PRESENTATION: one or more of jaw claudication, scalp tenderness, neck pain, malaise, temporal artery tenderness, visual reduction or loss in the patient over 55 years of age (some argue that this condition does not occur before the age of 60 or 65 years). Episodes of amaurosis fugax may occur prior to infarction of the optic nerve head. Patients may also complain of flashing lights and periocular pain.
• (Arteretic ; giant cell arteritis)
![Page 25: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/25.jpg)
![Page 26: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/26.jpg)
papilledema (d.t increased ICP). space occupying lesion of the optic nerve
head optic neuritis AION malignant hypertension CRVO Diabetic papillopathy others (panuveitis, scleritis, thyroid eye dis,
meningitis, uremia,…..)
Differential diagnosis of optic disc swelling ..
![Page 27: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/27.jpg)
Inflammation of the optic nerve, which can occur as a result of demyelinating or infective disease processes. The optic nerve head is occasionally swollen but pallor of the disc is the norm.
5-Optic neuritis
![Page 28: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/28.jpg)
![Page 29: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/29.jpg)
papilledema (d.t increased ICP). space occupying lesion of the optic nerve
head optic neuritis AION malignant hypertension CRVO Diabetic papillopathy others (panuveitis, scleritis, thyroid eye dis,
meningitis, uremia,…..)
Differential diagnosis of optic disc swelling ..
![Page 30: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/30.jpg)
PRESENTATION: reduced vision; may complain of diplopia if globe movement is restricted. Large lesions may also cause epiphora (tearing) and discomfort as a result of proptosis and the patient may complain of a red eye due to congested blood vessels.
OCULAR FINDINGS: few or no findings to a proptosed eye which is congested (conjunctiva is red and may be oedematous) and has a limited range of movement. VA reduced in later stages and there may be an RAPD
6-space occupying lesion of the optic nerve head
![Page 31: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/31.jpg)
papilledema (d.t increased ICP). space occupying lesion of the optic nerve
head optic neuritis AION malignant hypertension CRVO Diabetic papillopathy others (panuveitis, scleritis, thyroid eye dis,
meningitis, uremia,…..)
Differential diagnosis of optic disc swelling ..
![Page 32: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/32.jpg)
swelling of the optic disc from increased intracranial pressure (ICP)]
7- papilledema
![Page 33: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/33.jpg)
![Page 34: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/34.jpg)
Causes
1- space occupying lesion 2- decreased CSF drainage3-Idiopathic Intracranial Hypertenion4-increased CSF production such as from a choroid plexus tumor
![Page 35: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/35.jpg)
DETECT ?!
![Page 36: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/36.jpg)
Headache Nausea and vomiting . Visual fields often demonstrate increased size
of the blind spot. transient visual obscurations. Farsightedness (hypermetropia) may increase pulsatile tinnitus. peripheral visual field loss as seen in IIH. cranial nerve palsies, usually an abducens
palsy
Symptoms :
![Page 37: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/37.jpg)
According to grading:
signs
![Page 38: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/38.jpg)
Grade I papilledema is characterized by a C-shaped halo with a temporal gap
![Page 39: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/39.jpg)
Grade II papilledema, the halo becomes circumferential
![Page 40: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/40.jpg)
Grade III papilledema is characterized by loss of major vessels AS THEY LEAVE the disc (arrow)
![Page 41: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/41.jpg)
Grade IV papilledema is characterized by loss of major vessels ON THE DISC.
![Page 42: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/42.jpg)
Grade V papilledema has the criteria of grade IV plus partial or total obscuration of all vessels of the disc.
![Page 43: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/43.jpg)
![Page 44: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/44.jpg)
Fluorescein angiography
![Page 45: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/45.jpg)
Perimetry: enlarged blind spot
![Page 46: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/46.jpg)
CNS imaging study (CT or MRI with contrast).
![Page 47: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/47.jpg)
![Page 48: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/48.jpg)
The primary cause of the increased intracranial pressure must be addressed. If a mass is present, primary therapy should be directed towards that. If medications (tetracyclines, vitamin A analogues, etc.) are felt to be causative they should be discontinued.
![Page 49: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/49.jpg)
The visual prognosis is generally good if the intracranial pressure is controlled.
Prognosis
![Page 50: optic nerve head swelling](https://reader034.vdocuments.net/reader034/viewer/2022042819/55cd7e5bbb61eb61138b4865/html5/thumbnails/50.jpg)