OPTIC DISC SWELLING Flashcards
What are the three broad categories of causes for optic disc swelling?
Intracranial - papilloedema
Ocular
Systemic
What is papilloedema?
Bilateral disc swelling due to raised intracranial pressure (ICP)
What are the symptoms of papilloedema?
Visual obscurations - transient loss of vision on standing up
Headache
Vomiting and nausea
Double vision - sixth nerve palsy
Reduced visual acuity
Reduced colour vision
What are the signs of papilloedema?
Venous engorgement
Absent spontaneous venous pulsations at the disc
Bilateral swollen hyperaemic discs
Elevated discs
Loss of optic cup
Disc haemorrhages
Blurring of disc margin
Visual field defect - bilateral enlarged blind spot
‘Champagne cork’ appearance - chronic
Optic atrophy
What are the causes of papilloedema?
Space occupying lesion
Idiopathic intracranial hypertension
Hydrocephalus
Meningitis
Sagittal sinus thrombosis
Hypercapnia
Which group is most at risk of developing idiopathic intracranial hypertension?
Young obese females
What investigations should be done for someone who presents with papilloedema?
Urgent CT / MRI - SOL
If normal CT/MRI do LP to assess for idiopathic intracranial hypertension - should only be done with neurologist referral
BM
BP
TFTs
CRP
FBC
Tests for uveitis
What are the ocular causes of optic disc swelling?
Central retinal vein occlusion
Uveitis
Optic neuritis
Ocular hypotony
Anterior ischaemic optic neuropathy
Optic disc infiltration - granulomatous as in sarcoidosis or malignant as in leukaemia
Leber’s optic neuropathy
Optic nerve tumours
Orbital thyroid disease
What are the causes of optic neuritis?
Multiple sclerosis
Diabetes
Syphilis
What are the features of optic neuritis?
Unilateral decrease in visual acuity over hours
Poor discrimination of colours - red saturation
Pain worse on eye movement
Relative afferent pupillary defect
Central scotoma
How do we treat optic neuritis?
High dose steroids
Needs investigating for MS with MRI
What is the likelihood of developing multiple sclerosing over the next 5 years if you have had optic neuritis?
Depends on what the MRI shows. If it shows more than 3 lesions then the chances are as high as 50%
What are the systemic causes of optic disc swelling?
Malignant hypertension - most common systemic cause
Anaemia
Uraemia
Hypoxia and hypercapnia
What are the clinical features of hypertensive retinopathy?
Disc swelling - malignant hypertension
Haemorrhages
Cotton wool spots
AV nipping
Copper/silver wiring
Macular oedema
Arterial microaneurysms
Choroidal ischaemia
What is the main clinical feature of hypertensive retinopathy that distinguishes it from diabetic retinopathy?
AV nipping - arteriole crosses a venule resulting in compression of the vein and bulging on either side of the compression.
