Ophthalmology · MU Sofia

72. Oedema of the optic disc

Covers optic disc oedema, distinguishing papilloedema, which is driven by raised intracranial pressure, from other causes of disc swelling such as papillitis and vascular or orbital disease. It lists causes, the pathogenesis via axoplasmic stasis at the lamina cribrosa, and clinical features across four named stages from early to atrophic. It ends with treatment and prognosis and a differential from papillitis.

Inside: 1 section · 4 labelled pictures · 15 flashcards · 3 min

Topic 72 of 91 in the MU Sofia syllabus for Ophthalmology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 401 words (3 min of reading), with 15 flashcards.

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  1. Papilloedema & vascular disease of the optic nerve Topic 47

Papilloedema & vascular disease of the optic nerve Topic 47

= similar disc oedema (Papillitis) and are swelling of the optic disc but papilloedema= disc swelling due to passive associated with IOP which is usually always bilateral but may be asymmetrical

In general the following cause disc oedema (both of aforementioned)

  1. 1. Inflammations (Papillitis, Neuroretinitis)
  2. 2. ocular diseases (uveitis &vein occlusion)
  3. 3. Orbital causes (graves, tumours and orbital cellulitis)
  4. 4. Vascular causes (anaemia, uraemia)
  5. 5. Secondary to IOP (papilloedema)
  • Brain tumours, abscess, tuberculoma, aneurysms, lesions or inflammation of cerebellum, medulla oblongata etc.
  • Intracranial infections (meningitis, encephalitis)
  • Intracranial haemorrhages (cerebral and subarachnoid)
  • Tumours of spinal cords and CSF obstruction
  • Systemic: Hypertension, pregnancy HP ,nephritis, cardio problems
  • Cerebral oedema (bleeding) after trauma

Pathogenesis :

-caused by stasis of axoplasm in the prelaminar region of the optic disc due to an alteration in the pressure gradient across the lamina cribrosa

- the abovementioned caused change the gradients thus cause

- venous congestion and ultimately extracellular oedema

-it develops quickly within a few days and recovers slow

Clinical presentation

-related with IOP= headache ,nausea, diplopia & vomiting

-Ocular features = blackouts, reduced visual acuity + pupillary actions may be slower at later stager and they are divided up into 4 stages

1. Early

  • Symptoms absent ,normal visual acuity, pupillary and visual field
  • Signs : margins become unclear , mild hyperaemia and usually lack of pulsating vein, cup still visible but not as clear

2. Fully developed

  • Symptoms only when standing and not for long + normal pupillary and normal acuity
  • Signs: obvious oedema as disc is now elevated and no cup Big hyperaemia + blurry margins all around + engorged veins + visual field shows enlargement of blind spot

3. Chronic papilloedema

  • DD visual acuity is reduced but pupillary reaction normal
  • Acute haemorrhages but peripapillary oedema is resorbed and white splash is seen instead of the disc
  • Big enlargement of blind spot & visual field=constricted

4. Atrophic papilloedema

  • Severely impaired visual acuity after 6-9 months of chronic
  • DD pupillary light reflex is impaired
  • Decrease in congestion and narrowing retinal arterioles and white striped (sheath) can be seen around vessels
  • Atrophy around disc seen as bigger whiter circle
  • Visual field is concentric DD

Treatment and prognosis

It is a neurological emergency and requires immediate hospitalisation

Treating of underlying cause and it is usually chronic bad thus has a bad prognosis

Differential from Papillitis

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