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 pulsations (but this is absent in 20% of people anyway).
- Papillitis – characterised blurred disc margins, that is usually unilateral, associated with decreased visual acuity and red desaturation, a central scotoma and relative afferent pupillary defect and pain on eye movements.
- Optic atrophy – pale insipid optic disc (loss of the normal yellowish colour), with absence of normal physiological cupping.
- space-occupying lesions (e.g. neoplasms, trauma, infection, and vascular causes)
- benign intracranial hypertension (trauma, drugs, idiopathic, Addisons, sinus thrombosis)
- central venous sinus thrombosis
- hydrocephalus – obstructive, communicating (production vs. absorption of CSF)
- high CSF protein — e.g. Guillain-Barre Syndrome
- central retinal vein occlusion (CRVO)
- retro-orbital mass
- hypertension (grade IV)
Pseudopapilledema mimics papilloedema and may result from the presence of optic disc drusen or a congenitally anomalous disc.
- multiple sclerosis
- viral — e.g. infectious mononucleosis, herpes zoster, viral encephalitis
- childhood infections or vaccinations — e.g. measles, mumps, chickenpox
- Granulomatous inflammations — e.g. tuberculosis, syphilis, sarcoidosis, cryptococcus
- Contiguous inflammation of the meninges, orbit, or sinuses.
The differential includes optic neuropathies such as:
- toxic optic neuropathy — e.g ethambutol, chloroquine, nicotine, alcohol
- metabolic optic neuropathy — vitamin B12 deficiency
- ischemic optic neuropathy — diabetes mellitus, giant cell arteritis, atherosclerosis
- compressive optic neuropathy — e.g. orbital tumour, intracranial mass
Optic atrophy may be the end stage of:
- chronic papiloedema
- chronic optic neuritis
- optic neuropathies (e.g. toxic, metabolic, ischemic and compressive)
- familial, e.g. retinitis pigmentosa
References and Links
- Ophthalmology Befuddler 009 — That optic disc doesn’t look right
Journal Articles and Textbooks
- Ehlers JP, Shah CP, Fenton GL, and Hoskins EN. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease (5th edition), Lippincott Williams & Wilkins 2008.