optic nerve swelling differential diagnosis

2. You can notice:
 Disc hyperemia
 Blurred margins
 Nerve fiber layer (NFL) opacification and
swelling
 Disc elevation
 Tortous veins

4.  The headache was mainly at waking,
increased by coughing, associated with
nausea and vomiting

5.  Visual acuity, color vision, and pupillary
examination were normal.

7.  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,…..)

12.  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,…..)

13.  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

15.  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,…..)

16.  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,..)

18.  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,…..)

19.  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’

21.  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,…..)

22.  (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)

24.  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.

26.  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,…..)

27.  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.

29.  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,…..)

30.  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

31.  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,…..)

32.  swelling of the optic disc from increased
intracranial pressure (ICP)]

34. 1- space occupying lesion
2- decreased CSF drainage
3-Idiopathic Intracranial Hypertenion
4-increased CSF production such as from a
choroid plexus tumor

36.  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

44.  Fluorescein angiography

45.  Perimetry: enlarged blind spot

46.  CNS imaging study (CT or MRI with contrast).

48.  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.

49.  The visual prognosis is generally good if the
intracranial pressure is controlled.
