Disk swelling ‐ differential diagnosis in orbital space occupying lesions

Abstract

AbstractWe frequently cannot decide with certainty whether a disk with blurred margins and slight elevation represents a pathologic condition or not. If unequivocal pathologic findings are lacking, it is up to the examiner to decide how far the diagnostic procedures should be carried out. It may be necessary to obtain neurologic consultation and to perform neuroradiologic investigations, including MRI and possibly angiographic techniques. On the other hand, after weighing the cost‐benefit ratio and the risk of some side effects, the investigator may rely on his clinical acumen and decide that the condition only represents a variant of the norm.Main differential diagnosis are pseudopapilledema in hyperopia, disk drusen, ocular hypotony, posterior scleritis, optic neuritis, disk edema (due to increased intracranial pressure, due to compression of the orbital part of the optic nerve), optic nerve tumours (meningioma, glioma), metastatic carcinoma, blurred disk margins without echographically demonstrable changes, congenital disk anomalies , central vein occlusion and anterior ischemic optic neuropathy.