Optic disc swelling: Prospective study of sixty‐seven patients

Abstract

PurposeTo assess the clinical features and etiologic work‐up of patients presenting with optic disc swelling (ODS) in the emergency room.MethodsPatients seen in the ophthalmology emergency department of a single tertiary center between November 2014 and October 2015 were prospectively included. Each patient underwent an etiologic work‐up including a brain‐MRI, blood work, fluorescein angiography, and visual evoked potential.Results67 patients (39 female and 28 male) were included in this study. Average age was 46 years (17–86 years). ODS was unilateral in 45% of cases and bilateral in 55% of cases. The average time between the onset of symptoms and diagnosis of papillary edema was 80 days (3 days to 8 months). The mean initial visual acuity was 0.2 logMAR, and the mean final VA was 0.1 logMAR. Final diagnosis was intracranial idiopathic hypertension (43%), anterior ischemic optic neuropathy (25%), inflammatory or infectious papillitis (22%), compressive optic neuropathy (2%) and unknown in 3 cases (8%). The etiologic work‐up was contributive for the final diagnosis in 10% of cases for fluorescein angiography; 35% for MRI of the optical nerve; 32% for laboratory tests; 67% for visual evoked potentials; 90% for the visual field of Goldman. Findings of Goldman's visual field included central or caecocentral scotoma (32%), exclusion or enlarged blind spot (41%), inferior altitudinal scotoma (19%), and bitemporal quadrantanopia (5%).ConclusionsOur results demonstrate that causes of ODS could be identified in 92% of patients presenting with ODS. According to the clinical features at presentation, the etiologic work‐up can be further adjusted but a standard minimal etiologic work‐up is usually efficient to state the diagnosis.