OPTIC DISC SWELLING Flashcards

1
Q

What are the three broad categories of causes for optic disc swelling?

A

Intracranial - papilloedema

Ocular

Systemic

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2
Q

What is papilloedema?

A

Bilateral disc swelling due to raised intracranial pressure (ICP)

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3
Q

What are the symptoms of papilloedema?

A

Visual obscurations - transient loss of vision on standing up

Headache

Vomiting and nausea

Double vision - sixth nerve palsy

Reduced visual acuity

Reduced colour vision

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4
Q

What are the signs of papilloedema?

A

Venous engorgement

Absent spontaneous venous pulsations at the disc

Bilateral swollen hyperaemic discs

Elevated discs

Loss of optic cup

Disc haemorrhages

Blurring of disc margin

Visual field defect - bilateral enlarged blind spot

‘Champagne cork’ appearance - chronic

Optic atrophy

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5
Q

What are the causes of papilloedema?

A

Space occupying lesion

Idiopathic intracranial hypertension

Hydrocephalus

Meningitis

Sagittal sinus thrombosis

Hypercapnia

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6
Q

Which group is most at risk of developing idiopathic intracranial hypertension?

A

Young obese females

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7
Q

What investigations should be done for someone who presents with papilloedema?

A

Urgent CT / MRI - SOL

If normal CT/MRI do LP to assess for idiopathic intracranial hypertension - should only be done with neurologist referral

BM

BP

TFTs

CRP

FBC

Tests for uveitis

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8
Q

What are the ocular causes of optic disc swelling?

A

Central retinal vein occlusion

Uveitis

Optic neuritis

Ocular hypotony

Anterior ischaemic optic neuropathy

Optic disc infiltration - granulomatous as in sarcoidosis or malignant as in leukaemia

Leber’s optic neuropathy

Optic nerve tumours

Orbital thyroid disease

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9
Q

What are the causes of optic neuritis?

A

Multiple sclerosis

Diabetes

Syphilis

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10
Q

What are the features of optic neuritis?

A

Unilateral decrease in visual acuity over hours

Poor discrimination of colours - red saturation

Pain worse on eye movement

Relative afferent pupillary defect

Central scotoma

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11
Q

How do we treat optic neuritis?

A

High dose steroids

Needs investigating for MS with MRI

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12
Q

What is the likelihood of developing multiple sclerosing over the next 5 years if you have had optic neuritis?

A

Depends on what the MRI shows. If it shows more than 3 lesions then the chances are as high as 50%

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13
Q

What are the systemic causes of optic disc swelling?

A

Malignant hypertension - most common systemic cause

Anaemia

Uraemia

Hypoxia and hypercapnia

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14
Q

What are the clinical features of hypertensive retinopathy?

A

Disc swelling - malignant hypertension

Haemorrhages

Cotton wool spots

AV nipping

Copper/silver wiring

Macular oedema

Arterial microaneurysms

Choroidal ischaemia

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15
Q

What is the main clinical feature of hypertensive retinopathy that distinguishes it from diabetic retinopathy?

A

AV nipping - arteriole crosses a venule resulting in compression of the vein and bulging on either side of the compression.

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