swollen optic disc Q - list causes and describe signs/symptoms Flashcards
Papilloedema
swelling and raising of ONH in the back of the eye
result of increased pressure in and around the brain
can also be result of mass in brain e.g. tumour, trauma of infection in CNS or infiltration
Optic nerve is connected to the brain
between the brain and the eye, the optic nerve is surrounded by cerebral spinal fluid and so an increase in the CSF can compresses the optic nerve leading to inflammation and swelling
Symptoms/ signs of Papilloedema
symptoms vary depending on depending on stage papilloedema
4 stages:
- early stage: px occasionally asymptomatic
- can present with headaches usually waking px up from sleeps which gets worse on head movement.
- Nausea and vomiting can occur at the same time as H/A. but the visual symptoms are absent at this point.
- On disc appearance we will see disc hyperaemia in which it does appear elevated and there will be an absent SVP but in this stage but the VA is usually normal, colour vision is normal as well as pupil responses. - acute/ established stage:
- same systemic symptoms
- begin to get transient visual loss lasting a few seconds with normal or slightly reduced VA
- VF shows enlarged blind spot and sic shows severe redness, moderate elevated, optic nerve head looks bigger with loads of haemorrhages and cotton wool spots. - Chronic stage:
the vision is reduced and the VF is restricted
- VA varies from 6/12 to 6/60 with nasal loss, arcuate defects and generalised depression.
- The disc appearance will be pale due to axonal loss with severe disc elevation
- cotton wool spots and haemorrhages NOT present with the development of optociliary shunt vessels - last atrophic stage:
VA and fields is severely reduced and the disc is pale with mild elevation.
Arteritic anterior ischaemic optic neuropathy (AAION)
involves rapid loss of vision as a result of interrupted flow of blood to the optic nerve in the back of the eye and so inflamed arteries supplying the ON, due to a condition known as GCA.
systemic symptoms include:
- tender and hardened temporal artery with a big vein popping out at that region
- whilst brushing their hair they notice that they have a very tender scalp which may cause it to become inflamed and irritated.
- If they also have GCA then they are more likely to have jaw claudication which is pain when speaking etc, proximal muscle weakness on the shoulders at the side where the eye is affected so in this case it will be the left side.
- They will also present with a reduced appetite so unable to consume as much food, they will begin to lose weight and will be lethargic throughout the day.
-Headache which may be frontal or temporal.
visual symptoms include:
- sudden loss of vision due to blockage of blood supply,
- pain around the eye typically affecting one eye
- may also present with transient visual disturbances such as flashes. VA check, ishihara, test RAPD
Non-arteritic anterior ischaemic optic neuropathy
a vascular condition in which there is compromised blood flow to the optic nerve.
Once the blood flow is compromised there is damage to the optic nerve head kind of like a mini stroke to the optic nerve.
NAION symptoms
sudden and painless loss of vision in the one eye with a lack of systemic symptoms.
- may notice deterioration of vision on wakening.
Signs include:
VA - moderate to severe reduction ranging from 6/12 to 6/24.
VF check - mostly altitudinal inferior defects.
ishihara test - we find out the patient has a colour vision deficiency.
The pupil responses are not too good with the patient showing an RAPD.
Fundus examination shows disc oedema which can be at one location or across the full disc with also redness.
Telangiectasia may be noticed on the surface of the disc
Optic neuritis
typically caused by inflammatory, infective or demyelination of the Optic Nerve Head.
- Infective causes include local infection e.g. syphilis, lime disease, herpes zoster or cat scratch disease
viral infection cause e.g. chicken pox, whooping cough, grandular fever, measles, mumps
inflammation of the optic nerve head may happen as a result of sarcoidosis or autoimmune and demyelination as a result of multiple sclerosis.
Optic neuritis symptoms
- monocular visual impairment
- Subacute - develops over several days - 2 weeks
- discomfort, exacerbated by eye movements which precedes visual loss in majority of cases
- globe tenderness
Optic neuritis signs
VA - 6/18 - 6/60 or worse
RAPD
reduced colour vision
reduced contrast sensitivity
VF - central loss, generalised depression, nerve fibre bundle defects
Neuroretinitis
inflammatory disorder which causes optic disc oedema and formation of a macular star. Infective causes include cat-scratch disease.
Diabetic papillopathy
a condition characterised with optic disc oedema and loss of vision
typically seen in diabetic patients.
causes swelling of the optic nerve head due to vascular leakage in and around the optic nerve head due to possible damage of smaller capillaries .
Optic nerve sheath meningioma
benign tumour beginning from the arachnoid cap cells at the optic nerve sheath.
In simple terms a sheath surrounds the optic nerve and along this sheath a benign tumour can form.
The optic disc is raised due to the tumour surrounding and compressing the nerve.
Optic nerve glioma
a slow growing tumour that begins to develop in and around the optic nerve, again the compression to the optic nerve makes it raised
Optic nerve melanocytoma
a benign tumour made up on melanocytes which tends to grow but doesn’t become malignant- if this is close to the optic nerve and then it may compress leading to raised disc appearance
Inherited optic neuropathy
this one tends to be inherited and so there most likely is a family history of this condition such as a mutation to certain genes. The swelling of the disc may occur due to pseudo-oedema of the NFL
Traumatic optic neuropathy
optic nerve damage as a result of trauma to the eye, the direct compression can lead to raising of the optic disc
