True and pseudo optic disc oedema facts
Pseudo optic disc edema Due to Drusen
• Nerve fiber layer around the disc is clear and sharp
Lumpy waxy appearance
• Vessels ride over top of disc (not buried within it)
• Increased number and branching of vessels on the disc (increased traffic),three or more vessel
branching points are seen on the disc
• Elevated center of disc
True optic disc oedema
• Edema lines are seen concentric to the temporal disc (Paton’s lines)
• Hemorrhages and exudates around disc
• The nerve fibers around the disc are not sharp and are more opaque
• An increasing blur at the disc border
• The vessels pass through the substance of the disc ( burried ) rather than on the surface
True and pseudo optic disc oedema facts PowerPoint presentation :
Dd of disc edema
1. Guide: Dr Anupama Karanth Presenter: Dr Madhurima
2. Causes of pseudo disc edema • Optic nerve head drusen : disc elevation • Medullated nerve fibres : blurred margins • Morning glory syndrome: elevated disc • Tilted disc: blurred margins • Small hyperopic disc: hyperemic disc • Optic disc dysplasia • Bergmeister’s papilla
3. True disc edema Pseudo disc edema Disc color Hyperemic Yellow Nerve fibre layer Opacified Transparent Large vessels Normal Anomalous- trifurcation, spoke like Small vessels Telangiectatic Normal
4. True disc edema Pseudo disc edema Spontaneous venous pulsation Absent Present in 80% Hyaline bodies Absent May be present Optic cup Normal initially, filled Small or absent Nerve fibre layer hemorrhages Frequent Absent Fluorescein angiography Dye leakage at disc No leakage/ late staining
5. • Hyaline like calcific material in the substance of optic nerve head, autofluorescence, trifurcation of vessels • Causes disc edema if buried, diagnosed by B Scan
6. • Obliquely entering nerve, inferonasal chorioretinal thinning • Bitemporal hemianopia Blurred margin Nasally entering vessels
7. Large disc with funnel shaped excavation surrounded by chorioretinal atrophy, with central tuft of white material Spoke like vessels Elevated disc Hyperemic
8. Presence of feathery grey streaks may simulate disc edema, but distal fan shaped appearance aids recognition Feathery streaks Margins blurred, disc elevated
9. Mechanical signs Elevation of the optic disc (3D=1mm) Blurring of the optic disc margins Filling in of optic cup Edema of peripapillary nerve fiber Retinal or choroidal folds Vascular signs Hyperemia of disc Venous congestion Peripapillary hemorrhages Exudates in disc or peripapillary area Nerve fiber layer infarcts
10. Diagnosis is done best by binocular stereoscopic viewing using a high convex lens, with magnification especially to detect the subtle changes in disc elevation.
11. Once true disc edema is established, papilledema (due to raised ICT) has to be distinguished from other optic neuropathies which can be of varied etiology The main difference is visual acuity and optic nerve function which is normal in papilledema and disturbed in papillitis.
12. Papilledema is a bilateral, passive, non inflammatory swelling of the optic disc secondary to raised intracranial tension Stages of papilledema: • Early papilledema • Established papilledema • Chronic papilledema • Atrophic papilledema
13. Difficult to diagnose Disc hyperemia Blurring of peripapillary retinal nerve fibre layer Blurring of the disc margins Disc elevation Dilatation of retinal veins Hemorrhages on disc margins Absence of spontaneous retinal vein pulsations (normal in 20% population)
14. Established papilledema: obscuration of all borders, disc elevated, cup filled, blood vessels obscured on the surface, peripapillary hemorrhages. Chronic papilledema: cup is obliterated, hard exudates occur within the nerve head Post papilledema atrophy: post neuritic type, arterioles are narrowed or sheathed, optic disc appears dirty gray and blurred
15. Early papilledema Chronic papilledema Atrophic papilledema Established papilledema Yanoff and Duker
16. Papilledema Papillitis Laterality Bilateral Unilateral Symptoms Transient loss of vision Sudden diminution of vision No pain Pain on extra ocular movement Pupillary reaction Normal RAPD Media Clear Posterior vitreous cells
17. Papilledema Papillitis Disc elevation 2-6 D Does not exceed 2-3D Venous engorgement, peripapillary hemorrhages More frequent Less frequent
18. Papilledema Check BP Stage IV hypertensive retinopathy Bilateral disc edema, other signs of raised ICT
True and pseudo optic disc oedema facts Videos:
Approach to the Patient with Bilateral Optic Disc Swelling – YouTube
True and pseudo optic disc oedema facts