Optic Nerve
Patient Presentation
- 31-year-old female social worker
- Presenting Complaint: 2-month history of fluctuating vision in both eyes, becoming more permanent in the last 3 weeks.
- Peripheral Vision: Affected, unable to see cars unless turning head.
- Associated Symptoms:
- Denies flashes or floaters.
- Occasional side-to-side diplopia when watching TV (last 3 months).
- Intense and persistent headaches over the whole head (last month), worse when lying down.
- Occasional “whooshing” sound in ears.
- Past Ocular History: Negative.
- Trauma or Surgery: Denied.
- Family History: Negative for macular degeneration, glaucoma, or other blinding diseases.
- Medications: Multivitamin.
- Allergies: No history of allergies.
Ocular Exam
- Visual Acuity:
- OD: 6/9
- OS: 6/9
- IOP (tonoapplantation):
- OD: 13 mmHg
- OS: 12 mmHg
- Pupils: Round and reactive bilaterally.
- Extraocular Movements: Full OU.
- Confrontational Visual Fields: Visual field defects superionasally and superiotemporally.
- External: Normal, both eyes.
- Slit Lamp: Normal.
Fundus Examination
- Revealed findings consistent with papilledema.
Diagnostic Features
- Symptoms
- Vision
- Bilaterality
- Field
Papilledema
Differential Diagnosis
DD of Papilledema
- Pseudo papilledema
- Papilitis
Investigations
Ophthalmological Examination
- VA
- Pupillary response: relative afferent pupillary defect (RAPD)
- Ocular motility
- VF examination
- Fundus examination
- FA and OCT
Investigations
-
CT or MRI
-
Lumbar puncture
-
Blood pressure
-
Benign intracranial tension for lumbar puncture
Treatment
Treat the Cause