Urgent advice line: 01708 435 000 Ext. 6662

Please fill in the urgent eye care referral form [docx] 17KB and email it to bhrut.urgenteyecare@nhs.net

Optic disc swelling

Optic disc swelling can be seen in the context of several clinical scenarios including optic neuritis, optic neuropathies, retinal vein occlusion, papilloedema, or can be due to pseudo-disc swelling (e.g optic disc drusen).

Optic neuritis:

  • This is always associated with optic nerve function loss: decreased vision, RAPD, decreased colour vision, depressed visual field, or a caeco-central visual field defect. Often seen in young patients
  • Please provide a detailed account of findings and refer by email
  • Consider MRI imaging to assess for demyelinating disease and liaise with neurology

Optic neuropathies:

a) Arteritic Ischaemic Optic Neuropathy: the main cause is giant cell arteritis.

i. An elderly patient with systemic signs of general malaise, musculoskeletal pains, headaches, scalp tenderness, jaw claudication, malaise, appetite loss and other systemic signs requires immediate referral to main Emergency Department. The patient needs an ESR/CRP and medical assessment..

American college of Rheumatology diagnostic criteria for GCA (positive if 3 out of 5 present)
Criteria Details
Age >/ 50 years Symptoms begin at age 50 or above
Headache New onset. Often around the temporal scalp area
Raised ESR ESR >50 mm/hr by Westergren method
Temporal artery abnormality Tenderness over the area where the temporal artery runs or lack of palpable pulsation
Temporal artery biopsy (TAB) TAB shows granulomaotus inflammation with multi nuclei giant cells

ii. Vision loss in the context of giant cell arteritis presents as acute and severe vision loss.

Please contact the eye department emergency service by phone on the number 01708 435 000 ext. 6662 to arrange a review on the same day.

iii. Giant cell arteritis can sometimes present with horizontal diplopia caused by sixth cranial nerve palsy, in addition to other systemic signs and symptoms.

b) Optic neuropathies other than that associated with giant cell arteritis would include visual field loss, visual acuity and colour vision loss, and RAPD. Causes included infiltrative diseases (tumours/sarcoidosis), trauma, nutritional (B12/folate deficiency), toxic causes (methanol, ethambutol, amiodarone) or hereditary causes (Lebers heredity optic neuropathy). Often in an elderly patient. These tend to have a long-standing onset.

Please include any past medical history, medication or imaging results which may be useful.

Central retinal vein occlusion:

This can sometimes be associated with optic disc swelling in addition to the expected retinal haemorrhages and venous engorgement.

Disc swelling in the context of papilloedema:

This is due to raised intracranial pressure. This is associated with headaches, visual obscuration, swollen optic discs, and venous congestion and tortuosity. Visual acuity and fields are commonly unaffected, but this is variable. It is often associated with a history of weight gain.

Please provide a detailed account of findings with any fundus photography or OCT images of the optic disc if possible.

Pseudo disc swelling

This is common and the patient typically does not have any other visual symptoms.

For suspected disc swelling with no other symptoms and where you are not able to be sure of the diagnosis, please provide a fundus photo and an OCT image of the disc if possible and send for advice and guidance.

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