Bilateral optic disc edema with preserved visual function not related to papilledema

Area of Science:

• Ophthalmology
• Neuro-ophthalmology
• Neurology

Background:

• Bilateral optic disc edema (ODE) with preserved visual function is often attributed to papilledema.
• However, causes of ODE without elevated intracranial pressure require systematic evaluation.

Purpose of the Study:

• To identify the causes of bilateral optic disc edema with preserved visual function unrelated to intracranial hypertension.
• To aid in developing a differential diagnosis for this clinical presentation.

Main Methods:

• Retrospective review of 221 consecutive patients at a tertiary neuro-ophthalmology practice over two years.
• Analysis of four patients meeting inclusion criteria for bilateral ODE with preserved visual function and normal intracranial pressure.

Main Results:

• Four patients (mean age 53) were diagnosed with: optic perineuritis (p-ANCA vasculitis), incipient non-arteritic anterior ischemic optic neuropathy (NAION), hypertensive emergency, and intermediate uveitis.
• One patient with NAION developed visual field defect; others maintained normal vision.
• Optic disc edema resolved in all cases within 3-6 months.

Conclusions:

• Bilateral optic disc edema with preserved visual function can occur without papilledema.
• Differential diagnosis should include optic perineuritis, incipient NAION, hypertensive emergency, and intermediate uveitis.