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Unilateral Isolated Paucisymptomatic Optic Disc Edema.

Eman Hawy1, Rahul A Sharma, Jason H Peragallo

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Summary

Unilateral isolated optic disc edema (UIODE) diagnosis can be challenging. A systematic approach identified various causes, with only a few cases presumed to be the poorly defined papillophlebitis.

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Area of Science:

  • Ophthalmology
  • Neuro-ophthalmology
  • Medical Diagnostics

Background:

  • Unilateral isolated optic disc edema (UIODE) presents a diagnostic challenge, often leading to extensive work-ups.
  • Patients lacking a clear diagnosis are frequently labeled with the poorly defined term 'papillophlebitis'.
  • This study addresses paucisymptomatic UIODE cases to refine diagnostic strategies and clarify clinical features.

Purpose of the Study:

  • To describe characteristics of patients with paucisymptomatic UIODE.
  • To determine the optimal diagnostic approach for UIODE.
  • To clarify the clinical features of presumed papillophlebitis.

Main Methods:

  • Retrospective analysis of 29 patients with UIODE seen by neuro-ophthalmologists (2005-2019).
  • Comprehensive neuro-ophthalmic evaluation, including ophthalmic and systemic investigations.
  • Data collection on demographics, examination findings, and diagnostic work-up details.

Main Results:

  • A variety of diagnoses were identified in 29 UIODE patients.
  • Key diagnoses included idiopathic intracranial hypertension (10), optic nerve sheath meningioma (5), and nonarteritic anterior ischemic neuropathy (4).
  • Most patients achieved favorable visual outcomes, with variable duration of disc edema based on etiology.

Conclusions:

  • A systematic evaluation and long-term follow-up enabled definitive diagnosis in most UIODE cases.
  • Only 4 patients were presumed to have papillophlebitis, highlighting the controversial nature of this diagnosis.
  • The study emphasizes the importance of thorough investigation over the presumptive diagnosis of papillophlebitis.