Approach to patient with unilateral optic disc edema and normal visual function.

Area of Science:

• Ophthalmology
• Neurology
• Neuroimaging

Background:

• Optic disc drusen (ODD) is a frequent finding in patients presenting with a swollen optic nerve head and preserved visual function.
• Distinguishing ODD from other causes of optic disc swelling is critical for appropriate patient management.

Purpose of the Study:

• To outline a diagnostic approach for patients with optic disc swelling and normal visual function.
• To differentiate ODD from other serious neurological conditions that can mimic its presentation.

Main Methods:

• Utilizing fundus autofluorescence and enhanced-depth imaging ocular coherence tomography (EDIOCT) for ODD detection.
• Performing MRI of the brain and orbits with contrast and venography to evaluate for increased intracranial pressure (ICP) and other pathologies.
• Conducting lumbar puncture with opening pressure measurement and cerebrospinal fluid (CSF) analysis when indicated by imaging or clinical signs.

Main Results:

• EDIOCT and fundus autofluorescence are highly effective in diagnosing ODD.
• Asymmetric papilledema, after ruling out ODD, necessitates neuroimaging to identify potential causes of elevated ICP, optic perineuritis, or compressive lesions.
• MRI findings suggestive of raised ICP warrant lumbar puncture, especially in atypical cases or those with specific clinical symptoms.

Conclusions:

• A systematic diagnostic pathway is essential for managing optic disc swelling.
• Ophthalmological and neurological evaluations, including advanced imaging and CSF analysis, are key to accurate diagnosis and timely intervention.