Optic nerve diameters and perimetric thresholds in idiopathic intracranial hypertension

Idiopathic intracranial hypertension (IIH) is a central nervous disorder characterised by abnormally increased cerebrospinal fluid (CSF) pressure leading to optic nerve compression. An indirect estimate of increased CSF pressure can be obtained by the ultrasonographic determination of optic nerve sheaths diameters. Computerised static perimetry is regarded as the method of choice for monitoring the course of the optic neuropathy in IIH. The aims were to compare the echographic optic nerve diameters (ONDs) and the perimetric thresholds of patients with IIH with those of age-matched controls, and to examine the correlation between these two variables in individual patients with papilloedema.

Standardised A-scan echography of the mid orbital optic nerve transverse diameters and automated threshold perimetry (Humphrey 30-2) were performed in 20 patients with IIH with variable degree of papilloedema (according to the Frisén scheme) and no concomitant ocular diseases. Echographic and perimetric results were compared with those obtained from 20 age-matched controls.

When compared with controls, patients with IIH showed a significant increase in mean ONDs and significantly reduced mean perimetric sensitivities. In individual patients with papilloedema, the transverse ONDs correlated negatively with Humphrey mean deviation values and positively with pattern standard deviation values.

These results indicate that OND changes in IIH are associated with perimetric threshold losses, and suggest that IIH functional deficits may be related to the degree of distension of optic nerve sheaths as a result of an increased CSF pressure.