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Swollen Optic Disc

Swollen optic disc

Blurred optic disc margins
The optic disc tissue rises above the surface and its margins are blurred. These findings could be caused by a congenital optic disc anomaly or by optic disc edema, an acquired slowing of axoplasmic flow.

Differentiating between congenital and acquired optic disc swelling is tough. The presence of hemorrhages and cotton wool spots is a sign of an acquired disorder.

Optic disc margin hemorrhages
They reflect ischemic leakage of retinal vessels on the optic disc surface.

Cotton wool spots
The toothpaste-like white spots on the disc surface. They reflect explosion of ischemic axons and leakage of their axoplasm.

Swollen optic disc
At any age, think of increased intracranial pressure (ICP), particularly if both eyes have swollen optic discs. The increased ICP slows down axoplasmic flow at the optic disc, and the axons become constipated. If the pressure remains high, they may explode or die quietly without exploding. In young individuals, inflammation is a common cause; in the elderly, think of infarction caused by microvascular occlusion, especially in chronic hypertension and sudden hypotension.

Patients who have swollen optic discs on the basis of increased ICP may not notice any visual loss at first. In other causes, they will report blurred vision, but it may not involve the center of the visual field.

What to do?
Refer immediately to an ophthalmologist. Increased intracranial pressure is a rule-out, particularly if swelling is binocular. Giant cell arteritis is a consideration in the elderly, particularly if the patient has had acute vision loss in one or both eyes. No matter the cause, the problem is always serious, and it demands emergent evalution.

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