Clinical short communicationBilateral optic disc edema with preserved visual function not related to papilledema
Introduction
Optic disc edema (ODE) with preserved visual function has a differential diagnosis and differs between bilateral and unilateral cases. Hawy et al. reported a case series of 28 consecutive patients with unilateral ODE and preserved vision function and found that the top three causes were unilateral papilledema from idiopathic intracranial hypertension (IIH), optic nerve sheath meningiomas, and incipient non-arteritic anterior ischemic optic neuropathy (NAION) [1]. Bilateral ODE with preserved visual function is most often a result of papilledema from various causes including idiopathic intracranial hypertension (IIH) [2]. However, when raised intracranial pressure has been ruled out, the etiology can be difficult to discern. The differential diagnosis for this finding has not been systematically studied, and the investigations indicated in these circumstances remains unclear. The goal of this study was to determine the causes of bilateral ODE with preserved visual function not related to intracranial hypertension to help in developing a differential diagnosis for this finding.
Section snippets
Methods
We retrospectively reviewed consecutive patients presenting to a tertiary neuro-ophthalmology practice over a period of 2 years (July 2018 to June 2020) with bilateral ODE and preserved visual function. Research ethics board approval from the University of Toronto Research Ethics Board was obtained. Inclusion criteria included bilateral ODE and preserved visual function defined as a best corrected visual acuity (BCVA) of 20/25 or better in each eye and no defect identified on Humphrey 24–2
Results
A total of 221 consecutive patients with bilateral ODE were reviewed, and 217 were excluded as they had IIH or presumed IIH (n = 189) or papilledema secondary to an intracranial process (n = 28). Four patients met the inclusion criteria. Mean age of included patients was 53 years (range 43 to 63), and 2 patients were men and 2 were women. The final diagnoses were bilateral optic perineuritis secondary to p-ANCA vasculitis/microscopic polyangiitis (case 1), bilateral incipient NAION (case 2),
Discussion
Our review of consecutive patients with bilateral ODE revealed that causes unrelated to intracranial hypertension include bilateral optic perineuritis, incipient NAION, hypertensive emergency, and intermediate uveitis. Only the patient with NAION developed a visual field defect. The patient with bilateral optic perineuritis had bilateral episcleritis, which was a clinical clue to the localization to the orbits. Hypertensive urgency was suspected due to macular exudate, a cotton wool spot, and
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