DISC EDEMA    Working Towards The Cause

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September 2006.. www.riogohchennai.ac.in. 2. HISTORICAL INTEREST FUNDOSCOPY. 1704-Jean Merry- Animal Experiment1847-Charles Babbage- 1st primitive Ophthalmoscope1851- Von Helmholtz- Clinically useful Ophthalmoscope1860- Von Grafe- Reported disc changes in brain Tumour1908-Parson coined the term

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DISC EDEMA Working Towards The Cause

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1. www.riogohchennai.ac.in 1 September 2006. DISC EDEMA – Working Towards The Cause Prof. V. RAJARAM Sri Balaji Medical College Chennai.

2. September 2006. www.riogohchennai.ac.in 2 HISTORICAL INTEREST FUNDOSCOPY 1704-Jean Merry- Animal Experiment 1847-Charles Babbage- 1st primitive Ophthalmoscope 1851- Von Helmholtz- Clinically useful Ophthalmoscope 1860- Von Grafe- Reported disc changes in brain Tumour 1908-Parson coined the term Papilloedema 1911- Paton & Holmes differentiated Papilloedema from papillitis

3. September 2006. www.riogohchennai.ac.in 3 CLUE More changes in the disc- think of neurological problem More changes away from the disc with less or no changes in the disc – Think systemic or Intra ocular problems

4. September 2006. www.riogohchennai.ac.in 4 FUNDUS – NEUROLOGICAL INTEREST Papilloedema Papilitis Primary Optic Atrophy Sec. Optic Atrophy - Post papilloedemic Optic Atrophy Post Neuritic Optic Atrophy Glaucomatous Optic Atrophy Consecutive Optic Atrophy

5. September 2006. www.riogohchennai.ac.in 5 PAPILLOEDEMA PAPILLOEDEMA = DISC OEDEMA All disc oedema are not PAPILLOEDEMA PAPILLOEDEMA is a passive bilateral non inflammatory non ischemic disc swelling associated with increased intra cranial tension and normal vision with or without correction in the early stage

6. September 2006. www.riogohchennai.ac.in 6 PATHOPHYSIOLOGY OF PAPILLOEDEMA Increased ICT Trasmitted elevated CSF pressure in the sub arachnoid space around the optic nerve Interrurpted orthograde axoplasmic outflow PAPILLOEDEMA

7. September 2006. www.riogohchennai.ac.in 7 ICT WITHOUT PAPILLOEDEMA? POSSIBLE Unilateral POA with contralateral PAPILLOEDEMA - Foster-Kennedy Syndrome When there is preexisting bilateral optic atrophy - congenital or acquired arachnoid sheath disorders - opto-chiasmal arachnoiditis

8. September 2006. www.riogohchennai.ac.in 8 HOW TO DIAGNOSE- PAPILLOEDEMA EARLY PAPILLOEDEMA - Hyperemic Disc ( Telengectasis) Indistinct margin - Splinter Hge at or just off the disc margin - Absence of spontaneous venous pulsation

9. September 2006. www.riogohchennai.ac.in 9 ESTABLISHED PAPILLOEDEMA Disc margin more indistinct Cup filled Disc elevated more than 3D Venous engorgement and tortuous Flame shaped Hge around the disc

10. September 2006. www.riogohchennai.ac.in 10 CHRONIC PAPILLOEDEMA DISC elevated pale in appearance Margin blurred Hges and exudates gradually resolve

11. September 2006. www.riogohchennai.ac.in 11 ATROPHIC PAPILLOEDEMA Dirty white appearance of the disc Reactive gliosis from the disc Attenuation and sheathing of peripapillary part of the vessels

12. September 2006. www.riogohchennai.ac.in 12 DIFFERENTIAL DIAGNOSIS OF PAPILLOEDEMA PSEUDO PAPILLOEDEMA - High Hypermetropia - Cong disc anomaly - Drusen optic nerve head Hypertensive retinopathy Diabetic retinopathy Papillitis

13. September 2006. www.riogohchennai.ac.in 13 Distinguish

14. September 2006. www.riogohchennai.ac.in 14 INVESTIGATION Visual acuity Pupillary reaction Visual fields EOM FFA- In doubtful cases –Pseudo-papil BP

15. September 2006. www.riogohchennai.ac.in 15 INVESTIGATION-(CONTD) CT/MRI If SOL seen refer to Neurosurgeon if no SOL do LP and CSF analysis

16. September 2006. www.riogohchennai.ac.in 16 OPTIC ATROPHY OPTIC ATROPHY WILL HAVE PALE DISC BUT NOT ALL PALE DISCS ARE OPTIC ATROPHY

17. September 2006. www.riogohchennai.ac.in 17

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