Q.1 The following are associated with papilloedema?
A) Anterior ischemic optic neuropathy
B) Optic disc drusen
C) Hypermetropic disc
D) Intracranial mass
Q.2 Which of the following features are associated with disc edema?
A) Blurred disc margin
B) Visual field defect
C) Optic disc cupping
D) Optic atrophy
Q.3 What ophthalmic examinations will you perform on a patient suspected of or having disc edema?
A) Color vision
B) Visual acuity
C) Pupil for RAPD
D) Ocular motility
E) All of the above
Q.4 What visual field defects may present with papilledema?
A) Baring of Blind spot
B) Central scotoma
C) Enlargement of blind spot
D) Ceco-central scotoma
Q.1 Ans D The term “papilledema” describes optic disc swelling resulting from increased intracranial pressure. Causes of papilledema include intracranial tumors, idiopathic intracranial hypertension (pseudotumor cerebri), subarachnoid hemorrhage, subdural hematoma, and intracranial inflammation. Optic disc edema may also occur from many conditions other than papilledema, including central retinal artery or vein occlusion, congenital structural anomalies and optic neuritis, and anterior ischemic optic neuropathy.
Whiting AS, Johnson LN. Papilledema: clinical clues and differential diagnosis. Am Fam Physician. 1992 Mar;
Q.2 Ans A, B, and D. Signs of optic disc swelling include elevation and blurring of the disc margins, visual field loss, and eventually optic disc atrophy. Cupping is not classically associated with disc swelling.
Whiting AS, Johnson LN. Papilledema: clinical clues and differential diagnosis. Am Fam Physician. 1992 Mar;45(3):1125-34. PMID: 1543098.
Q.3 Ans E. These patients may demonstrate symptoms of visual loss, headache, nausea, vomiting, pain on ocular motility, decreased color vision, constriction of the visual field, and diplopia. Optic disc edema arises from the blockage of retrograde and orthograde axoplasmic transport in the optic nerve.
Urfalioglu S, Ozdemir G, Guler M, Duman GG. The evaluation of patients with optic disc edema: A retrospective study. North Clin Istanb. 2021 Apr 14;8(3):280-285. doi: 10.14744/nci.2020.25483. PMID: 34222810; PMCID: PMC8240241.
Q.4 Ans. C. In the acute stage, papilledema leads to enlargement of the blind spot, which is the most common and often the only visual field change. The papillomacular bundle and thus central visual acuity is spared until later stages of the disease. Central scotomaand cecocentral scotoma is in optic neuritis and toxic optic neuropathy. Baring of blind spot is an early, non-specific visual field change, without much diagnostic value in glaucoma.
Rigi M, Almarzouqi SJ, Morgan ML, Lee AG. Papilledema: epidemiology, etiology, and clinical management. Eye Brain. 2015 Aug 17;7:47-57. doi: 10.2147/EB.S69174. PMID: 28539794; PMCID: PMC5398730.