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A 56-year-old man with acute vision loss
Digital Journal of Ophthalmology 2016
Volume 22, Number 3
August 18, 2016
DOI: 10.5693/djo.03.2015.05.006
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Fani Akritidou | General Hospital of Kavala
Maria Karafyloglou | General Hospital of Kavala
Dimitrios Karamanis | General Hospital of Kavala
Differential Diagnosis
The differential diagnosis includes all of the most common causes of unilateral optic disc swelling,(1,2) such as anterior ischemic optic neuropathy, central retinal vein occlusion (unilateral, associated with an acute loss of vision), demyelinating optic neuritis, intracranial tumors, and orbital tumors and lesions (usually there are also motility defects and proptosis). However, optic disc swelling can also be a sign of papillitis (inflammatory, infiltrative, and infective conditions that cause true disc edema—typically unilateral condition with an accompanying vitritis), papillophlebitis (with mild visual loss and disc swelling in young, healthy patients), and diabetic papillopathy (frequently with a unilateral disc edema with minimal visual loss and resolving spontaneously). Finally, compressive optic neuropathy and Graves’ ophthalmopathy, which may include thyroid dysfunction, lid lag, and proptosis, can cause optic disc edema, as can Leber optic neuropathy, which occurs typically in young males (at an early stage there is unilateral acute and severe visual loss).

Causes of pseudopapilledema should also be considered. Finally, oblique insertion of the optic nerve head, small (heaped up) optic nerve head, myelinated nerve fibers, buried disc drusen (swelling of the optic nerve head due to infiltration by hyaline bodies, which can be associated with visual field defects or afferent pupillary defect) and remnants of the hyaloid canal can simulate real optic disc edema.