Bilateral swollen optic nerve head etiology and management

Abstract

Background & Aim: The differential diagnosis of bilateral swollen optic nerve head varies according to the presence of unilateral or bilateral edema and also varies according to the presence of reduced visual acuity or normal visual acuity.

This study aimed to find out the causes of bilateral swollen optic nerve head and their prevalence among patients attending Al-Assad and Al-Mouawast University Hospitals in Syria, emergency management, Observing the extent of edema response to treatment within a month.

Materials and Methods: This cross-sectional study was conducted in Al-Assad and Al-Mowasat Hospitals in Damascus during the time period from October 2020 to the beginning of  February 2022.It included 50 patients who visited the neurological department in the two hospitals, aged over 18 years, and it was found that they had bilateral optic nerve head edema ,then they were carefully examined in the ophthalmological department to exclude pseudoedema (Drusen) and determine the visual acuity .Then a full study was carried out to reach the diagnosis and management appropriately and to monitor the extent of The efficacy of conservative measure in reducing edema, and how many of them needed surgical intervention.

Results: the study included 50 patients, 13 males and 37 females, the most common diagnosis was venous sinus thrombosis (12 cases with 24%), followed by idiopathic intracranial hypertension and tumors (10 cases each by 20%), infectious meningitis (8 cases by 16%), leptomeningeal metastasis (5 cases by 10%), arterial hypertension (3 cases by 6%) and autoimmune meningitis (2 by 4%). Edema improved after management within a month in most patients (37 patients by 74%) while it worsened or remained the same in 13 patients (by 26%) and edema was accompanied by low visual acuity in 21 patients (4%). 30 patients (60%) improved with conservative treatment, while 20 patients (40%) needed surgical intervention. Visual acuity reduced in 10 patients (20%) despite all treatments, including surgical treatment.

Conclusion: venous sinus thrombosis is the most common cause of bilateral optic nerve head edema then idiopathic intracranial hypertension and tumors, and despite the provision of all treatments, the visual acuity of 20% of patients has decreased.