Hypertensive Optic Disc Edema

    • Swollen optic discs in the setting of acute systemic hypertension
    • Signs of hypertensive retinopathy (and sometimes choroidopathy) are always present
    • Caused by leakage of optic disc capillaries
    • If vision loss is present, it is not attributable to an optic disc abnormality
    • Other brain effects of acute systemic hypertension may be present
    • Core features
      • Acquired optic disc elevation in both eyes
      • Tip: if optic disc edema is marked, do not blame malignant hypertension; look for an alternative cause
      • Cotton wool spots, flame-shaped retinal hemorrhages
      • Visual dysfunction, if present, is not caused by the optic disc abnormality
      • Predisposing condition is a relatively acute rise in systemic blood pressure
      • Fluorescein retinal angiography shows leakage at the optic disc and other abnormalities related to retinopathy and/or choroidopathy
    • Possible accompanying features
      • MRI may show signs of posterior reversible encephalopathy syndrome (PRES), brain hemorrhage, or ischemic stroke
      • Tip: new vision loss is usually attributable to retinopathy, choroidopathy, or PRES
      • Tip: intracranial pressure is not typically elevated
      • Tip: when choroidopathy predominates, a misdiagnosis of Harada disease may occur
    • Papilledema
    • Harada disease
    • Hypotensive optic neuropathy
    • Optic neuritis
    • Non-arteritic ischemic optic neuropathy
    • Infiltrative optic neuropathy
    • Optic disc edema in POEMS syndrome, perhaps caused by increased vascular permeability from high levels of vascular endothelial growth factor (VEGF)
    • Look for the fundus signs of hypertensive retinopathy and choroidopathy
    • Measure blood pressure
    • Tip: an acute relative rise in blood pressure is more contributory than the absolute level of blood pressure
    • Perform brain MRI to exclude PRES and other manifestations of acute systemic hypertension
    • Lower blood pressure slowly to avoid the adverse effects of relative systemic hypotension
    • Tip: if PRES is present, lowering of blood pressure is urgent to avoid ischemic stroke
    • Optic disc edema, other fundus signs, and visual dysfunction should disappear within weeks unless infarction has occurred
    • Trap: delay in diagnosis and lowering of blood pressure, or precipitous lowering of blood pressure, may lead to stroke in the visual cortex or optic disc and severe visual disability

    Optic Nerve And Chiasm Disorders

    Drusen Optic Neuropathy Colobomatous Optic Neuropathy Optic Pit Neuropathy Morning Glory Optic Neuropathy Hypoplastic Optic Neuropathy Typical Optic Neuritis Atypical Optic Neuritis Papillitis (Neuroretinitis) Non-arteritic Ischemic Optic Neuropathy Arteritic Ischemic Optic Neuropathy Posterior Ischemic Optic Neuropathy Hypotensive Ischemic Optic Neuropathy Radiation-induced Optic Neuropathy Diabetic Papillopathy Hypertensive Optic Disc Edema Papilledema Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) Compressive Optic Neuropathy: Overview Optic Neuropathy of Graves Disease Optic Nerve Sheath Meningioma Sphenoid Meningioma Craniopharyngioma Pituitary Adenoma Pilocytic Astrocytoma (Optic Glioma) Carotid Aneurysm Suprasellar Germinoma Infiltrative (Neoplastic) Optic Neuropathy Paraneoplastic Optic Neuropathy Traumatic Optic Neuropathy Toxic Optic Neuropathy Nutritional Deficiency Optic Neuropathy Dominantly-Inherited Optic Neuropathy Leber Hereditary Optic Neuropathy Primary Open Angle Glaucoma