The Swollen Optic Disc in Childhood

Abnormal optic disc and retinal vessels in children with surgically treated hydrocephalus

“…Optic atrophy is characterised by a similar histopathology, except that the diameter of the optic nerve may be diminished in some cases but preserved in others 4 7. It is possible that ONH could be regarded as a non-progressive optic atrophy acquired at any time before full development of the visual system 7.…”

The diagnostic challenge of evaluating papilledema in the pediatric patient

“…Similar to retinal ganglion cell atrophy exhibited in late papilledema, chronic ODD may also show nerve fiber layer defects on OCT. Orbital computed tomography (CT) and B-scan ultrasonography both may demonstrate calcification within the optic disc though ultrasound is much more sensitive and reliable than CT imaging at detecting ODD and avoids radiation exposure. [ 3 ] Acoustic shadowing at the junction of the retina and the optic nerve is a telltale sign of ODD on ultrasound. Another distinguishing sign includes the “30° test” during the B-scan, in which the patient is directed to look 30° laterally.…”

“…FAF may detect buried drusen which may not appear on dilated fundus examination, exhibiting papillary fluorescence corresponding to surface or superficially buried drusen. [ 3 ] Autofluorescence can be detected using angiography filters before injection of contrast[ 5 ] or using the FAF mode on some OCT imaging equipment. EDI-OCT images deeper structures of the choroid and optic nerve head.…”

“…[ 7 ] Some of the proposed mechanisms by which damage to visual function occurs with ODD include impediment of axonal transport, atrophic degeneration from compressive factors, and focal vascular occlusions. [ 3 ] Others suggest that ODD are simply a byproduct of slow axonal degeneration due to underlying structural irregularities of the optic disc and that they represent a structural corollary rather than a direct cause of chronic optic neuropathy progression and vision loss. [ 3 ] Typically, visual field deficits are mild to moderate, and most patients remain asymptomatic throughout their lives.…”

“…[ 3 ] Others suggest that ODD are simply a byproduct of slow axonal degeneration due to underlying structural irregularities of the optic disc and that they represent a structural corollary rather than a direct cause of chronic optic neuropathy progression and vision loss. [ 3 ] Typically, visual field deficits are mild to moderate, and most patients remain asymptomatic throughout their lives.…”