Trends and Clinical Characteristics of Pediatric Patients Presenting to an Ophthalmology Emergency Department with an Initial Diagnosis of Optic Nerve Head Elevation

Abstract

Objective Optic nerve head elevation may be the only clinical sign of a vision- and/or life-threatening condition, particularly in children who are asymptomatic or fail to report symptoms. The purpose of this study is to identify epidemiologic trends, clinical characteristics, and diagnostic outcomes of pediatric patients presenting to an ophthalmology emergency department (ED) with suspected optic nerve head elevation. Methods This retrospective study identified pediatric patients (≤18 years) presenting to an ophthalmology ED over a five- year period with suspected optic nerve head elevation to describe demographic trends, clinical characteristics, and diagnostic outcomes. Results Of the 213 patients, the majority were female (73.2%) and tended to be older than males (14.3 vs 11.2 years, p<0.001). The most common diagnoses were papilledema (52.6%), pseudopapilledema (31.5%), and optic nerve drusen (8.0%). When symptoms were present, most (73.7%) patients presented with headache (67.5%) or visual disturbance (54.8%). Of 144 neuroimaging studies obtained, 80 (55.6%) had positive findings and these were significantly associated with symptoms at presentation (p=0.017) and age (p=0.034), but not sex (p=0.791). Asymptomatic females and children >12 years old were more likely to have an abnormal MRI than males and children ≤ 12 (OR=1.56 and 1.22, respectively). Conclusion Patient demographics such as age and sex in conjunction with concurrent symptoms are important factors in determining the urgency of neuroimaging in children with suspected optic nerve head elevation.

Influence of sex and disease etiology on the development of papilledema and optic nerve sheath extension in the setting of intracranial pressure elevation in children

“…Whether sex influences the development of papilledema has not yet been adequately clarified. Cavuoto et al recently published a retrospective study on 213 pediatric patients presenting to an ophthalmologic emergency department with suspected optic head elevation ( Cavuoto et al, 2022 ). The majority of all patients with papilledema (52.6%) were female (76.8%) and only 23.2% were male, but it has to be considered, that the majority of the entire cohort was as well female (73.2%).…”

Optic Disc Swelling in Cancer Patients: Etiology and Implications

“…In the United States, idiopathic intracranial hypertension (IIH) ranks as the primary cause of papilledema. Other factors contributing to bilateral optic disc swelling encompass conditions like infiltrative optic neuropathy, toxic optic neuropathy, and malignant hypertension [1][2][3]. When optic disc swelling affects only one eye, it may be attributed to various underlying causes, such as optic neuritis (ON), non-arteritic anterior ischemic optic neuropathy (NA-AION), compressive optic neuropathy, retinal vein occlusion, and diabetic papillopathy.…”