Diseases of the Optic Nerve

Papillophlebitis and the differential diagnosis of unilateral optic disc oedema

“…8 The condition is usually bilateral, with the exception of the Foster-Kennedy syndrome in which the optic disc of one Unilateral optic disc oedema Walker eye is oedematous and that of the contralateral eye is atrophic. 7 As the left optic disc appearance is normal, spontaneous venous pulsation can be elicited and CT scan is negative, we can reasonably exclude the diagnosis of papilloedema due to raised intracranial pressure for this patient.…”

“…9 Any patient over 60 years of age with AION should be treated as though they have the arteritic form (that is, underlying temporal arteritis) until proven otherwise due to its life and sight threatening potential. 9 Demyelinating neuropathies usually manifest as retrobulbar neuritis, where 'the patient sees nothing and the clinician sees nothing', 7 although some may be seen as a papillitis. 8 As such we would expect profound vision loss, an RAPD, periocular pain or pain on eye movement 7 and extraocular muscle involvement (for example, diplopia).…”

“…Painless vision loss and an acquired colour vision defect are anticipated. 7 The condition is also most likely to be bilateral. 7 Therefore, it is unlikely that a toxic neuropathy is the cause of this patient's fundus appearance.…”

“…In this condition, visual acuity is little affected and there is no RAPD. 7 Visual field investigation may show an enlargement of the blindspot and/or a variable central scotoma. 7 Colour vision is not disturbed and the venous phase of the fluorescein angiogram is prolonged.…”

“…7 Visual field investigation may show an enlargement of the blindspot and/or a variable central scotoma. 7 Colour vision is not disturbed and the venous phase of the fluorescein angiogram is prolonged. 5 Patients with papillophlebitis are otherwise healthy in the majority of cases.…”