eMedicine Specialties > Ophthalmology > Optic Nerve

Pseudopapilledema: Differential Diagnoses & Workup

Author: Mitchell V Gossman, MD, Partner and Vice President, Eye Surgeons and Physicians, St Cloud
Coauthor(s): Joseph Giovannini, MD, Chief of Ophthalmology, Eye Surgery Center, David Grant Medical Center, Travis Air Force Base
Contributor Information and Disclosures

Updated: Dec 10, 2008

Differential Diagnoses

Idiopathic Intracranial Hypertension
Scleritis
Optic Neuritis, Adult
Toxic/Nutritional Optic Neuropathy
Optic Neuritis, Childhood
Toxoplasmosis
Optic Neuropathy, Anterior Ischemic
Uveitis, Classification
Optic Neuropathy, Compressive
Papilledema
Sarcoidosis

Other Problems to Be Considered

Optic disc infiltrates
Papillitis
Leber hereditary optic neuropathy
Orbital and other optic nerve tumors
Diabetic papillitis

Workup

Laboratory Studies

  • Laboratory studies are not usually necessary in the workup of patients with disc drusen.
  • In patients with suspected Leber hereditary optic neuropathy, mitochondrial mutations are helpful.

Imaging Studies

  • B-scan ultrasonography may be useful in identifying buried disc drusen. Because drusen are calcified, they demonstrate high reflectivity on ultrasound.
  • While rarely indicated, a CT scan may show small areas of calcification within the disc substance, which represent calcified disc drusen. Progressive field loss, dyschromatopsia, or visual acuity loss in patients with suspected buried disc drusen or visible disc drusen warrants consideration of neuro-imaging studies to rule out occult CNS lesions, in which case a CT scan carries the advantage of possibly detecting buried disc drusen.
  • Fluorescein angiography can be used to rule out true papilledema, which exhibits increased dilation of the peripapillary capillaries with late dye leakage.  
    • Disc drusen may autofluoresce on fluorescein angiography, which can be seen with red-free photo techniques, using the appropriate filters. (Buried disc drusen may not autofluoresce.)
    • In Leber hereditary optic neuropathy, disc leakage is not seen on fluorescein angiography.

Other Tests

  • Visual field tests should be considered, especially if optic nerve drusen are suspected. Constriction of the visual field can gradually occur; patients rarely have progressive field loss that is insidious or rapid.
  • Stereo color photographs of the optic discs are useful to document changes.

Procedures

  • No additional procedures are indicated.

More on Pseudopapilledema

Overview: Pseudopapilledema
Differential Diagnoses & Workup: Pseudopapilledema
Treatment & Medication: Pseudopapilledema
Follow-up: Pseudopapilledema
Multimedia: Pseudopapilledema
References
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References

  1. Grippo TM, Shihadeh WA, Schargus M, Gramer E, Tello C, Liebmann JM, et al. Optic nerve head drusen and visual field loss in normotensive and hypertensive eyes. J Glaucoma. Mar 2008;17(2):100-4. [Medline].

  2. Acheson JF, Sanders MD. Common Problems in Neuro-ophthalmology. 1997;78-84.

  3. Auw-Haedrich C, Staubach F, Witschel H. Optic disk drusen. Surv Ophthalmol. Nov-Dec 2002;47(6):515-32. [Medline].

  4. Cullom RD, Chang B. The Wills Eye Manual. 1994;270-272.

  5. Kline LB. Optic Nerve Disorders. 1996;37-53.

  6. Miller NR, Newman NJ. Clinical Neuro-Ophthalmology - The Essentials. 1999;166-195.

  7. Vaphiades MS. The disk edema dilemma. Surv Ophthalmol. Mar-Apr 2002;47(2):183-8. [Medline].

  8. Yanoff M, Duker JS. Ophthalmology. 1999;11.5.1-5.4.

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Further Reading

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Keywords

pseudopapilledema, papilledema, optic disc drusen, optic disc swelling

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Contributor Information and Disclosures

Author

Mitchell V Gossman, MD, Partner and Vice President, Eye Surgeons and Physicians, St Cloud
Mitchell V Gossman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, Minnesota Medical Association, North American Neuro-Ophthalmology Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Giovannini, MD, Chief of Ophthalmology, Eye Surgery Center, David Grant Medical Center, Travis Air Force Base
Joseph Giovannini, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

Medical Editor

Edsel Ing, MD, FRCSC, Assistant Professor, Department of Ophthalmology & Vision Sciences, University of Toronto: Consulting Staff, Toronto East General Hospital
Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American College of Physician Executives, American Society of Contemporary Ophthalmology, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, North American Neuro-Ophthalmology Society, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Brian R Younge, MD, Professor of Ophthalmology, Mayo Clinic School of Medicine
Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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