A Child Presenting With Optic Nerve Edema
A Child Presenting With Optic Nerve Edema
An 8-year-old male presented to the emergency room for possible bilateral optic nerve edema. During a routine eye evaluation, his optometrist had expressed concern about bilateral optic nerve edema, which appeared worse on the right side. The boy's ophthalmic history was limited due to the fact that he had been placed recently in foster care; however, he reported that he had worn a right eye patch in the past. He had no ocular complaints and specifically denied headaches, visual obscurations, and blurred vision.
Uncorrected visual acuity was 20/20-1 OD and 20/40 OS. Color vision was normal bilaterally with the Ishihara color test. Pupils were equal, round, and contracted briskly to light. There was no relative afferent pupillary defect (RAPD). Visual fields were normal by confrontation. There was mild right optic nerve elevation and very mild left optic nerve elevation. No optic disc hyperemia was noted, nor were disc margin blurring or optic nerve hemorrhages seen in either eye (Figure 1).
(Enlarge Image)
Figure 1.
Optic nerve.
What is the most appropriate diagnostic test at this point?
View the correct answer.
<p>A, B, or C</p><br/><b>Discussion</b><br/><br/><p>Neuroimaging would be the first step required if disc edema or papilledema is suspected. Given the lack of hyperemia, hemorrhages, or disc margin blurring, however, an orbital B-scan could also be done to investigate causes such as drusen.</p>
Clinical Presentation
An 8-year-old male presented to the emergency room for possible bilateral optic nerve edema. During a routine eye evaluation, his optometrist had expressed concern about bilateral optic nerve edema, which appeared worse on the right side. The boy's ophthalmic history was limited due to the fact that he had been placed recently in foster care; however, he reported that he had worn a right eye patch in the past. He had no ocular complaints and specifically denied headaches, visual obscurations, and blurred vision.
Uncorrected visual acuity was 20/20-1 OD and 20/40 OS. Color vision was normal bilaterally with the Ishihara color test. Pupils were equal, round, and contracted briskly to light. There was no relative afferent pupillary defect (RAPD). Visual fields were normal by confrontation. There was mild right optic nerve elevation and very mild left optic nerve elevation. No optic disc hyperemia was noted, nor were disc margin blurring or optic nerve hemorrhages seen in either eye (Figure 1).
(Enlarge Image)
Figure 1.
Optic nerve.
What is the most appropriate diagnostic test at this point?
Orbit CT
Brain and orbit MRI
Orbital B-scan
Lumbar puncture
A, B, or C
View the correct answer.
<p>A, B, or C</p><br/><b>Discussion</b><br/><br/><p>Neuroimaging would be the first step required if disc edema or papilledema is suspected. Given the lack of hyperemia, hemorrhages, or disc margin blurring, however, an orbital B-scan could also be done to investigate causes such as drusen.</p>
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