Ask yourself to differentiate Disc odema/ optic neuropathy causes!

1. Interactive cases
(Disc odema)
Samhaa Mohammed Abd Elmoneim
FRCS Glasgow, Egyptian Fellowship, MSc.
Zagazig Ophthalmic Hospital
(2021)
Samhaa Mohammed

2. Samhaa Mohammed
58 years-old male,
comes to you with
sudden painless drop
of vision (OS).
He is diabetic and
hypertensive.
BCVA 6/60
DD?
RAO
RVO
NAION
GCA
RD
Vitreous
haemorhage
Pre-existing
unilateral visual loss

3. Samhaa Mohammed
What will
examine after VA
assessment?
Pupillary light
reflex
(before dilatation)
↓
RAPD (OS)

4. Samhaa Mohammed
58 years-old male,
comes to you with
sudden painless drop
of vision (OS).
He is diabetic and
hypertensive.
BCVA 6/6, 6/60
RAPD (OS)
Fundus ex. Shows →
Hyperemic, swollen,
blurred edges,
obliterated cup

5. Samhaa Mohammed
How do you
comment on
disc?
What do you
look for in disc
examination?
https://www.slideshare.net/samhaamohammed
/glaucoma-basic-principles-part-1
(slides 15 to 36)

6. Samhaa Mohammed
https://www.slideshare.net/samhaamohammed
/glaucoma-basic-principles-part-1
(slides 15 to 36)

7. Samhaa Mohammed
58 years-old male,
comes to you with
sudden painless drop
of vision.
He is diabetic and
hypertensive.
BCVA 6/60
RAPD
Disc swelling (OS)
Now narrow your
DD?

8. Samhaa Mohammed

9. Samhaa Mohammed

10. Samhaa Mohammed

11. Samhaa Mohammed
Is every disc
swelling
considered
papillodema?
Disc swelling is a sign
Papillodema is a
condition/ disease

12. Samhaa Mohammed
Is every optic
neuropathy
presented with
disc swelling?
Disc swelling
Pallor
Normal !
Glaucomatous changes
Congenital anomalies

13. Samhaa Mohammed

14. Samhaa Mohammed

15. Samhaa Mohammed
What is the first simple test have to be
performed before any systemic
investigation?

16. Samhaa Mohammed
What is the emergent condition (from DD list)
you have to rule out to save this patient life?
AION
NAAION
(common)
Control DM
AAION
(life threating)
Systemic steroid

17. Samhaa Mohammed
What do you think if the male patient is
teenager?

18. Samhaa Mohammed
What if disc swelling is bilateral in obese
patient?

19. Samhaa Mohammed
What if disc swelling with bilateral acute
vision loss is in alcoholic patient?

20. Samhaa Mohammed
When will you say it is pseudo-papillodema?
VS

21. To conclude what we learn today
• Revise how to comment on ON/ assess ON
function
• Sudden loss of vision: ocular and
neurological causes
• Disc odema in elderly: remember (common
cause NAAION, life-Threating cause AION)
• NAAION Tx depends mainly on systemic
diseases control
• One word can be the only clue to reach one
Dx from long DD list
Samhaa Mohammed

22. Samhaa Mohammed Dr H. Sweillam Scheme

23. Samhaa Mohammed

24. Samhaa Mohammed

25. Samhaa Mohammed
Other Ophthalmic associations and DM?

26. Samhaa Mohammed
Thank
you