optic disc edema
Introduction
Introduction to optic disc edema Optic disc edema is characterized by blurred edge of the optic disc, redness of the optic disc, and distortion of the vein when severe; optic nerve and peripheral blood vessels cannot be seen due to high edema, sometimes flaky hemorrhage or exudate plaque around the optic disc; late optic disc edema The optic disc has shrunk. Optic disc edema is a common clinical sign, mainly caused by increased intracranial pressure, which has important clinical significance. It is believed that optic disc swelling caused by increased intracranial pressure is called optic disc edema, which is non-inflammatory obstructive edema of optic disc. About 80% are caused by intracranial space-occupying lesions, such as inflammation, trauma or congenital skull. deformity can also be caused. Because the name of optic disc edema does not reflect its clinical signs and pathology, it is replaced by Swellingoftheopticdisc. Hayern's findings disapprove of the use of optic nipples (opticdiscoedema) specifically for intracranial hypertension, and optic disc edema for other causes, because the nature of the two is no different. basic knowledge The proportion of the disease: 0.05% - 0.08% (the incidence of this disease in patients with hypertension is about 0.05% - 0.08%) Susceptible people: no special people Mode of infection: non-infectious Complications: brain tumor headache hyperosmotic dehydration eye movement disorder
Cause
Cause of optic disc edema
Increased intracranial pressure (25%):
About 80% of the optic disc edema seen in the clinic, such as brain tumor, brain abscess, hydrocephalus, cerebral edema, arachnoiditis, meningitis, chronic subdural hematoma, cavernous sinus thrombosis and narrow cranial disease.
Eye disease (30%):
Disc edema, such as intraorbital tumors, abscesses, etc., can also occur in lesions that block the venous return of the iliac vein. It can also be seen after a sudden decrease in corneal spasm or intraocular pressure.
Systemic disease (20%):
More common in acute hypertension, chronic nephritis, pregnancy poisoning, pernicious anemia and leukemia.
Pathogenesis:
Can be summarized into two viewpoints of mechanical and non-mechanical. Mechanistic theory believes that optic disc edema is caused by increased intracranial pressure, the pressure can be transmitted to the subarachnoid space around the optic nerve, so that the cerebrospinal fluid diffuses to the optic nerve, then the tissue pressure will increase, so that the cells of the gods to the optic nerve, The optic chiasm of the geniculate body is blocked, the optic tract is blocked, the stagnation occurs in the plane of the sieve plate, the nerve fibers at the optic disc produce axoplasmic accumulation and swelling, and the swollen axons compress small blood vessels in the anterior region of the sieve plate, resulting in veins. Stasis expansion, microaneurysm formation, optic disc and nearby bleeding, central retinal vein compression can cause venous congestion, optic nerve-blood barrier collapse, and a large amount of extracellular fluid accumulation at the optic disc. Non-mechanical theorists believe that optic disc edema occurs on the basis of toxic inflammatory reactions.
Prevention
Optic disc edema prevention
Foods that are harmful to the eyes are generally considered to have two types: sweets and garlic, which of course refers to excessive consumption. Excessive sweets damage most people only know that eating sweets is easy to increase weight, in fact, it will affect eye health, induce or aggravate some eye diseases, such as myopia, cataract, optic neuritis, optic disc edema. This is because the sugar in the sweets needs a lot of vitamin B1 when it is metabolized in the human body. If the sugar in the body is excessively consumed, the vitamin B1 will be relatively insufficient, and vitamin B1 is one of the indispensable nutrients for the eyes.
Therefore, for the health of the eyes, the elderly should try to eat less sweets. Excessive garlic is harmful to the eyes. Garlic is a good vegetable and has a certain preventive effect on many diseases. However, if you eat garlic in a long-term and excessive amount, especially those with eye diseases and those who have frequent fever, hot flashes, night sweats, etc., who eat more garlic, there will be adverse consequences. Therefore, there are folks who have "there are many benefits for garlic." Say. Therefore, it is more important for elderly people with eye diseases to notice this during treatment, otherwise it will affect the efficacy.
Complication
Optic disc edema complications Complications brain tumor headache hyperosmolar dehydration eye movement disorder
Optic disc edema surgery complications:
Common surgical complications include eye movement disorder, pupillary abnormality and diplopia, and most of them recover naturally within 1-2 months after surgery. This is related to the interruption of the rectus muscle and the disturbance of the ciliary ganglion. In some patients, there was no significant improvement in postoperative visual function, and some even decreased visual acuity, and the optic disc was pale, which was associated with irreversible optic atrophy before surgery. The most serious type of complication is damage to the optic nerve, central retinal artery, and central venous obstruction, which can cause permanent loss of visual function. According to reports in the literature, the incidence of such complications can be as high as 11%. It is important to fully expose the optic nerve during surgery and to select the correct site for incision to open the optic nerve sheath.
Symptom
Symptoms of optic disc edema Common symptoms Blind spot erythema retinal edema visual field defect increased intracranial pressure
symptom
(1) Visual acuity changes: Early visual acuity is normal, but there is a transient black sputum. This is due to changes in the head position (such as sudden standing up, turning heads, etc.), and the vascular pressure at the optic disc site increases, resulting in rapid anemia of the retina. At the end of the period, vision loss, and finally can be completely blind.
(B) visual field changes: early physiological blind spots expanded. At the end of the field, the telecentricity is reduced and even a tubular view is formed.
(3) Double vision: It is a symptom of patients with optic disc edema, which is caused by an external abductor paralysis caused by a transverse branch of the basilar artery.
(D) seen in the fundus: often bilateral: according to the formation of optic disc edema. Can be divided into the following periods.
Staging
1. Initial stage: the optic disc is congested, the boundary is blurred, the upper and lower boundaries are the same, the physiological depression disappears, the sieve plate is small, the front is slightly raised, the height is not more than 2 diopters, the eyeball is lightly pressed, and the venous lumen is thinned. The beat weakens or disappears. Early optic nerve fiber swelling can be found by stereoscopic fundus color photography or stereoscopic ophthalmoscopy. Fluorescent fundus angiography can increase the number of capillaries and slow venous return, which are helpful for early diagnosis.
2. Progression period: In this period, the edge of the optic disc is unclear, the physiological depression disappears, the height is 3-4 diopters, the retina around the optic disc is gray, the capillaries are dilated, the venous swell is bent, the pulsation disappears, and the vein is intermittent. There are bleeding and exudate, about 15% of patients, the macular portion reproduces a fan-shaped starburst white exudation.
3. Malignant phase: The optic disc edema in this period is mushroom-like bulge, which can be up to 5 diopter and more, and there are more hemorrhages and exudates. They are merged into each other and scattered widely. This is the most serious stage of optic disc edema.
4. Terminal: Also known as chronic atrophy, optic disc edema. This is the late manifestation of papilledema, the degree of optic disc bulging gradually decreases or disappears, the color is pale, the edge is unclear, the physiological depression disappears, the sieve plate is small, the artery is thinner, the vein returns to normal or slightly fine, due to nerve fiber degeneration Glial hyperplasia, there may be white sheath around the blood vessels.
Examine
Inspection of optic disc edema
Select the necessary tests based on possible causes:
1, blood routine, blood biochemistry, electrolyte examination has a diagnostic value for the primary disease.
2, blood sugar, immune items, cerebrospinal fluid examination if abnormalities have a differential diagnosis.
3, fundus examination is a routine examination item, but early detection of optic disc edema is more difficult.
4, T, MRI, cerebral angiography and digital subtraction angiography (DSA) examination can help diagnose the primary disease.
5, electrogram, skull base film has a differential diagnosis.
Diagnosis
Diagnosis and differentiation of optic disc edema
diagnosis
The optic disc becomes red and red, normal people can also appear, hyperopia has a tendency to congestive and myopia has a pale tendency; relying solely on fundus examination to find optic disc edema early is more difficult, often requires signs of nervous system positioning and increased intracranial pressure Can be diagnosed.
Optic disc edema is mainly caused by increased intracranial pressure. Increased intracranial pressure is also manifested as headache, vomiting, and accompanied by focal signs of the nervous system. The diagnosis must be combined with medical history. If necessary, special examinations such as MRI, CT, and cerebral angiography should be performed. Digital subtraction angiography (DSA) can confirm the diagnosis.
Clinically, it must also be differentiated from pseudo-optic edema and optic nerve papillitis.
