Papilloedema & Optic Neuritis

Key points

• Papilloedema: bilateral optic disc swelling from raised ICP — early vision normal except enlarged blind spot; late — field constriction.
• Causes: space-occupying lesion, idiopathic intracranial hypertension (obese young women; headache, pulsatile tinnitus, transient visual obscurations), malignant hypertension, venous sinus thrombosis.
• Optic neuritis: painful subacute monocular visual loss with pain on eye movements + RAPD; classically associated with multiple sclerosis.
• Uhthoff's phenomenon: worsening of MS symptoms with heat/exercise.
• Optic atrophy: pale disc — chronic process (compression, ischaemia, hereditary).

Decision points in this pathway

• Obese young woman + headache + pulsatile tinnitus + transient obscurations?

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