Optic disc swelling
The optic disc margin is blurred. There is hyperaemia with or without splinter haemorrhage(s). The venous pulsation is absent. Note: it is safer to state that  the patient has optic swelling rather than papilloedema unless you have evidence of raised intracranial pressure. 

Sometimes you may encounter patients with indistinct optic disc 
without disc swelling or haemorrhages. In such cases, consider pseudo-papilloedema as in patients with high hypermetropia.

Look for:

  • hypertensive changes in malignant hypertension 
  • extensive haemorrhages in central retinal vein occlusion 
  • examine the contralateral eye for similar changes. The presence of bilateral disc changes strongly suggests intracranial hypertension as the cause. The most common case seen in the examination is a young overweight woman with benign intracranial hypertension. 
  • optic atrophy in the contralateral eye ie. Foster-Kennedy's syndrome which is classically caused by meningioma of the optic canal (in the eye with optic atrophy). However, in both examination and real life the most common cause is sequential ischaemic optic neuropathy.  


1. What are the causes of a indistinct optic disc margin?


2. How can you differentiate between optic disc swelling resulting from papilloedema from that caused by optic nerve compression?

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