A 65 year old woman presented with headache,confusion and blurring of vision after head injury.The fundoscopic examination of the eye shows the following picture.
Which among the following is the first clinical sign of the condition shown in the picture ?
A. Elevation of disc.
B. Macular Star
C. Disc Pallor
D. Blurring of disc margins.
Ans:D. Blurring of Disc margins
The condition shown in the picture above represents papilledema.
The patient is suffering from raised inctracranial hypertension after head injury.
- It is optic disc swelling that is caused by increased intracranial pressure.
- The swelling is usually bilateral and can occur over a period of hours to weeks.
- Unilateral papilledema can suggest a disease in the eye itself, such as an optic nerve glioma.
- It may be asymptomatic or present with headache in the early stages.
- It may progress to enlargement of the blind spot, blurring of vision, visual obscurations (inability to see in a particular part of the visual field for a period of time) and ultimately total loss of vision may occur.
Ophthalmoscopic signs of papilloedema
Early papilledema –
- Disc hyperemia possibly with dilated disc capillaries.
- Nerve fiber layer opacification and swelling.
- Blurred disc margin(s).
- Venous pulsations are absent.
More severe developed papilledema
- Elevation of the disc and opacified NFL obscuring disc vessels.
- Dilated veins, disc splinter hemorrhages, cotton wool spots, or hard exudates.
With severe disc leakage
- Macular star may be seen, this is more prominent on the disc side of the macula.
- Retinochroroidal folds called Paton’s lines may be present.
With chronicity of papilledema
- The start of disc pallor along with decreasing disc swelling with the loss of axons.