Clinical approach for suspected optic disc swelling in children: Recommendations based on a six-year review

Abstract

Purpose: To report the outcome of referrals for suspected optic disc swelling in children and define features that may assist in the differentiation between true disc swelling and pseudopapilledema. Methods: A retrospective review of children who were referred to the Queensland Children's Hospital in Brisbane, Australia between January 2014 - June 2020 for suspected optic disc swelling was performed. Referral details, subsequent investigations, and the final diagnosis were noted. Statistical analyses were performed for the presence of neurological symptoms and differences in retinal nerve fibre layer thickness. Results: Sixty-six of 410 (16.1%) children referred for suspected optic disc swelling had confirmed disc swelling, 25 (37.9%) were secondary to idiopathic intracranial hypertension. Twenty-two of 55 (40%) children who underwent neuroimaging prior to ophthalmology review had confirmed disc swelling. Of the 344 (83.9%) children with pseudopapilledema, 239 (69.5%) were optic nerve drusen and the remainder were tilted or crowded discs. Children with confirmed disc swelling were more likely to present with headache (odds ratio = 8.68, p < 0.01) and visual disturbance (odds ratio = 2.14, p = 0.03). Retinal nerve fibre layer was significantly thicker in true disc swelling compared to pseudopapilledema (p < 0.01). B-scan was the most sensitive ancillary investigation in the detection of drusen (100%), followed by OCT (70.4%) and fundus autofluorescence (44.9%). Conclusions: The majority of referrals for optic disc swelling were pseudopapilledema. Ancillary investigations can be useful in the exclusion of drusen. Referrers should include a neurological assessment, visual acuity, and ancillary investigations to assist in the triage of ophthalmology review. We discourage the use of neuroimaging prior to ophthalmology review.L6366696742021-12-27 <br />