Swollen Optic Nerve
Causes as related to oncology:
Raised Intracranial Pressure (Papilloedema)
- `Benign` Intracranial Hypertension
- steroids
- chlorambucil
- cisplatin
- Intracranial tumour
- Leukemic / Lymphomatous infiltration of the optic nerve
- Hypertension (grade 4 retinopathy)
- Infective infiltration (rare but consider in the immunocompromised)
Assessment of Optic nerve function
- Visual acuity
- Colour vision
- Visual fields
- Pupil reactions
Differentiating raised ICP from other causes of swollen discs
- Visual acuity OK until end-stage
- Enlarged blind spot visual field defect
- Absence of spontaneous venous pulsation
Clinical Tip :
Swollen optic nerves in a child with known history of leukemia is considered a CNS relapse of their leukemia until proven otherwise.
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The pictures below were taken of a 12 year old girl with history of ALL presenting with reduced visual acuity secondary to leukaemic optic nerve infiltration (CNS relapse). Emergency orbital radiation therapy and intrathecal chemo resulted in excellent visual recovery and remission.
