視神經乳頭水腫與眼科臨床所見

Ophthalmological Observation on Papilledema

陳德照(Te-Tsaw Chen) ； 楊燕飛(Yen-Fei Yang)

《中華民國眼科醫學會會刊》 4卷 (1965/05) Pp. 75-85

https://doi.org/10.30048/ACTASOS.196505.0009

並列摘要

The ophthalmological observation on 75 cases of papilledema, mostly caused by brain tumors (66.7%) is presented in this report.
1. Symptoms; Non-ocular general symptoms are headache, projectile vomiting, nausea and psychic disturbances caused by increased intracranial pressure. Ocular symptoms consist of visual disturbances and diplopia due to unspecific ocular paresis, especially that of the abducent nerve paresis. Of the visual disturbance, momentary attack of blurred vision is the usual complaint, and rarely there presents transient amaurosis, lasting only seconds or several minutes. The visual disturbance is occasionally accompanied by headache. At times, unformed photopsia and photophobia are reported. Asthenopia, non-specific but may be secondary to papilledema, is the frequent subjective complaint.
2. Ophthalmoscopic findings of incipient papilledema: It is difficult to arrive at a definite decision as to the diagnosis of an incipient papilledema, Yet its determination is particularly urgent in regard to early treatment. In its early stage, redness of disc color becomes prominent due to increased visibility of disc capillaries and hyperemia. The physiological cup may be filled with clear transudate or delicate tissue veil, and occassionally grayish sheathing of vessels can be found in the cup. Furthermore, disc margin becomes hazy with grayish-white striation of the surrounding retina. This indistinct disc margin should be differentiated from highly mobile and elusive phisiological reflexes and the normal nerve fiber pattern of fine striae radiating in all directions from disc margin. Weiss's reflex, a mobile annular reflex on the nasal side of the disc, is usually more prominent and less mobile due to slight edema of disc margin. This kind of reflex is an important finding in incipient or developing papilledema in our series. Occassionally one or several bleeding spots near the disc may mark an important diagnostic evidence if associated with other early signs. Repeated examinations with the fundus photography are important in the diagnosis of incipient papilledema.
3. Clinical course based on the ophthalmoscopic view: Papilledema is classified into 4 stages, i. e., incipient, developing, advanced and atrophic stages, according to progressive changes in the outline, colour and prominence of the optic disc as well as findings of the neighbouring retina and retinal blood vessels.
4. Hemorrhage: In our series, bleeding is noted in 51 eyes (36.4%). Hemorrhage does not occur with any great regularity, and usually with a radial arrangement from the disc near large branches of retinal veins in flame shape and occassionally in blot form. The appearance and severity of the retinal hemorrhage have a parallel relation with the venous engorgement and the disc prominence.
5. Visual impairment: Most cases reserve good visual acuity except those cases of advanced or atrophic stage.
6. Visual field; Concentric contraction appears in the advanced and atrophic stages. The concentric enlargement of blind spots is found in most cases and parallel with the blurred disc margin and the disc prominence. It is more easily detected by red, green or small targets.
7. Bilaterality: Bilateral form of papilledema is noted in 65 cases in our series of 75 cases. The difference in size (horizontal diameter) of the blind spot between right and left eyes in the same case is mostly under 5 degree with 5/1000 white target. Monoocular papilledema is found in ocular or orbital etiology.
8. Decompression treatment performed in 4 cases: Following the decrease in the intracranial pressure after the decompression treatment, much improvement is observed in general and local symptoms, ophthalmoscopic findings, and the blind spot enlargement.