Clinical profile and etiological spectrum of patients presenting with bilateral optic disc swelling: A prospective observational study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Bilateral optic disc swelling is an important neuro-ophthalmic finding that requires prompt evaluation because it may represent papilledema secondary to raised intracranial pressure, an inflammatory or infectious optic neuropathy, vascular disease, malignant hypertension, infiltrative disorders or pseudopapilledema. Papilledema specifically refers to optic disc edema caused by increased intracranial pressure and should be distinguished from other causes of bilateral disc elevation. Accurate identification of the underlying etiology is essential because some causes may threaten vision or life if diagnosis and treatment are delayed. Neuroimaging, assessment of visual function, systemic evaluation and where appropriate, cerebrospinal fluid examination constitute important components of diagnostic evaluation. Objective: To evaluate the clinical profile, ophthalmic manifestations, associated systemic and neurological features and etiological spectrum of patients presenting with bilateral optic disc swelling in a tertiary care hospital. Methods: This prospective observational study was conducted in the Department of Ophthalmology, Sher-e-Bangla Medical College Hospital, Barishal, from January to June 2026 and included 50 consecutive patients with bilateral optic disc swelling. Demographic, systemic, neurological and ophthalmological data were recorded. Participants underwent visual acuity, pupillary, intraocular pressure, fundus, and visual-field assessments with color vision and optical coherence tomography performed when indicated. Blood pressure, relevant laboratory investigations, neuroimaging and selected lumbar puncture with CSF analysis were performed according to clinical indications. Etiological diagnoses were established using clinical, imaging, laboratory and CSF findings. Results: Among 50 patients, the mean age was 35.8±14.7 years and 58.0% were female. Headache was the most common symptom (74.0%), followed by transient visual obscuration (42.0%) and blurred vision (38.0%). Vessel obscuration (64.0%) and disc hyperemia (58.0%) were the predominant fundus findings. BCVA was 6/12 or better in 58.0% of patients, while an enlarged blind spot was the most frequent visual-field abnormality (46.0%). Neuroimaging was normal in 48.0%, whereas raised-ICP features, space-occupying lesions and CVST were identified in 18.0%, 14.0% and 10.0% respectively. Elevated CSF opening pressure was found in 36.0%. Idiopathic intracranial hypertension was the leading etiology (30.0%), followed by space-occupying lesions and inflammatory/infectious optic neuropathy (14.0% each). Raised-ICP/papilledema was significantly associated with age <40 years (p=0.012) and headache (p<0.001), while RAPD was associated with inflammatory/ischemic optic neuropathy (p=0.003). Acetazolamide or other ICP-lowering therapy was used in 36.0% of patients. At short-term follow-up, vision improved in 62.0%, remained stable in 26.0% and worsened in 8.0%. Conclusion: Bilateral optic disc swelling represents a heterogeneous clinical presentation rather than a single disease entity. Raised intracranial pressure, particularly idiopathic intracranial hypertension, represents an important cause but serious secondary intracranial and ocular/systemic disorders must be excluded. A structured diagnostic approach incorporating blood pressure measurement, detailed ophthalmic examination, visual-field testing, neuroimaging and selective CSF analysis is essential for early diagnosis and prevention of permanent visual loss.
Institution: Mugda Medical College
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7204657446