Optic Nerve Head Swelling vs Pseudoswelling: Differentiating Diagnoses

Two eyes and their optic nerves, seen on a radial section scan. (Photo by: BSIP/Universal Images Group via Getty Images)
Course offers guidance for managing patients with apparent optic nerve swelling.

The following article is a part of Ophthalmology Advisor’s conference coverage of the Southeastern Educational Congress of Optometry (SECO) 2021, held in Atlanta and virtually from April 28 to May 2, 2021. The team at Ophthalmology Advisor will be reporting on the presentations offered by these leading experts in optometry and ophthalmology. Check back for more from the SECO 2021 Meeting.


Numerous ophthalmic conditions may be associated with optic nerve head swelling, according to a presentation at the 2021 Southeastern Educational Congress of Optometry (SECO), held April 28 to May 2 in Atlanta.

In optic nerve swelling, clinicians must differentiate between swelling and pseudoswelling. Optometrists can accomplish this through direct viewing of the optic nerve head; clinicians can determine if the vessels are blurred as they cross the disc margin, and if there is a spontaneous venous pulse. Another is through the use of optical coherence tomography (OCT) to determine retinal nerve fiber layer thickness and if there is splitting of layers deep in the retina. 

The presenter, Nathan Lighthizer, OD, an educator at Northwestern State University’s Oklahoma College of Optometry, illustrated his course with the case of a 12-year-old boy who presented for his annual eye exam. The patient had no complaints, concerns, or symptoms, but a history of longstanding alternating esotropia and +3.25 with mild astigmatism in both eyes. Visual acuity was 20/20. Dr Lighthizer’s recommendation in this case was to refer the patient to a pediatric or neuro-ophthalmologist for a second opinion; a pediatric ophthalmologist diagnosed the patient with pseudopapilledema, requiring monitoring and follow-up in 4 to 6 weeks. 

The presentation also covered 5 other conditions that might lead to optic nerve swelling: pseudotumor cerebri or idiopathic intracranial hypertension, nonarteritic ischemic optic neuropathy, giant cell arteritis, optic neuritis, and neuroretinitis. Dr Lighthizer outlined the ways in which these conditions impact the optic nerve head, including signs and symptoms, differential diagnoses, and potential treatment modalities. 

Disclosure: The presented declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

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Lighthizer N. Swollen optic nerves: Now what? Presented at: Presented at: Southeastern Educational Congress of Optometry (SECO) 2021 Annual Meeting; April 28-May 2, 2021; Atlanta, GA. Course 515.