Differentiating between papilledema, papillitis, and retrobulbar neuritis


Papilledema
Papillitis
Retrobulbar neuritis
Definition
Swelling of optic nerve head due to increased ICP
Inflammation or infarction of optic nerve head
Inflammation of orbital portion of optic nerve
Unilateral/bilateral
Bilateral
Unilateral
Unilateral
Vision impairment
Enlarged blind spot
Central/paracentral scotoma to complete blindness
Central/paracentral scotoma to complete blindness
Fundus appearance
Hyperemic disk
Hyperemic disk
Normal
Vessel appearance
Engorged, tortuous veins
Engorged vessels
Normal
Hemorrhages?
Around disk, not periphery
Hemorrhages near or on optic head
Normal
Pupillary light reflex
Not affected
Depressed
Depressed
Treatment
Normalize ICP
Corticosteroids if cause known
Corticosteroids with caution


References:
The Merck Manual, Centennial Edition.

Interesting readings:
Rothermel H, Hedges TR 3rd, Steere AC. Optic neuropathy in children with Lyme disease. Pediatrics. 2001 Aug;108(2):477-81.


Entry date: July 25, 2003.