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Eye and Vision Care

Swollen optical nerve

06/30/2009

Question:

My little boy is 4 yrs old. He is far sighted in his left eye. In December his eye specialist noticed that both optical nerves were swollen. The left eye more so than the right eye. We were sent imediately for an MRI - which came back normal in conjunction with a retina specailist who took a picture of the eyes. We were also sent to Loma Linda Children`s Hospital where they did a lumbar puncture - spinal tap on my son. This too, came back normal. The neurologist felt good about the results and along with the normal results from the MRI and felt that he would heal on his own. The specialist reluctantly - went along with these findings. Since December - the right eye has healed completely, the left eye is healing slower - there is still some swelling there. Now, the specialist is going to send us for another MRI. We are confused as to why this would be his next step when the initial MRI with both nerves swollen came back clear...If you would be kind enough to shed some light on this decision and a possible next step that would help me understand. In March we began patching his right eye and he wears his glasses full time. As mentioned, he is far sighted in left eye - a 6.50 magnification. Could this patching and prescription just be too strong for that left eye to heal properly - also it was more swollen than right eye to begin with - could this be a factor in all of this?

Answer:

It sounds like the care you are receiving is excellent. Bilateral swollen optic nerves is called papilledema. This is seen when the pressure of the fluid around the brain and nerve increases so the fluid compresses the nerve and makes it swollen. The increased pressure can be caused by a mass that is growing, a bleeding vessel in the brain, or a blockage of the vessels that drain the fluid out of the brain (it is formed and drained actively your entire life).

The MRI was run to rule out a mass and the lumbar puncture was performed to see if the pressure of fluid was elevated. Given a negative result on both, then I think another MRi to assure nothing was missed is appropriate as no radiation is associated with an MRI.

The wearing of glasses is essential in a child who is far sighted in one eye to avoid amblyopia or lazy eye in that more far-sighted eye. Patching will help reverse any amblyopia that is present. The glasses and patching will not in any way alter the reduction in papilledema in that eye. Likely the left eye is still swollen as it was more swollen than the right before.

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Response by:

Michael  Earley, OD, PhD, FAAO Michael Earley, OD, PhD, FAAO
Assistant Dean for Clinical Services
Professor of Clinical Optometry
College of Optometry
The Ohio State University