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Detecting optic nerve head swelling on ultrasound and optical coherence tomography in children and young people: an observational study
  1. Annegret Hella Dahlmann-Noor,
  2. Gillian W Adams,
  3. Moritz Claudius Daniel,
  4. Alison Davis,
  5. Joanne Hancox,
  6. Melanie Hingorani,
  7. Patricia Ibanez,
  8. Becky McPhee,
  9. Himanshu Patel,
  10. Marie Restori,
  11. Clare Roberts,
  12. Maria Theodorou,
  13. James Acheson
  1. NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
  1. Correspondence to Dr Annegret Hella Dahlmann-Noor, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, 162 City Road, London EC1V 2PD, UK; annegret.dahlmann-noor{at}


Background Following high-profile cases, referrals for evaluation of ‘suspicious optic discs’ to eye clinics in the UK have sharply increased, asking ophthalmologists to reliably distinguish between true and pseudopapilloedema. Optic nerve sheath dilatation (ONSD) on ocular ultrasound (US) is considered a reliable sign of true papilloedema, but this test is not widely available. Recently, anterior bowing of Bruch’s membrane (BM) and increased retinal nerve fibre layer thickness on optical coherence tomography (OCT) have emerged as indicators of intracranial hypertension, and OCT is widely available. We aimed to evaluate safety and efficacy of the diagnostic workup in our service, with particular emphasis of diagnostic reliability of US and OCT.

Methods Retrospective service evaluation/cohort study of children and young people younger than 16 years investigated for ‘suspicious discs’ over a 7-month period in 2016 at a single eye care provider in London, UK. 61 children and young people underwent clinical assessment, US scan and OCT.

Results Of 61 cases, 3 had intracranial pathology. At presentation, only one had ONSD on US and anterior bowing of BM on OCT. Increased nerve fibre layer thickness in at least one of three relevant sectors was observed in two cases. All three cases of intracranial pathology, however, had significant points in their presenting or medical history.

Conclusion Ophthalmologists and optometrists must not rely on funduscopy and ocular imaging when assessing a child for possible intracranial disease; history and basic neurological assessment are critical in the diagnostic workup.

  • Child health (paediatrics)
  • Vision
  • Diagnostic tests/Investigation
  • Optic Nerve

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  • Funding The work was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the National Health Service , the NIHR or the Department of Health.

  • Competing interests None declared.

  • Ethics approval This work had trust approval by Moorfields Eye Hospital as service evaluation CA/15/ONSP19.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data can be shared on request to corresponding author.

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