• Pseudopapilloedema
• papilloedema
• optic disc drusen
• optic disc haemorrhages
• B-mode ultrasound
• fluorescein angiography
• optic nerve
• anatomy
• diagnostic tests/investigation
• child health (paediatrics)

A 5-year-old boy was found to have elevated optic discs by his optometrist. The child had no ocular complaints and no symptoms of raised intracranial pressure but experienced daily headaches and poor attention at school. An ophthalmologist found a visual acuity of 6/6 in each eye, normal colour vision, bilateral optic disc swelling, absence of venous pulsation and a nerve fibre haemorrhage at the right optic disc. An MRI brain scan was normal.

A second ophthalmologist confirmed bilateral optic disc swelling with a nerve fibre haemorrhage at the right optic disc and a congested venous system. His blood pressure was normal as were systemic and neurological examination performed by a paediatric neurologist. A lumbar puncture carried out under sedation found the opening pressure to be 190 mm of water. A diagnosis of idiopathic intracranial hypertension was made, and he was commenced on systemic acetazolamide.

Over the following months, his optic disc appearances remained unchanged (figure 1A,B), and he continued to have normal visual function but developed side effects to the treatment. Repeat brain MRI showed no change. A third ophthalmologist suspected pseudopapilloedema and confirmed the presence of optic disc drusen (ODD) using B-mode ultrasound (figure 2A,B) and an auto-fluorescence study (figure 2C,D). Papilloedema was excluded by the absence of optic disc …