PT  - JOURNAL ARTICLE
AU  - Dahlmann-Noor, Annegret Hella
AU  - Adams, Gillian W
AU  - Daniel, Moritz Claudius
AU  - Davis, Alison
AU  - Hancox, Joanne
AU  - Hingorani, Melanie
AU  - Ibanez, Patricia
AU  - McPhee, Becky
AU  - Patel, Himanshu
AU  - Restori, Marie
AU  - Roberts, Clare
AU  - Theodorou, Maria
AU  - Acheson, James
TI  - Detecting optic nerve head swelling on ultrasound and optical coherence tomography in children and young people: an observational study
AID  - 10.1136/bjophthalmol-2017-310196
DP  - 2018 Mar 01
TA  - British Journal of Ophthalmology
PG  - 318--322
VI  - 102
IP  - 3
4099  - http://bjo.bmj.com/content/102/3/318.short
4100  - http://bjo.bmj.com/content/102/3/318.full
SO  - Br J Ophthalmol2018 Mar 01; 102
AB  - 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.