Bilateral swollen optic nerve head etiology and management: A cross-sectional study

Background: The differential diagnosis of optic disc edema varies according to the presence of unilateral or bilateral edema. Papilledema may occur due to benign and life-threatening causes, but even benign causes may leave serious consequences for vision if not treated emergently. This study aimed to find out the prevalence of these causes in two major hospitals in Syria and observing the response of edema to treatment within a month and how visual acuity can be saved if edema is treated urgently. Methods: This cross-sectional study was conducted in Al-Assad and Al-Mowasat Hospitals in Syria from October 2020 to the beginning of February 2022. It included 50 patients who had bilateral optic disc edema. Then a full study was carried out to reach the diagnosis and management appropriately and to monitor the extent of the efficacy of conservative measure in reducing edema, and how many of them needed surgical intervention. Results: the study included 50 patients, 13 males and 37 females, the most common diagnosis was venous sinus thrombosis (12 cases with 24%), followed by idiopathic intracranial hypertension and tumors (10 cases each by 20%), infectious meningitis (8 cases by 16%), leptomeningeal metastasis (5 cases by 10%), arterial hypertension (3 cases by 6%) and autoimmune meningitis (2 by 4%). Edema improved after management within a month in most patients (37 patients by 74%) and edema was accompanied by low visual acuity in 21 patients (42%). 20 patients (40%) needed surgical intervention. Visual acuity reduced in 10 patients (20%) despite all treatments. Conclusion: venous sinus thrombosis is the most common cause of bilateral optic disc edema then idiopathic intracranial hypertension and tumors, and despite the provision of all treatments, the visual acuity of 20% of patients has decreased.