Download PDF
CC BY-NC-ND 4.0 · Journal of Academic Ophthalmology 2019; 11(02): e40-e43
DOI: 10.1055/s-0039-3400546
Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Characteristics and Incidence of Inpatient Ophthalmology Consultations to Screen for Papilledema

Peter J. Belin 
1   Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York
,
Giovanni H. Greaves
1   Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York
,
Jules Winokur
1   Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York
,
Matthew Gorski
1   Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York
› Author Affiliations Funding None.
Further Information

Publication History

27 June 2019

16 October 2019

Publication Date:
03 December 2019 (online)

   Permissions and Reprints

Abstract

Objective A frequent reason for ophthalmology consultation is to rule out papilledema. The purpose of this study is to evaluate the incidence of consultations to screen for papilledema in an acute inpatient setting and determine the frequency and factors associated with a positive diagnosis of bilateral optic nerve swelling.

Methods A retrospective chart review was performed of consecutive adult and pediatric inpatient ophthalmology consultations at a tertiary hospital system to “rule out papilledema” from September through November 2016. All patients had a detailed neuro-ophthalmology examination including a dilated fundus exam.

Results A total of 36 consults—13 males and 23 females—with a mean age of 19.8 (range: 3–71) years were called to screen for papilledema. The most common service to request the consult was pediatrics (44%), followed by neurosurgery (42%), medicine (8%), and neurology (6%). The most frequent reason for consultation was headache (61%), followed by visual changes (30.5%) and nausea/vomiting (25%). A positive diagnosis of bilateral optic nerve swelling occurred in 14% (5/36) of consults. Of these five consults, four of them were sent into the hospital by an ophthalmologist who noted the bilateral optic nerve swelling and one was noted by an emergency room pediatrician.

Conclusion No new cases of bilateral optic nerve swelling were found in screening consults to “rule out papilledema.” All of the positive diagnoses in our study had been previously identified by another physician and known to the primary team prior to ophthalmology consultation. Screening consultations for optic nerve swelling may not be an effective way to rule out papilledema.

Keywords

papilledema - optic nerve edema - ophthalmology consultations - screening
 

  • References

  • 1 Türck L. Ein Fall von Hämorrhagie der Netzhaut beider Augen. Druck von C. Gerold & Sohn 1853; 9 (01) 214-218
    PubMedGoogle Scholar
  • 2 Hayreh SS. Pathogenesis of optic disc edema in raised intracranial pressure. Prog Retin Eye Res 2016; 50: 108-144
    CrossrefPubMedGoogle Scholar
  • 3 Carter K, Miller KM. Ophthalmology inpatient consultation. Ophthalmology 2001; 108 (08) 1505-1511
    CrossrefPubMedGoogle Scholar
  • 4 Grewal DS, Chiang E, Wong E, Volpe NJ, Bryar PJ. Adult ophthalmology inpatient consults at a tertiary care teaching hospital. Ophthalmology 2014; 121 (07) 1489-1491.e1
    CrossrefPubMedGoogle Scholar
  • 5 Segev-Becker A, Har-Gil M, Fainmesser P, Assia EL, Watemberg N. Yield and clinical efficacy of funduscopic examinations performed in the pediatric emergency room. Eur J Pediatr 2014; 173 (03) 375-379
    CrossrefPubMedGoogle Scholar
  • 6 Kovarik JJ, Doshi PN, Collinge JE, Plager DA. Outcome of pediatric patients referred for papilledema. J AAPOS 2015; 19 (04) 344-348
    CrossrefPubMedGoogle Scholar
  • 7 Steffen H, Eifert B, Aschoff A, Kolling GH, Völcker HE. The diagnostic value of optic disc evaluation in acute elevated intracranial pressure. Ophthalmology 1996; 103 (08) 1229-1232
    CrossrefPubMedGoogle Scholar
  • 8 Ehlers JP, Shah CP, Fenton GL, Hoskins EN, Shelsta HN. Papilledema. In: Ehlers JP, Shah CP, Fenton GL, Hoskins EN, Shelsta HN. , eds. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. 5th ed. Baltimore: Lippincott Williams & Wilkins; 2008: 252-254
    Google Scholar
  • 9 Tzekov C, Cherninkova S, Gudeva T. Neuroophthalmological symptoms in children treated for internal hydrocephalus. Pediatr Neurosurg 1991; -1992 17 (06) 317-320
    CrossrefPubMedGoogle Scholar
  • 10 Katz DM, Trobe JD, Muraszko KM, Dauser RC. Shunt failure without ventriculomegaly proclaimed by ophthalmic findings. J Neurosurg 1994; 81 (05) 721-725
    CrossrefPubMedGoogle Scholar
  • 11 Newman NJ. Bilateral visual loss and disc edema in a 15-year-old girl. Surv Ophthalmol 1994; 38 (04) 365-370
    CrossrefPubMedGoogle Scholar
  • 12 Lee HJ, Phi JH, Kim SK, Wang KC, Kim SJ. Papilledema in children with hydrocephalus: incidence and associated factors. J Neurosurg Pediatr 2017; 19 (06) 627-631
    CrossrefPubMedGoogle Scholar
  • 13 Levatin P, Raskind R. Delayed appearance of papilledema. Can J Ophthalmol 1973; 8 (03) 451-455
    PubMedGoogle Scholar
  • 14 Nazir S, O'Brien M, Qureshi NH, Slape L, Green TJ, Phillips PH. Sensitivity of papilledema as a sign of shunt failure in children. J AAPOS 2009; 13 (01) 63-66
    CrossrefPubMedGoogle Scholar
  • 15 Selhorst JB, Gudeman SK, Butterworth IV JF, Harbison JW, Miller JD, Becker DP. Papilledema after acute head injury. Neurosurgery 1985; 16 (03) 357-363
    CrossrefPubMedGoogle Scholar
  • 16 Wilne S, Collier J, Kennedy C, Koller K, Grundy R, Walker D. Presentation of childhood CNS tumours: a systematic review and meta-analysis. Lancet Oncol 2007; 8 (08) 685-695
    CrossrefPubMedGoogle Scholar
  • 17 Lewis DW, Qureshi F. Acute headache in children and adolescents presenting to the emergency department. Headache 2000; 40 (03) 200-203
    CrossrefPubMedGoogle Scholar
  • 18 Conicella E, Raucci U, Vanacore N. , et al. The child with headache in a pediatric emergency department. Headache 2008; 48 (07) 1005-1011
    CrossrefPubMedGoogle Scholar
  • 19 Ivan Y, Ramgopal S, Cardenas-Villa M. , et al. Feasibility of the digital retinography system camera in the pediatric emergency department. Pediatr Emerg Care 2018; 34 (07) 488-491
    CrossrefPubMedGoogle Scholar