Swollen Optic Nerve - Drs can't figure out cause

[awdw0714]

I was told by my opthamologist that my optic nerves are swollen in both eyes, but worse on my left eye. My vision is (according to him) 20/20, however I have some blurry vision up close (worse in my left eye). They did an MRI to rule out MS, blood work to rule out an infection of any kind. I have done several visual field tests and they show my peripheral vision is fine. I am NOT having headaches- which they say I should probably be having.. I do have slight vertigo from time to time, but other than that I have no symptoms. My neurologist now wants me to do a spinal tap, which may tell I was just born with large nerves.. I just don't know if the risk of the spinal tap and the pain from it is worth it?

Does anyone have any suggestions on what I should do? I am definitely going to talk to my PCP who should have all the information and get his opinion and possibly go to another neurologist, but I am very nervous and I am not sure what to do.. Thanks for your help!

[JohnHaganMD]

I also have to say "no" optic nerve swelling is not due to dehydration, diet or salt restriction. Given all the tests you've had it could be there is nothing serious going on in your eye and that they are just assymmetrical. This is called "pseudo-papilledema" it can occur due to optic nerve drusen or one eye being my farsighted than the other. So if its just "elevation" without papilledema or papillitis its not likely to be a problem.

Where do you live?  Have you seen a neuro-ophthalmologist?

JCH MD

[Mom2girls32]

I am wondering if being dehydrated and having orthostatic hypotension due to the dehydration could cause my optic nerve to be elevated.II started working out and eating healthy about 8 months ago I also cut out all salt and wasn't getting enough water I guess. About six months ago I started to have pressure and blurred vision in my right eye whenever I would get up to fast (orthostatic hypotension) I went to see my doctor who referred me to an eye doctor, who referred me to a "specialist " which referred me to another eye doctor "specialist" which also told me today he wants me to go see some one very far away from me who might have a better idea. I've had everything you can possibly think of done for blood work,all fine. cat scan came back fine eye ultrasound was done, periphial vision test was fine and no other issues. They all said my optic nerve is elevated in my right eye and they don't know why!!! Is it possible it is just from dehydration? They all tell me no, it can't be. Please help TIA

[John C Hagan III, MD, FACS, FAAO]

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[crickette127]

My granddaughter (27) is currently in the hospital with pseudotumor cerebri with the side effect of Papilledema (swollen optic nerves) with some blurring in her eyes. She has had two spinal taps: the first one they removed 22 cc of fluid and the pressure measured over 55 (the meter didn't go any higher). She ended up back in the hospital 3 days after she was released with severe headaches which the doctors are having a hard time controlling unless she is so drugged up with pain meds by IV. Once again they did a spinal tap and removed 28cc of fluid with a pressure of 43, so it has come down a little with the Diamox. She has had several MRIs and they did another one today due to suspecting a shift in her brain after relieving some of the pressure. She is also on IV for dehydration and also oxygen. They seem to think that it is inevitable that she will have to have a shunt. She is 100 lbs overweight which is a big risk but they told her time was against her in trying to lose that weight quick enough so they may have to do gastric surgery to insert a band.  All in all I suggest you listen to your doctor and do what he suggests; you don't want to mess around with this because your vision could be at risk.   Good Luck

[John C Hagan III, MD, FACS, FAAO]

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[mrse83]

I know how you feel, the anxiety about a spinal tap... I just had one done on Friday... and it was worth it, and not as bad I thought it was going to be.  The spinal tap itself wasn't painful at all actually, very similar to having a freezing needle at the dentist-just a quick pinch and once the freezing takes effect then you don't feel anything. For me the entire procedure took about 20-30 minutes. Your back will feel pretty uncomfortable afterwards once the freezing wears off, but for me thats all it was, discomfort for a few days and now I'm fine. It's worth it, espically if they can relieve some of that pressure on your optic nerve and get you diagnosed. Don't take chances when it comes to your sight

[John C Hagan III, MD, FACS, FAAO]

You should consider seeing a retina Eye MD to have an optic nerve OCT to rule out "buried optic nerve drusen" which is a usually benign condition that requires no treatment.

HOWEVER the most common cause of true swelling of optic nerves (papilledema) is pseudotumor cerebri and it usually requires a spinal tap to diagnose and often does require treatment (usually a drug called diamox).

JCH MD