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Peter J Belin, Giovanni Greaves, Alexander Weiss, Jules Winokur, Matthew Gorski; Characteristics and Incidence of Inpatient Ophthalmology Consultations to Screen for Papilledema. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3307.
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Ophthalmology consultation is common in the inpatient and emergency room setting to “rule out papilledema” in cases of headache, blurry vision, head trauma, intracranial mass, or elevated intracranial pressure. The purpose of this study is to evaluate the incidence of ophthalmology 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.
A retrospective chart review was performed of consecutive adult and pediatric inpatient ophthalmology consultations to “rule out papilledema” from September through November 2016. All patients had a detailed neuro-ophthalmology examination including a dilated fundus exam.
A total of 28 consults—11 males and 17 females—with a mean age of 17 (range 3-71) were called to screen for papilledema. The most common service to request the consult was pediatrics (50%), followed by neurosurgery (32%), medicine (11%), and neurology (7%). The most frequent reason for consultation was headache (57%), followed by visual changes (25%) and nausea/vomiting (21%) (Table 1). A positive diagnosis of bilateral optic nerve swelling occurred in 17.9% (5/28) of consults (Table 2). 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. All except one had corrected near visual acuity of 20/30 or better and none had an afferent papillary defect. Color vision was full in two of the patients, decreased in one patient, and unreliable in two patients.
No new cases of bilateral optic nerve swelling were found in screening consults to “rule out papilledema” in our study. 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. There were no significant associations of subjective complaints or objective findings in patients with optic nerve swelling. Further larger studies must assess the cost effectiveness and utility of screening inpatient eye exams for papilledema.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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