Optometrist Saves Child’s Life With Rare Optic Nerve Swelling

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As optometrists, we know how important regular eye exams are.  Children don’t present with just sore eyes or learning related problems.  Sometimes it can be much more significant and life threatening.

Early this year, Eyecare Plus Chullora had a lovely 8 year old boy, Ahmad visit for his very first eye test.  He met Dr Melissa El Azzi, and she found out he had headaches, double vision and neck pain.  His general health was great, nutrition was adequate and he did not suffer from dehydration.  Now most of the time, we consider these symptoms to be possibly associated with functional visual problems such as focusing and teaming difficulties.  So was this a simple case of an eyestrain?  At our practices, we never take anything for granted and we certainly take our time to make sure all our bases are covered.  For example, your eye test won’t be scheduled in for 20 min  It will be 30 min or more with repeated testing as necessary!

Dr Melissa El Azzi’s exam revealed significant papilloedema in the back of his eyes as well as an eye turn (strabismus). What is papilloedema? As Dr Melissa explains, “Papilloedema is swelling of the optic nerve located at the back of the eye secondary to elevated intracranial pressure in the brain. It requires urgent attention and is considered an emergency! There are many underlying causes which may be infectious or inflammatory. Early detection and identification of the cause may be life-saving. It can present at any age and affects boys and girls.”

These are the main symptoms you need to be aware of:

  • Headache (usually worse in the morning)
  • If the rise in brain intracranial pressure is severe, nausea and vomiting may occur, potentially leading to loss of consciousness and possible death
  • Vision is usually unaffected, but double vision, transient graying out of vision or flickering of lights may occur
  • Patients may even have no symptoms at all!

An optometrist is your first point of contact for primary eye care and we are trained with the required clinical skills essential for detecting and diagnosing diseases such as papilloedema. Not all practices are blessed with the latest in diagnostic equipment, but fortunately for Ahmad, our practice has state of the art technology including Digital Retinal Photography, Humphreys Visual Field Analyser and an Optical Coherence Tomography (OCT) 3D machine to confirm the diagnosis.

Dr Melissa was aware of the urgency of his condition and she urgently referred him to the Westmead hospital and ensured the neurologist was contacted. Unfortunately in this case, the neurologist did not seem too concerned and ignored the initial for urgent attention for the boy.  Dr Melissa persisted for a follow-up appointment and he was eventually seen on the 3rd day again by the emergency department. When the doctors finally realised Sam* was suffering from papillodema, he underwent urgent brain shunt surgery on the very same day at 10pm as he had a faulty valve.

Ahmad’s mother says, “You don’t realise just now important an eye test can be for children.  In Ahmad’s case, an eye exam with an optometrist saved his life!”

A month later Ahmad came back to see Dr Melissa with a large smile on his face. The swelling at the back of his eye has almost completely resolved and he no longer experiences any double vision or headaches.  As you can imagine, Dr Melissa had an even bigger smile on her face when she knew that Ahmad was going to be alright.

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