Vol. 7, Issue 1, Part A (2025)

Background: Optic disc swelling, encompassing terms like disc edema and papillitis, signifies distention and elevation of the optic nerve head due to fluid accumulation. It can present unilaterally or bilaterally, often indicating underlying ocular, intracranial, or systemic pathologies that can lead to vision loss. While optic neuropathy and optic neuritis have been identified as prominent causes in studies from India and Nepal, there is a notable scarcity of recent research on unilateral optic disc swelling in Bangladesh. Understanding the specific clinical symptoms and etiological spectrum in this region is crucial for prompt diagnosis, efficient management, and preserving visual outcomes, particularly in rural settings. 
Objectives: This study aimed to determine the visual outcomes and characterize the etiological spectrum of unilateral optic disc swelling among patients presenting to a tertiary care center in Bangladesh. 
Methodology: A cross-sectional observational study was conducted at the Department of Neuro-ophthalmology, National Institute of Ophthalmology (NIO&H), Dhaka, from March 2019 to July 2020. A total of 105 eyes from 105 patients with unilateral disc swelling were enrolled using non-random purposive sampling, adhering to ethical guidelines. Patients with other ocular surface/intraocular diseases, recent ocular surgery/trauma, or unwillingness to participate were excluded. Detailed evaluations, including color vision, visual fields, eye movements, pupillary reactions, and relevant laboratory tests (CBC, RBS, fasting lipid profile, CRP, HbA1C), were performed. Diagnoses were established based on clinical, laboratory, and imaging findings. Data were analyzed using SPSS v26.0, with quantitative data presented as mean ±standard deviation and qualitative data as percentages. Results: The mean age of the 105 patients was 45.9±14.84 years, with a male-to-female ratio of 1.23:1. The most frequent presenting symptom was sudden dimness of vision (78 patients). Sluggish pupils were observed in 83.81% of patients, and a relative afferent pupillary defect (RAPD) was present in 79.55%. At presentation, 45.72% of patients had severe visual impairment (Counting Fingers to Perception of Light). Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) was the most common etiology, accounting for 40.95% of cases, followed by optic neuritis (25.71%). Other causes included Pseudo Foster Kennedy Syndrome, infiltrative/compressive neuropathy, neuroretinitis, and central retinal vein occlusion. 
Conclusion: This study highlights that NAION and optic neuritis are the predominant causes of unilateral optic disc swelling in a tertiary care setting in Bangladesh, aligning with global patterns. The high incidence of sudden vision loss and RAPD underscores the urgency of neuro-ophthalmic evaluation. Despite the limitations of a cross-sectional design and single-center data, these findings provide valuable regional insights, emphasizing the need for early diagnosis and intervention to optimize visual prognosis, particularly in resource-limited environments.