Differential Diagnosis

The patient's symptoms of swelling of the optic disc and visual field testing showing peripheral blind spots bilaterally with central visual acuities intact, especially in the setting of hypertension and hyperlipidemia, can be approached by considering the following categories:

• Single Most Likely Diagnosis

  • Papilledema due to Hypertensive Emergency: This condition is characterized by the swelling of the optic disc due to increased intracranial pressure, which can be caused by severely elevated blood pressure. The presence of hypertension and the specific pattern of visual field defects (peripheral blind spots with intact central vision) support this diagnosis. Papilledema can lead to enlarged blind spots, which are often seen in the peripheral visual fields.

• Other Likely Diagnoses

  • Ischemic Optic Neuropathy: This condition, often associated with hypertension and hyperlipidemia, can cause optic disc swelling and visual field defects. However, it typically presents with altitudinal field defects rather than peripheral blind spots.
  • Diabetic Papillopathy: Although less common, this condition can cause optic disc swelling in diabetic patients. It might present with similar visual field defects but is less directly linked to hypertension and hyperlipidemia.
  • Migraine with Visual Auras: Some patients with migraines can experience visual field defects, including peripheral blind spots, but these are usually transient and accompanied by headache and other migraine symptoms.

• Do Not Miss Diagnoses

  • Giant Cell Arteritis: This condition can cause optic disc swelling and visual field defects, including peripheral blind spots. It is critical to consider in older adults, especially those with symptoms like headache, jaw claudication, or polymyalgia rheumatica, as untreated giant cell arteritis can lead to permanent vision loss.
  • Brain Tumor (e.g., Glioma, Meningioma): Although less likely, a brain tumor can cause increased intracranial pressure leading to papilledema and visual field defects. The presence of other neurological symptoms or signs would increase the suspicion for this diagnosis.

• Rare Diagnoses

  • Leber's Hereditary Optic Neuropathy: A rare mitochondrial inherited disorder that can cause optic neuropathy and visual field defects, typically in young males. It does not directly relate to hypertension or hyperlipidemia.
  • Toxic or Nutritional Optic Neuropathy: Certain toxins or nutritional deficiencies can cause optic neuropathy and visual field defects. These are less common and would require specific exposures or deficiencies to be considered.