OPTIC DISK EDEMA WITH A MACULAR STAR

Optic disk edema with a macular star is a descriptive term encompassin g a heterogeneous group of disorders, The clinical features include su dden visual loss, swelling of the optic disk, peripapillary and macula r exudates that may occur in a star pattern, and cells in the vitreous , Herein we describe the clinical features, potential etiologic factor s, differential diagnosis, work-up, and natural history of this entity , Although optic disk edema with a macular star is usually idiopathic, infectious causes, especially syphilis, Lyme disease, cat-scratch dis ease, and toxoplasmosis, should be considered, The macular exudate lik ely results from primary optic nerve disease, not from inflammation of the retina; therefore, we prefer the term ''idiopathic optic disk ede ma with a macular star'' for idiopathic cases rather than ''neuroretin itis.'' When optic disk swelling and macular star are associated with focal or multifocal inflammatory lesions in the retina (retinitis), es pecially if an infectious cause is documented, the term ''neuroretinit is'' is appropriate, The prognosis for visual recovery is usually good , but residual visual loss may be severe in a few cases, Patients with a recurrent type of the disease may not experience pronounced improve ment in optic nerve function, The macular exudate may not develop in c ases of disk edema until 2 weeks after the patient's initial assessmen t; thus, patients who have acute papillitis with a normal macula shoul d be reexamined within 2 weeks for development of a macular star, The presence of a macular star militates strongly against subsequent devel opment of multiple sclerosis.