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American Journal of  Medical 
Science and Innovation (AJMSI) 

Associated Systemic Risk Factors and Neuro-imaging Findings of  Unilateral Optic Disc 
Swelling in a Bangladeshi Population

Farjana Sharmeen Shimu1*, Abir Bin Sajj2, Tohura Sharmin3

Volume 4 Issue 2, Year 2025
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v4i2.5742
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: July 12, 2025
Accepted: August 18, 2025
Published: September 20, 2025

The presence of  unilateral optic disc swelling (ODS) is linked to several illnesses, such 
as hypertension and diabetes mellitus. While the incidence of  diabetes is increasing in 
Bangladesh, not much is known about its systemic links in the local population. This study 
aims to evaluate the relationships between systemic factors and unilateral optic disc swelling 
among people in Bangladesh. A cross-sectional observational study was done at the Neuro-
Ophthalmology Department in Dhaka from March 2019 to July 2020, covering 105 patients 
with unilateral ODS. Eye health was evaluated clinically, visual functioning was measured, 
and brain scans were performed for diagnosis. Basic demographics, historical details, and 
results from blood tests (CBC, RBS, HbA1c, lipid profile, CRP) were all collected with the 
use of  structured forms. The statistical analysis was done using SPSS version 26.0, and the 
level of  significance was p<0.05. NAION was the leading cause (40.95%), with optic neuritis 
(25.71%) coming next, and Pseudo Foster Kennedy syndrome (12.38%). About half  of  
the patients (52.38%) had hypertension, and about three-quarters of  all patients (42.86%) 
had diabetes, with around one-quarter (26.67%) having both conditions. The laboratory 
results showed that 46 patients (43.81%) had high blood pressure and 45 (42.86%) had 
elevated random blood sugar, matching what was found in their clinical records. Twenty-
seven-point six percent of  the population experienced abnormal lipid results, and 20.95% 
had raised HbA1c. Nearly half  of  the patients (45.72%) were seen for serious blindness 
(approximately 2 ft of  vision). A visual field problem called an inferior altitudinal scotoma 
was prevalent among people with NAION. Almost half  of  the patients (49.52%) were not 
receiving treatment for their long-term medical issues.  In neuro imaging findings, optic nerve 
enhancement & thickening was found in 26 patients (24.76%). There is a strong connection 
between hypertension and diabetes on one hand and unilateral optic disc swelling on the 
other. Early identification of  systemic diseases and treating them promptly might prevent 
patients from losing sight.

Keywords
Diabetes Mellitus, Hypertension, 
NAION, Neuro-ophthalmology, 
Non-arteritic Anterior Ischemic 
Optic Neuropathy, Optic Neuritis, 
Optic Neuropathy, Unilateral 
Optic Disc Swelling

1 Department of  Ophthalmology, National Institute of  Ophthalmology & Hospital, Dhaka, Bangladesh
2 Department of  Cornea and Refractive Surgery, Vision Eye Hospital, Dhaka, Bangladesh
3 Department of  Community Medicine, Ad-Din Women’s Medical College, Dhaka, Bangladesh
* Corresponding author’s e-mail: shaemeeen.shimu@gmail.com

INTRODUCTION 
Unilateral optic disc swelling is a condition that refers to 
the inflammation of  the optic nerve head in one eye caused 
by different conditions or when axoplasm accumulates at 
the back of  the eye, slowing anterograde flow and causing 
both the disc and the retinal nerves to become opaque 
(Hata, 2017; Stenoien, 1999). It is often referred to as 
papilledema or Optic Disc Edema (ODE) in a unilateral 
setting, occurs rarely, in just 4% of  all IIH patients, and 
may be thought to be local eye disease, which can make 
IIH diagnosis difficult (El-Gendy, 2024). A Bangladeshi 
study found that Optic Disc Edema was present in 
53.3% of  eyes and 56.7% of  patients (Morshed, 2024). 
Unilateral optic disc swelling may result from causes 
such as optic neuritis, anterior ischemic optic neuropathy 
(AION), non-arteritic anterior ischemic optic neuropathy 
(NAION), papilledema, and different eye diseases (Hata, 
2017). In particular, NAION and optic neuritis are known 
to lead to optic disc swelling in people over 50 years of  
age all around the world (Raizada, 2022). In particular, 
NAION shows a clear association with vascular concerns 
such as systemic hypertension, diabetes mellitus, and 

dyslipidemia, which affect the microcirculation in the 
optic nerve head, resulting in damage to small vessels 
and leading to infarction and swelling of  the disc (Singla, 
2024). Besides NAION, in Bangladesh and many other 
low- and middle-income countries, more people are 
suffering from treatment-resistant conditions such as 
hypertension and diabetes (Uddin, 2022), increasing 
patient presentation in ophthalmic clinics. While there 
is an increase in systemic disorders linked to optic disc 
swelling, not many local studies have focused on this 
relationship among people from Bangladesh. People with 
unilateral ODS may suddenly and painlessly lose vision in 
one of  their eyes (Salvetat, 2023). During ophthalmoscopy, 
the disease may be found as disc inflammation, elevation, 
and bleeding spots. However, these signs are not specific 
and should be interpreted along with the patient’s age, 
general health status, and other lab results such as blood 
pressure, random blood sugar (RBS), and lipid levels. 
Ophthalmologists and general physicians must know how 
systemic risk factors affect unilateral ODS. Therefore, 
this study aims to analyze the number and pattern of  
key risk factors—hypertension and diabetes mellitus—



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in patients coming to our hospital with only one optic 
disc expanded. The main goal is to contribute meaningful 
epidemiological information and develop protocols for 
the timely diagnosis and overall care of  individuals with 
optic disc swelling.

MATERIALS AND METHODS
To assess the systemic risk factors with unilateral optic disc 
swelling among the Bangladeshi population, we used a cross-
sectional observational study in the Neuro-ophthalmology 
department of  the National Institute of  Ophthalmology in 
Dhaka. The period from patient enrolment to data analysis 
lasts from 1st March, 2019, to 31st July, 2020, with all 
ethical considerations. During the entire study period, 105 
patients were enrolled by the researchers using particular 
study-defined inclusion and exclusion criteria.

Inclusion Criteria
• There is no age limit for this study.
• Patients diagnosed with unilateral optic disc swelling.
• Must be a Bangladeshi by birth to eliminate genetic 

factors.
• Patients were ready to provide signed informed consent.

Exclusion Criteria
• Patients with traumatic eye injury.

• Patients with uveitis or keratitis, or a disease condition 
on the surface tissues of  the eyes.

• Lack of  informed consent.
Demographic information, suggestions of  what the 
participants presented, medical history, and all the 
medications each one received have been captured 
using a structured form following informed consent. 
Standard ophthalmologic examinations were given 
to everyone. In the laboratory, complete blood count 
(CBC), random blood sugar (RBS), HbA1c, a fasting 
lipid profile, and C-reactive protein (CRP) tests were 
used to check for overall connections. All information 
from the study was transported into SPSS version 26 
and analyzed by using basic statistics. The categorical 
variables were reported as the number of  cases and 
their percentages, and continuous variables were shown 
as the mean with their standard deviations. A test result 
with a p-value lower than 0.05 was significant at a 95% 
confidence level.

RESULTS AND DISCUSSION
The study was carried out with 58 male and 47 female 
patients. The male-to-female ratio recorded for this study 
was 1:23:1, and the mean age of  the enrolled patients was 
45.9±14.84 years. 

Table 1: Distribution of  Study Subjects by History of  Systemic Diseases (N=105)
Systemic Disease Frequency (n) Percentage (%)
Hypertension 55 52.38%
Diabetes Mellitus 45 42.86%
Dyslipidemia 5 4.76%
Both HTN & DM 28 26.67%
No Systemic Illness 22 20.95%

Table 2: Laboratory Parameters of  the Study Subjects (N=105)
Laboratory Findings Abnormal (n) Percentage (%)
High Blood Pressure 46 43.81%
Elevated Random Blood Sugar 45 42.86%
HbA1c 22 20.95%
Abnormal Lipid Profile 29 27.62%

Table 1 shows that about half  of  the patients had 
hypertension and approximately 43% had diabetes 
mellitus, suggesting that a lot of  them were at increased 
risk of  vascular health problems. About a quarter of  the 

sample showed both conditions concurrently. According 
to these findings, having systemic disorders is strongly 
related to unilateral swelling of  the optic disc.
Clinical measurements in Table 2 highlight that about 

44% of  subjects had high BP and RBS, which was very 
close to what was reported in their medical histories. 
Around 21% of  patients reported persistent DM, and 
27% of  the participants were found to have elevated lipid 
levels (dyslipidemia). The study results strengthen the 
idea that small blood vessel abnormalities may underlie 
the development of  optic disc swelling.

According to Table 1, about half  the participants said they 
were not on regular medication for high blood pressure 
or diabetes, indicating that many such patients may have 
gone undetected or off-track with their treatment. The 
majority of  those using medications were found to be 
taking anti-hypertensives (31.43%) or OHAs (22.86%), 
which highlighted that several patients knew they were at 
risk of  cardiovascular problems.



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Figure 01 shows the neuroimaging findings of  the study 
subjects. Among 105 study subjects, neuroimaging 
was done on 68 patients, whose fundus findings were 
suggestive of  having intraocular and intracranial lesions. 
Of  them optic nerve enhancement & thickening 
was found in 26 patients (24.76%), intracranial space 
occupying lesion was present in 5 patients (4.76%), and, 
moderate inflammatory change & orbital soft tissue 
enhancement was found in 4 patients (3.81%) and optic 
nerve enhancement with whitish lesion in periventricular 
white matter in both cortex and intra cerebral infraction 
& cerebral atrophy were found in 3 patients each (2.86%). 
Intra-cerebral infarction & cerebral atrophy, and orbital 
space-occupying lesion were found in 1 patient each 
(0.95%). No significant abnormality was detected in 24 
patients (22.86%) on neuro-imaging

Discussion
Unilateral Optic Disc Swelling (ODS) is a serious 
neurological condition. The primary objective of  this study 
was to assess how systemic risk factors relate to unilateral 
disc swelling amongst the Bangladeshi population. During 
the study, there were 105 cases (58 male, 47 female) 
selected with 45.9±14.84 years mean age of  with a clinical 
presentation of  unilateral disc swelling. Diagnosis in this 
study was based on considering the presenting complaint, 
observing patients’ symptoms, laboratory examinations, 
and scans. In 43 patients (40.95%), the condition was 
NAAION, 28 (25.71%) were noted for optic neuritis, 13 
(12.38%)cases were of  Foster Kennedy syndrome, while 
1 (0.94%) had CRVO and others like infiltrative optic 

neuropathy, neuroretinitis, Foster Kennedy syndrome, 
Pseudo disc swelling happened. NAION is the leading 
cause of  optic disc swelling in the optic nerve and loss 
of  vision in people aged over 50 (Hayreh, 2009), as 
reflected in this study. Youssef  et al. (2018) also agreed to 
this finding by stating that showed that the main cause of  
unilateral disc swelling was non arteritic anterior ischemic 
optic neuropathy (NAION) at 72%, with traumatic 
optic neuropathy, optic neuritis, disc swelling related 
to an orbital mass, disc swelling related to a brain mass 
and disc swelling with thyroid ophthalmopathy or cilio 
retinal artery occlusion comprising 6% each and different 
other connections in each group (Ahmed Mohammed 
Youssef, 2018). The current study revealed that the 
best-corrected visual acuity of  the majority (45.72%) of  
subjects at the time of  presentation was not within CF 2 
feet-PL, while only 4.76% had their vision within the 6/6 
to 6/12 range. A significant decrease in vision is often 
noticed in inflammatory and ischemic optic neuropathy. 
The vast majority of  the patients were diagnosed with 
NAION, and in these cases, vision reduction occurs 
early in the disease. A 2017 observational study also 
replicates the similar result of  vision loss by optic disc 
edema (Anuradha, 2017). According to the results, 
41.90% of  the participants displayed a visual field defect 
during the confrontation test. Humphrey visual analysis 
was carried out in 44 patients with visual field defects 
on confrontation to identify the type of  defect. Most 
of  the patients (14 out of  44) had an inferior altitudinal 
field defect, which matches the results found by Jung et 
al. (2011). Other visual defects observed in the present 

Table 3: Distribution of  Patients by Drug History (N=105)
Drug History Frequency (n) Percentage (%)
Antihypertensive Drugs 33 31.43%
Oral Hypoglycemic Agents (OHA) 24 22.86%
Insulin 7 6.67%
Antiplatelet/Anticoagulant Drugs 5 4.76%
Lipid-lowering Agents (Statins) 4 3.81%
No Regular Medication 52 49.52%

Figure 1: Bar chart showed distribution of  Neuro-imaging findings of  the study subjects (N=105)



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study included enlarged blind spot, superior altitudinal 
field defect, paracentral scotoma, centrocecal scotoma, 
arcuate scotoma, and generalized depression, as reported 
by other studies (Shah, 2017; Jung, 2011). This research 
found that 52.38 % of  individuals had a background 
of  hypertension, 42.86 % had diabetes, and 4.76 % had 
dyslipidemia, which agrees with what was found in several 
researchers (Anuradha, 2017; Jung, 2011). In our study, 
more than half  were found to have hypertension, more 
than half  had DM, more than half  had hyperlipidemia 
and abnormal values were found for blood pressure 
in 46, for random blood sugar in 45, HbA1c in 22 and 
lipids in 29 patients as shown by Jung (2011). In previous 
studies, Hata M. et al., 2017 indicated that vasculopathic 
risk factors were present in 57% of  AION patients. Each 
of  these findings supports the results from our research 
(Hata, 2017). Research on drug history in the study found 
that a total of  31.43% of  patients took antihypertensive 
drugs, 22.86% used oral hypoglycemic agents, and 6.67% 
received insulin treatment. A large share of  patients 
taking part in the study (49.52%) did not regularly use 
any medications, despite having hypertension (52.38%) 
and diabetes mellitus (42.86%). It is possible that 
patients are not being diagnosed, are not aware of  their 
diseases, or are not following their treatment correctly 
for chronic conditions. Among the current cohort, 
statins were prescribed for only 3.81% of  people, even 
though 4.76% had dyslipidemia, which matches results 
from previous research by Solanki et al. (2019) in Bhopal, 
India, showing that lipid abnormalities were commonly 
ignored even when they played a role in ischemic optic 
neuropathies (Solanki, 2019). In 2018, a report showed 
that although systemic diseases were common, patients 
did not receive proper care, which resulted in many 
acute eye complications (Ijeri & Jyoti, 2018). In this 
study, findings of  the neuroimaging of  68 patients 
showed that the majority of  the patients, about 24.76%, 
had optic nerve enhancement & thickening intracranial 
space-occupying lesion was present in 4.76% cases, and 
22.86% had normal imaging findings. However, the study 
of  Solanki et al. (2016) reported that one-third of  the 
patients with optic disc edema had non-space-occupying 
lesions (Solanki, 2019). The dissimilarity might be since 
their study was conducted in a multidisciplinary hospital 
and many of  their study subjects were referred from the 
department of  neurosurgery, where most of  the patients 
were clinically diagnosed as intracranial space-occupying 
lesions. This finding is consistent with the study 
conducted by Jung et al. (2011). The research shows that 
Bangladesh and nearby areas face the same problems in 
access to healthcare and health-seeking patterns, showing 
that this is a shared issue in South Asia.

Limitation
Since this was a single-center and cross-sectional study, 
the findings may not apply to the whole population. Only 
a small number of  patients were included, so information 
on long-term changes in vision and treatment effects 

is not available. In some cases, conditions affecting the 
body may have gone unreported because there were no 
clear diagnoses or patients did not realize.

CONCLUSION
This research found a clear connection between vascular 
issues, like hypertension and diabetes in Bangladeshi 
participants, and unilateral swelling of  the optic disc. 
In the majority of  cases, NAION caused the disease, 
resulting in severe loss of  vision and specific types of  
visual field defects for many patients. Clinical history 
and laboratory findings supported each other, suggesting 
that microvascular problems led to optic nerve head 
ischemia. Almost half  of  the people studied did not take 
regular medicine for their ongoing health issues. Early 
identification and combined patient care help avoid 
unnecessary vision loss in these individuals.

Abbreviation
ODS: Optic Disc Swelling
ODE: Optic Disk Edema
NAION: Non-Arteritic Anterior Ischemic Optic 

Neuropathy
AAION: Arteritic Anterior Ischemic Optic Neuropathy
BCVA: Best Corrected Visual Acuity
CRVO: Central Retinal Vein Occlusion 

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