Papilledema is a serious medical condition in which the optic nerve at the back of the eye becomes swollen. The symptoms can include visual disturbances, headaches, and nausea.
Papilledema occurs when there is a buildup of pressure in or around the brain, which causes the optic nerve to swell. It is critical to identify what is responsible for papilledema, as some causes can be life threatening. The condition can affect one or both eyes.
This article will discuss papilledema in more detail, including its symptoms and the treatment options.
Papilledema refers to the swelling of the optic nerve due to increased pressure inside the cranium. There are various possible causes, including a mass, a hemorrhage, and meningitis.
Some other conditions cause optic nerve swelling without intracranial pressure. However, papilledema cannot exist without high intracranial pressure.
The condition typically occurs on both sides and is symmetric, but it can occur on one side only. It has a variety of causes and can affect anyone, regardless of sex, age, and ethnicity.
Cerebrospinal fluid (CSF) surrounds the brain and optic nerve, helping keep them stable and protecting them from any damage that results from sudden movements.
Papilledema occurs when there is increased pressure on the optic nerve from the brain and CSF. This pressure causes the nerve to swell as it enters the eyeball at the optic disc.
There are some serious medical conditions that can cause this increased pressure to develop,
- head trauma
- inflammation of the brain or surrounding tissue
- severely high blood pressure, which doctors call a hypertensive crisis
- infection in the brain
- brain tumor
- bleeding in the brain
- blockages of blood or CSF in the brain
- abnormalities of the skull
- idiopathic intracranial hypertension (IIH)
- spinal cord lesions
IIH describes a
The exact cause of this condition is still unclear and appears to be unrelated to any brain disease or injury.
IIH typically affects young females with obesity. Certain medications, such as lithium, antibiotics, and corticosteroids, are also possible causes.
The treatment options for papilledema will depend on the cause of this condition.
In the case of IIH, common treatments include weight loss, a low salt diet, and medications, such as acetazolamide, furosemide, or topiramate.
Surgery — in the form of shunting the excess fluid or making cuts into the optic nerve sheath — is usually only an option when lifestyle changes and medications are not working.
Tumors, head injury, or infection
Certain underlying conditions will require more intensive treatment. For example, a brain tumor, bleeding within the brain, or a blood clot may require surgery. The recommended types of surgical procedures will depend on the conditions that need addressing.
Doctors may treat infections with antibiotics or antiviral medications.
High blood pressure
In rare cases, papilledema can be due to extremely high blood pressure, which doctors refer to as a hypertensive crisis. In these cases, it is essential to reduce blood pressure to avoid more serious harm, so emergency medical care will be necessary. A person will need to receive medical treatment in the emergency room and intensive care unit.
A wide variety of other medical problems and conditions can lead to increased pressure inside the brain.
Brain and eye specialists can determine the best treatment options based on the diagnosis.
As papilledema occurs due to an increase in pressure inside the brain, its symptoms can include:
- visual disturbances, including double vision
- a ringing sound in the ears, which is often pulse-like
According to the American Academy of Ophthalmology, doctors determine the severity of papilledema using a grading system called the Frisen scale. An eye specialist can observe the structure of the eye to determine where an individual falls on the scale. The stages are:
- Stage 0: Normal optic disc with some blurring of the nasal, superior, and inferior poles.
- Stage 1: Very early papilledema with obscuration of the nasal border of the disc.
- Stage 2: Early papilledema with obscuration of all borders, an elevation of the nasal border, and a halo.
- Stage 3: Moderate papilledema with obscurations of all borders, one or more major blood vessels, a halo, and increased diameter of the optic nerve head.
- Stage 4: Marked papilledema with an elevation of the entire nerve head, obscuration of all borders and a major blood vessel, and a halo.
- Stage 5: Severe papilledema with dome-shaped protrusions from the optic nerve head, a narrow halo, destruction of the optic cup, and, sometimes, a total obscuration of a major blood vessel.
Without treatment for the underlying cause of the high intracranial pressure,
There is also a risk of infection or the formation of scar tissue from surgery, which may interfere with treatment outcomes. Doctors may use CSF shunts to relieve pressure, but these can become blocked and less effective.
Initially, a doctor who suspects that a person may have papilledema will conduct a complete physical examination of the eyes and nervous system.
Doctors typically use an ophthalmoscope, which is an instrument resembling a pen with a lighted wheel at the tip.
With the ophthalmoscope, the doctor inspects the back portion of the eye through the pupil. They may use drops to dilate the pupil and make it easier to inspect. The appearance of the eye plays a key role in the diagnosis of papilledema.
A doctor will assess the optic disc for any abnormalities, such as it being out of position or appearing more blurred than normal. These changes can indicate that the optic nerve is swollen.
Tests, including visual accuracy assessments, can also reveal changes in color vision, loss of vision, or double vision.
If the doctor detects signs of papilledema, they will order brain imaging scans, which may include MRI or CT scans.
Blood tests and an analysis of CSF from the spinal canal may also be necessary.
In all instances, it is vital to determine the reasons for an increase in pressure that affects the brain.
A person should contact a doctor if they experience the following combination of symptoms:
- blurred vision
- double vision
- flickering vision or total vision loss
- a headache
- nausea, vomiting, or both
A doctor can view the back of the eye using an ophthalmoscope. If they see swelling of the optic nerve, they will order further tests to determine the cause of the inflammation.
Papilledema is a sign that the brain is under increased pressure, which is abnormal. Uncovering the cause of this change in pressure is a necessary step toward treating papilledema.
An accurate diagnosis will require a variety of tests, along with the input of eye and brain specialists. These individuals can determine how best to manage the condition.